Disclosure of Medical Errors: Physicians’ Knowledge, Attitudes and Practices (KAP) in an Oncology Center

doi:10.21203/rs.3.rs-21159/v1

Download PDF

Research article

Disclosure of Medical Errors: Physicians’ Knowledge, Attitudes and Practices (KAP) in an Oncology Center

https://doi.org/10.21203/rs.3.rs-21159/v1

This work is licensed under a CC BY 4.0 License

Journal Publication

published 20 Aug, 2020

Read the published version in BMC Medical Ethics →

You are reading this older preprint version

Read the latest preprint version →

Background: Between the need for transparency in healthcare widely promoted by patient’s safety campaigns and the fear of negative consequences and malpractice threats, physicians find themselves faced with challenging decisions on whether to disclose medical errors to patients and families or not.

We aim to assess the knowledge, attitudes and practices (KAP) of physicians in our center towards medical error disclosure.

Methods: This is a cross-sectional self-administered questionnaire study. The questionnaire was piloted and no major modifications were made.

A day-long training workshop consisting of didactic lectures, short and long case scenarios with role playing and feedback from the instructors were conducted. Physicians who attended the training workshops were invited to complete the questionnaire at the end of the training and physicians who did not attend any training were sent a copy of the questionnaire to their offices to complete. To assure anonymity and transparency of responses, we did not query names or departments.

Descriptive statistics were used to present demographics and KAP. The differences between response\s of physicians who received the training and those who did not were analyzed with t-test and descriptive statistics. The 0.05 level of significance was used as a cutoff measure for statistical significance.

Results: Eighty-eight physicians completed the questionnaire (55 attended training (62.50%), and 33 did not (37.50%)). 65.5% of physicians were males and mean years of experience was 16.5 years. 86.9% (n=73) of physicians were more likely to report major harm, compared to minor harm or no harm. Physicians who attended the workshop were more knowledgeable of articles of Jordan’s Law on Medical and Health Liability (66.7% vs 45.5%, p-value = 0.017) and the Law were more likely to affect their decision on error disclosure (61.8% vs 36.4%, p-value= 0.024).

Conclusion: Formal training workshops on disclosing medical errors have the power to positively influence physicians’ KAP toward disclosing medical errors to patients and possibly promoting a culture of transparency in the healthcare system.

Medical Ethics

Medical error

Disclosure

Law

Training

Medical Error disclosure is defined as ''communication between a health care provider and a patient, family members, or the patient's proxy that acknowledges the occurrence of an error, discusses what happened, and describes the link between the error and outcomes in a manner that is meaningful to the patient'' [1]. Despite the increasing efforts health care institutions and healthcare workers make to prevent medical errors and adverse events[2], medical errors are still inevitable. In the United States, more than 1 million medical error occurs annually, and the mortality from medical errors is estimated to be about 98,000 [3]. In Jordan, a study found that 28% of all hospital admissions in Jordan were affected by medical errors, with medication errors as the most common cause, followed by the wrong medical diagnosis and healthcare associated infections [4].

Disclosure of medical errors is recommended and governed by ethical and professional guidelines and legislations [5, 6], and the acknowledgement of medical errors, even if those errors classify as minor or insignificant, is desired by the overwhelming majority of patients. Furthermore, patients were more inclined to consider the litigation of medical errors if their physician did not disclose them[7], which further reinforces the importance of the physician's knowledge on how to properly disclose medical errors to their patients[8, 9]. This also includes when and where to disclose the errors.

