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 health care 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 deaths/year [3]. In Jordan, a study reported that 28% of all hospital admissions are believed to be affected by medical errors. Fifty-six percent of participants reported medication errors as the most significant type of adverse events (AEs). This was followed by wrong diagnosis, infections, bedsores and falls reported by 21.3%, 21.3%, 16% and 8% of participants, respectively[4]. Other AEs reported in the study were errors of patient identification, transfusion errors, and medical errors that lead to patients' death.
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 [7, 8]. Furthermore, patients were more inclined to consider the litigation of medical errors if their physician did not disclose them[9], which further reinforces the importance of the physician's acquaintance on how to properly disclose medical errors to their patients[10, 11], including when and where to disclose.
Interestingly, the prevalence of disclosure of medical errors remains fluctuant, as studies found that 50% to 96% of errors in the US are underreported [12, 13]. Nevertheless, physicians still acknowledge disclosure of medical errors as a fundamental part of patients' care [14-17]. They have entrusted their physicians with their health. While trust is the cement that holds the physician-patient relationship, hiding (or lying about) errors cracks that trust and leads to distrust in the medical profession at 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 [18]. 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 [19, 20]. It also includes proper reporting to the institution, and the possibility of legal liability [14, 21-23]
Stemming from the importance of a physician's knowledge and willingness to report medical errors in improving healthcare standards and quality, the 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. The aim is 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 31 August 2018 [24]. Article-5 of the MHLL states that physicians and health care workers are required to perform services subject to the requirements of the morals, accuracy, and loyalty of the profession, which must 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 [25].
Although disclosure of medical errors remains consequential in all fields of medical practice, medical errors have a specialty-sensitive dimensions [26