Interestingly, the prevalence of disclosure of medical errors remains relatively low, as studies found that 50–96% of errors in the US are underreported by physicians [10, 11]. Nevertheless, physicians still acknowledge disclosure of medical errors as a fundamental part of patients' care [12–15]. They have entrusted their physicians with their health. While trust is the cement that holds the physician-patient relationship, hiding (or lying about) errors fractures that trust and leads to distrust in the medical profession writ large. To further emphasize the importance of disclosing errors to patients, there is a need to better understand the elements that interfere with error disclosure [16]. Challenges and barriers of disclosing medical errors are not limited only to the fear of disclosing the event to the patients, but also include the repercussions of discussion with peers such as blame, embarrassment or even loss of reputation [17, 18]. It also includes proper reporting to the institution, and the possibility of legal liability [12, 19–21]

Given the importance of a physician's knowledge and willingness to report medical errors in improving healthcare standards and quality, King Hussein Cancer Center (KHCC) in collaboration with the Salim El-Hoss Bioethics and Professionalism Program (SHBPP) at the American University of Beirut Faculty of Medicine and Medical Center (AUBMC) conducted several workshops, which aimed to coach physicians at KHCC on how, when and where to effectively disclose medical errors to patients and their families, especially in view of the recently enacted “Medical and Health Liability Law” (MHLL) in Jordan which was published by the government of Jordan and took effect on August 31st, 2018 [22]. Article 5 of the MHLL illustrates that physicians and healthcare workers are required to perform services subject to the requirements of the morals, accuracy, and loyalty of the profession and they must also be in line with the established scientific standards. According to the Law, a medical error occurs when physicians, are involved in an act or omission, which does not correspond to the standard professional rules resulting in harm to the patient. The aim of the Law is to better govern and regulate the relationship between physicians and patients, especially when medical error is suspected.

The King Hussein Cancer Center is a standalone, and one of the most comprehensive cancer centers in the Middle East which treats both adult and pediatric patients. It provides state of the art cancer care for the citizens of Jordan and many neighboring countries. The center treats over 6,000 new cases and its' outpatient clinics have almost 300,000 encounters annually [23].

Although disclosure of medical errors remains consequential in all fields of medical practice, medical errors have a specialty-sensitive dimensions [24], and one example would be when it comes to cancer patients. Cancer care can be complex and integrative, as the use of many medications, the tendency for cancer patients to be enrolled in clinical trials, the long follow up time frame, and the involvement of multidisciplinary teams can make it especially challenging for physicians and may add to the risk of medical errors and to the difficulty of disclosing them to patients [25]. Given the complexity of error disclosure in cancer patients, ethical professional practice in KHCC is driven by its' 6 core values of cultural and ethical sensitivity, excellence, compassion, team work, innovation, and person-centered care. Ethical practice is reflected in the various medical and administrative functions of the institution, from decision making at the Hospital Ethics Committee (HEC) for dealing with ethical issues that arises when delivering the standard of care procedures, to the review of human subject research at the Institutional Review Board (IRB) to ensure only ethically sound research is conducted at the center.

The aim of this cross-sectional study is to assess the knowledge, attitudes and practices (KAP) of physicians at KHCC towards error disclosure in addition to the effect of the formal training workshops on physicians’ KAP.

This is a cross sectional self-administered questionnaire study. The questionnaire was based mainly on the work of Kaldijian et al. (2007). The research team obtained permission to use the questionnaire from the study first author then made some modifications and omissions to adapt to KHCC culture. The questionnaire was administered in English as the formal language used during training and the routine medical documentation is the English language. A 5-point Likert scale responses were used ranging from strongly agree to strongly disagree for questions related to attitude and ranging from very likely to very unlikely for questions related to practices. The questionnaire was piloted and no major modifications were made. KHCC-IRB approval was sought before any formal data collection started.

A one-day workshop was held four time at KHCC; 2 in March and 2 in July, in English Language. Instructors from the SHBPP (T.A) and the University of Tennessee, Memphis (H.M) were hosted. The training included didactic introductory lectures including a lecture on the newly enacted MHLL, by the President of the Medical Association in Jordan. Group exercises were conducted using short and long case scenarios. In the short case scenarios, participants were divided and rehearsed the short cases in pairs, followed by disclosure of the event in front of the attendees, then receiving feedback by the instructors. This was followed by 2 long case scenarios with role playing by a professional actor and actress, who were given the headline of the case studies; they then improvised according to the way the medical error was disclosed by the participating physicians. Notes were collected by the instructors during the scenarios and a comprehensive feedback from the instructors and actors as well as participants themselves was shared with the physicians who played the role. This was a convenient sample. At the end of the day, physicians who attended the training (n = 55) were invited to complete the questionnaire. Physicians who did not attend the training (n = 33) were approached at the end of the formal training sessions during August and September in 2019 and handled a copy to complete the questionnaire. To assure anonymity and transparency of responses, identifiers were not collected, including the names, departments and the employee ID number.

Data was analyzed with SPSS 19 software. Descriptive statistics were used to present the demographics and KAP. Likert-scale responses were dichotomized as follows: (1) likely/very likely versus not sure/unlikely/very unlikely and (2) agree/strongly agree versus neutral/disagree/strongly disagree. To simplify reporting in the “Results,” likely signifies the combination of “likely” and “very likely” responses, and agree signifies the combination of “agree” and “strongly agree” responses. Missing data was minimal (< 1.0%) and was excluded from the analysis.

The differences between response\s of physicians’ who received and those who did and those who did not were analyzed with chi square test and ANOVA to find out the correlation, with a p-value of 0.05 used as a cutoff measure for statistical significance.

The questionnaire was completed by 88 physicians working at KHCC; 55 (62.50%) received training at the workshop, and 33 (37.50%) did not. There were 57 (64.8%) males and 30 (34.1%) females with a male to female ratio of 1.9:1. There was no significant difference among the distribution of gender in both groups. The mean medical practice experience of all physicians was 16.5 years (range 2–40). The mean experience for those who attended the workshop was 17.5 years, compared to 14.8 years of those who didn't (p-value = 0.169). Tables 1 shows the participants characteristics.

		Received Training N= 55	Did not received training N= 33
Gender	Male	34 (61.8%)	23 (69.7%)
Gender	Female	20 (36.4%)	10 (30.3%)
Experience (Years)	Min	3	2
	Max	40	32
	Mean	17.54	14.82

Table 1

Demographics of the study cohort.

We asked physicians about their likeliness of disclosure of errors that caused no harm, minor harm, and major harm. 86.9% (n = 73) of respondents (both groups) were more likely to report major harm, compared to minor harm or no harm (p-value 0.000). Table-2 displays the relation between the level of harm and the percentage of reporting physicians.

Harm Caused	Received Training	Number (%) of respondents who were likely to disclosure	p-value
No Harm	Yes	26 (50.0)	0.179
No Harm	No	23 (69.7)	0.179
Minor Harm	Yes	40 (76.9)	0.966
Minor Harm	No	27 (81.8)	0.966
Major Harm	Yes	47 (92.2)	0.162
Major Harm	No	26 (78.8)	0.162

Table 2

displays the relation between the level of harm and the percentage of physicians likely to disclose them.

Table 3

Attitudes toward error disclosure.
Questions	Received Training	Number (%) of respondents who agreed	p-value
Disclosing medical error to patients is the right thing to do even if it comes at a significant personal cost (e.g., harms my reputation or increases my malpractice risk).	Yes	50 (90.9)	0.003
	No	22 (66.7)	0.003
It is important for me to tell my patients about errors I have made in their care because that is how I would want to be treated if I were a patient.	Yes	53 (96.4)	0.103
	No	29 (87.8)	0.103
My decision to disclose a medical error to a patient depends on whether I think the information will help or harm him/her.	Yes	40 (72.7)	0.032
	No	19 (57.6)	0.032
If I made a medical error, disclosing the error to my patient would help alleviate my feelings of guilt.	Yes	47 (87.0)	0.121
	No	23(69.7)	0.121
Telling my patient about a medical error I have made in their care strengthens my patient’s trust in me as a physician.	Yes	28 (50.9)	0.24
	No	14 (42.4)	0.24
I am aware and knowledgeable of the articles/elements of Jordan’s Medical and Health Liability Law	Yes	36 (66.7)	0.017
	No	15 (45.5)	0.017
How likely would the issue of Jordan’s Law on Medical and Health Liability affect your decision to disclose an error to your patient?	Yes	34 (61.8)	0.024
	No	12 (36.4)	0.024

Jordan’s Law on Medical and Healthcare Liability was addressed in two questions especially that this law came into effect recently. Physicians who attended the workshop were more knowledgeable of articles and elements than those who did not attend (p-value = 0.017). More so the difference in knowledge on decision of error disclosure was in favor of physicians who have attended the workshop (p-value = 0.024).

The majority of physicians in both groups preferred disclosure of medical errors because it is how they would want to be treated if they were patients (96.4% and 87.8%, respectively, p-value = 0.103) and because they believed that disclosure of medical errors would help them alleviate the feeling of guilt (66.7% and 45.5%, respectively, p-value = 0.121. Almost half of the physicians in both groups believed that disclosure of medical error would not strengthen the doctor-patient relationship (50.9% and 42.4%, respectively, p-value = 0.24). Interestingly though, physicians who received training were more inclined to disclose errors depending on their perception of whether this will help or harm the patients (72.7% and 57.6%, respectively, p-value = 0.032)

90.9% of physicians who attended the workshop, compared to 66.7% of those who have not attended supported the disclosure of medical errors even if it comes at a significant personal cost, such as legal litigation or loss of reputation (p-value = 0.003).

In respect to professional relationships between physicians and their peers; physicians in both groups felt the need to share the burden of a medical error (76.4% vs 62.5%, p-value = 0.24). Physicians in both groups recognized at least one colleague who would give them support if needed (94.5% vs 78.8%, p-value = 0.064). Reasons for wanting to share the incident with colleagues included learning whether they would have made the same clinical judgments and decisions (90.9% vs. 78.8%, respectively, p-value = 0.149), learning from their errors (85.5% vs. 75.8%, respectively, p-value = 0.256), getting support and understanding (89.1% vs. 75.8%, respectively, p-value = 0.277), strengthening their professional relationships with the team (63.6% vs. 48.5%, respectively, p-value = 0.350), and unburdening themselves (67.3% vs. 51.5%, respectively, p-value = 0.280). Interestingly, those who witnessed their mentors disclosing errors to patients were more likely to do the same in front of their students and residents than those who did not recall a similar experience with their mentors (71.0% vs. 29.0%, respectively, p-value = 0.008) which reveals the importance of role modeling and the hidden curriculum.

When it comes to the relation with one’s institution, both groups believed that reporting medical errors to one’s own institution improves the quality of care for future patients (96.3% in the group who received the training and 84.8% who did not, p-value = 0.15) and they believed that the benefits of reporting medical errors outweigh the negative consequences for those who report them (67.3% vs 66.7%, respectively, p-value = 0.290). However, 85.5% of physicians who received the training knew how to report medical errors to the institution, compared to 66.7% physicians who did not (p-value = 0.02). In addition, receiving a feedback from the institution would enhance reporting of medical errors as perceived by those who received training against who did not (85.2% vs 56.3%, p-value = 0.003).

When thinking about disclosing medical errors, physicians who received the training and physicians who did not were both more concerned about malpractice litigation (58.2% vs 59.4%, respectively, p-value = 0.042), blame from colleagues (60.0% vs 50.0%, respectively, p-value = 0.584), professional discipline (59.3% vs. 67.7%, respectively, p-value = 0.720), loss of reputation, (61.8% vs. 56.3%, respectively, p-value = 0.842), negative reaction from the patients or their families (58.2% vs 75.6%, respectively, p-value = 0.089), and negative publicity in the news media (58.2% vs 65.6%, respectively, p-value = 0.564).

The purpose of this study was to investigate the different aspects associated with medical error disclosure among physicians at our center. It also aimed to measure their knowledge of the new Medical and Health Liability Law in Jordan and its' impact on physicians’ medical error disclosure. To our knowledge, this is the first study that looked into the effect of formal training of physicians on disclosing medical errors after the enactment of the MHLL in 2018. A literature review revealed that only a couple of studies addressing the issue in Jordan were previously published. Our study is different as it measures the KAP among physicians with and without formal training and after the enactment of the MHLL [26, 27]. Notable among our findings is the observation that although there was no significant difference in reporting major harm between both groups of physicians (p-value = 0.07), physicians who attended the workshop gained better knowledge of the MHLL and the Center’s policies (p-value = 0.017), and that these differences in knowledge was reflected on the perceived practice to disclose medical error in physicians who received the training (p- value = 0.024). This confidence about the practice of medical error disclosure in physicians who attended the workshop can either be attributed to their knowledge of the medical liability law which was addressed during the workshop or to their more comprehensive understanding of the importance of disclosure more after the attendance of the workshop (90.9% vs 66.7%, respectively, p-value = 0.003). Moreover, 85.5% of physicians who received the training reported better knowledge on how to report medical errors to the institution, compared to 66.7% of physicians who did not attend (p-value = 0.02). This comes in alignment with published literature on the effectiveness of educational workshops in enhancing medical error disclosure [28, 29]. When medical error disclosure was stratified according to gender and years of experience, our study found no difference between respondents in terms of gender and experience whether they attended the workshop or not. While some studies showed no significant gender differences regarding medical error disclosure, reporting was affected by years of experience, and physicians with more years of experience were more likely to report medical errors resulting in no harm, minor harm, and major harm than residents and physicians with less years of experience [30]. This variation in findings can be explained by the sample size in our study and the homogeneity of our participants.

In respect of physician-to-physician communication and collegial relationships, physicians in both groups were able to recognize at least one colleague who would support them when needed (p-value = 0.064). They identified many reasons on why they need to share this atrocity such as clarification and reassurance, to see what clinical judgment their peers would have made, and to receive the much needed emotional and moral support and understanding. This emphasizes the under-recognized need for psychological and moral support of physicians [12], which should be perceived as a learning opportunity for physicians and institutions as the toll of an medical error can be heaving on physicians themselves and thus, they too, in a way, are a victim of medical errors.

Research showed that the presence of role models and mentors to medical students or physicians has a key impact on improving the competency in medical error disclosure through providing a passive, experiential method of learning for these individuals [31, 32]. In our study, physicians who had witnessed a past experience of their mentors disclosing errors to patients were more likely to do it themselves than those who did not recall a similar experience with their mentors (p-value = 0.008), which highlights the important role senior/ experienced physicians plays in shaping the future practice of residents and junior physicians and how they can significantly improve their experience and capabilities of medical error disclosure. A potential venue for discussing and teaching medical errors and the significance of disclosure is through incorporating these in the curriculum of medical schools or residency programs which lack such an important aspect as far as we know and to ensure that later on, these physicians will be role models to others.

In regard to physicians' relation with the institution, more physicians attending the workshop knew how to report medical errors to the institution, compared to physicians who did not attend (p-value = 0.02). Furthermore, physicians who attended the workshops were more inclined to report medical errors given that they would receive feedback from the institution (p-value = 0.003). Thus, orientation of the newly hired physicians and a continuous update to physicians at the center might be a prerequisite for the continued professional development scheme. Moreover, building a no shame- no blame culture in the institution is very much warranted and will provide a safe space for physicians to enhance a culture of justice.

Medical error disclosure can be more sensitive in cancer care, an environment where medical errors can be especially detrimental. In literature, oncologists agreed that medical errors should be disclosed. However, fear of legal litigation was one of the main barriers to error disclosure, as well as fear of negative reaction or distrust from their patients, and institutional pressure regarding medical error disclosure [33, 34], which is concordant with our findings at KHHC. One other aspect is that oncologist tend to carry more emotional burden when medical errors occur to their patients [25], further stressing the need for emotional and psychological support to physicians from their peers and their institution when faced with medical errors.

We acknowledge some limitations in our study. First, the data was obtained from a single center with a relatively small number of participants. Also, while the mother language of Jordan is the Arabic language, the workshops and the role-playing were held in English, a factor that does not mirror the real world practice, when medical errors have to be disclosed in Arabic. Language barrier was expressed by some of the attendees. Indeed, when the trainers suggested that one simulation be done in Arabic, the way the error was disclosed was even more effective. This would call to assimilate some workshops in Arabic. Likewise, future studies tailored to accommodate the cultural norms in each community are in need; whereas the patient and one to a few relatives are involved in disclosure of errors, the need to disclose and explain the encounter is expected to involve many individuals including the extended families. Also, although physicians working at KHCC were the primary target, and despite the small sample size, the results can probably be generalized since the topics discussed, the update on the new MHLL, and the case scenarios were not cancer specific. However, repeating the training to include more physicians from other sectors is warranted.

Education of physicians on error disclosure by conducting the workshops using simulation helped physicians become more knowledgeable and competent about on this vital issue and improved their comprehension on the Medical and Health Liability Law, recognized by the attendees as the one of the most important factors in wanting to learn how to disclose medical errors. We also acknowledge the support needed from peers and institutions, as well as the importance of professional role model. We recommend extending the workshops to more institutions, and to incorporate it in medical and training curricula at different universities. We also recommend adding training on medical error disclosure and the local policies per institution, as well as raising more awareness of the Medical and Health Liability Law. Further studies are recommended where other institutions and more physicians are involved. The value of integrating such training in the curricula of medical schools and residency training programs cannot be over-emphasized.

Abbreviation	Full name
AUBMC	American University of Beirut Faculty of Medicine and Medical Center
HEC	Hospital Ethics Committee
IRB	the Institutional Review Board
KAP	knowledge, attitudes and practices
KHCC	King Hussein Cancer Center
MHLL	Medical and Health Liability Law
SHBPP	Salim El-Hoss Bioethics and Professionalism Program

Ethics approval and consent to participate

this is to confirm that ethical approval was obtained from KHCC-IRB, and that all subjects read and agreed to participate voluntarily. KHCC-IRB waives the need for documentation of the informed consents when either the a- only record linking the subject and the research would be consent document and the principle risk would be potential harm resulting from breach of confidentiality, or b- The research presents no more than minimal risk of harm to subjects and the research involves no procedure for which written consent is normally required outside of the research context. Thus KHCC-IRB approved the study with waiver of written documentation as in part b. A cover page at the beginning of the questionnaire is that includes all the elements of the IC document. Agreeing to complete the questionnaire is considered as an “implied” approval to participate in the study.

Consent for publication

this is to confirm that all participants agreed to the publication of anonymized data.

Availability of data and material

the dataset supporting the conclusions of this article is available with the Corresponding author and is present upon request.

Competing interests

this is to confirm that all authors have no competing interest.

Funding

Not applicable.

Authors' contributions

Inception of the idea; MH, AM, THA.

Collection of the data; AT, KA.

Analysis and interpretation of the data; RM, MH, KA, AT.

Writing the first draft; RM.

Reviewing the draft; MH, KH, AM, THA

Final approval; all authors

Accountability on the content; all authors.

Acknowledgements

Not applicable

Welsh D, Zephyr D, Pfeifle AL, Carr DE, Fink JL, 3rd, Jones M: Development of the Barriers to Error Disclosure Assessment Tool. Journal of patient safety 2017.
Institute of Medicine Committee on Quality of Health Care in A. In: Crossing the Quality Chasm: A New Health System for the 21st Century. edn. Washington (DC): National Academies Press (US) Copyright 2001 by the National Academy of Sciences. All rights reserved.; 2001.
Institute of Medicine Committee on Quality of Health Care in A. In: To Err is Human: Building a Safer Health System. edn. Edited by Kohn LT, Corrigan JM, Donaldson MS. Washington (DC): National Academies Press (US)Copyright 2000 by the National Academy of Sciences. All rights reserved.; 2000.
Hayajneh YA, AbuAlRub RF, Almakhzoomy IK: Adverse events in Jordanian hospitals: types and causes. International journal of nursing practice 2010, 16(4):374-380.
Buletsa S, Drozd O, Yunin O, Mohilevskyi L: Medical Error: Civil and Legal Aspect. Georgian medical news 2018(276):161-166.
Merry AF: How does the law recognize and deal with medical errors? Journal of the Royal Society of Medicine 2009, 102(7):265-271.
Witman AB, Park DM, Hardin SB: How do patients want physicians to handle mistakes? A survey of internal medicine patients in an academic setting. Archives of internal medicine 1996, 156(22):2565-2569.
Beckman HB, Markakis KM, Suchman AL, Frankel RM: The doctor-patient relationship and malpractice. Lessons from plaintiff depositions. Archives of internal medicine 1994, 154(12):1365-1370.
Hannawa AF, Shigemoto Y, Little TD: Medical errors: Disclosure styles, interpersonal forgiveness, and outcomes. Social science & medicine 2016, 156:29-38.
Leape LL: Error in medicine. Jama 1994, 272(23):1851-1857.
Barach P, Small SD: Reporting and preventing medical mishaps: lessons from non-medical near miss reporting systems. Bmj 2000, 320(7237):759-763.
Bell SK, White AA, Yi JC, Yi-Frazier JP, Gallagher TH: Transparency When Things Go Wrong: Physician Attitudes About Reporting Medical Errors to Patients, Peers, and Institutions. Journal of patient safety 2017, 13(4):243-248.
Dossett LA, Kauffmann RM, Lee JS, Singh H, Lee MC, Morris AM, Jagsi R, Quinn GP, Dimick JB: Specialist Physicians' Attitudes and Practice Patterns Regarding Disclosure of Pre-referral Medical Errors. Annals of surgery 2018, 267(6):1077-1083.
Ghalandarpoorattar SM, Kaviani A, Asghari F: Medical error disclosure: the gap between attitude and practice. Postgraduate medical journal 2012, 88(1037):130-133.
Kolaitis IN, Schinasi DA, Ross LF: Should Medical Errors Be Disclosed to Pediatric Patients? Pediatricians' Attitudes Toward Error Disclosure. Academic pediatrics 2016, 16(5):482-488.
Kaldjian LC, Jones EW, Rosenthal GE: Facilitating and impeding factors for physicians' error disclosure: a structured literature review. Joint Commission journal on quality and patient safety 2006, 32(4):188-198.
Lipitz-Snyderman A, Kale M, Robbins L, Pfister D, Fortier E, Pocus V, Chimonas S, Weingart SN: Peers without fears? Barriers to effective communication among primary care physicians and oncologists about diagnostic delays in cancer. BMJ quality & safety 2017, 26(11):892-898.
Asghari F, Fotouhi A, Jafarian A: Doctors' views of attitudes towards peer medical error. Postgraduate medical journal 2010, 86(1012):123-126.
Mendonca VS, Gallagher TH, de Oliveira RA: The Function of Disclosing Medical Errors: New Cultural Challenges for Physicians. HEC forum : an interdisciplinary journal on hospitals' ethical and legal issues 2019, 31(3):167-175.
Perez B, Knych SA, Weaver SJ, Liberman A, Abel EM, Oetjen D, Wan TT: Understanding the barriers to physician error reporting and disclosure: a systemic approach to a systemic problem. Journal of patient safety 2014, 10(1):45-51.
Finkelstein D, Wu AW, Holtzman NA, Smith MK: When a physician harms a patient by a medical error: ethical, legal, and risk-management considerations. The Journal of clinical ethics 1997, 8(4):330-335.
https://www.ammanchamber.org.jo/node/news.aspx?id=3601&lang=ar. In.
https://www.khcc.jo/en/section/about-center. In.
Surbone A, Gallagher TH, Rich KR, Rowe M: To Err Is Human 5 years later. Jama 2005, 294(14):1758; author reply 1759.
Surbone A, Rowe M, Gallagher TH: Confronting medical errors in oncology and disclosing them to cancer patients. Journal of clinical oncology : official journal of the American Society of Clinical Oncology 2007, 25(12):1463-1467.
Hwang JY: Physicians' Perspectives on the Current Handling of Medical Malpractice in Jordan. t (ISP) Collection 1927 2014.
Okour. Mohammad-Noor Said Deeb OKS, Melhem. Shefaa Mustafa, Ndjiembi A. Christiane, Zhanchun Feng: The Relation between Ethics and Law according to the Doctor’s Malpractice in Improving the Healthcare Quality in Jordanian Government Hospitals. IOSR Journal Of Humanities And Social Science 2014, 19(5):60-67.
Gunderson AJ, Smith KM, Mayer DB, McDonald T, Centomani N: Teaching medical students the art of medical error full disclosure: evaluation of a new curriculum. Teaching and learning in medicine 2009, 21(3):229-232.
Kim CW, Myung SJ, Eo EK, Chang Y: Improving disclosure of medical error through educational program as a first step toward patient safety. BMC medical education 2017, 17(1):52.
Kaldjian LC, Jones EW, Wu BJ, Forman-Hoffman VL, Levi BH, Rosenthal GE: Disclosing medical errors to patients: attitudes and practices of physicians and trainees. Journal of general internal medicine 2007, 22(7):988-996.
Cruess RL, Cruess SR, Boudreau JD, Snell L, Steinert Y: A schematic representation of the professional identity formation and socialization of medical students and residents: a guide for medical educators. Academic medicine : journal of the Association of American Medical Colleges 2015, 90(6):718-725.
Zhao Y, Cao Y, Che L, Fu Q, Song S, Zhao B, Zhang S, Zhang W, Li X, Choi S et al: Ethical dilemma of identity disclosure faced by medical students in clinical clerkships: A nationwide multicenter study in China. PloS one 2018, 13(7):e0200335.
Yardley IE, Yardley SJ, Wu AW: How to discuss errors and adverse events with cancer patients. Current oncology reports 2010, 12(4):253-260.
D'Errico S, Pennelli S, Colasurdo AP, Frati P, Sicuro L, Fineschi V: The right to be informed and fear of disclosure: sustainability of a full error disclosure policy at an Italian cancer centre/clinic. BMC health services research 2015, 15:130.

STROBEchecklistcrosssectional.doc

Download PDF

Journal Publication

published 20 Aug, 2020

Read the published version in BMC Medical Ethics →

Editorial decision: Major revision
28 May, 2020
Review #1 received at journal
27 May, 2020
Review #2 received at journal
26 May, 2020
Reviewer #2 agreed at journal
05 May, 2020
Reviewer #1 agreed at journal
04 May, 2020
Editor assigned by journal
03 May, 2020
Reviewers invited by journal
03 May, 2020
Submission checks completed at journal
01 May, 2020
Editor invited by journal
30 Apr, 2020
First submitted to journal
18 Apr, 2020

You are reading this older preprint version

Read the latest preprint version →

Disclosure of Medical Errors: Physicians’ Knowledge, Attitudes and Practices (KAP) in an Oncology Center

Status:

Journal Publication

Version 1

Abstract

Background

Methods

Results

Discussion

Conclusion

Abbreviations

Declarations

Ethics approval and consent to participate

Consent for publication

Availability of data and material

Competing interests

Funding

Authors' contributions

Acknowledgements

References

Supplementary Files

Status:

Journal Publication

Version 1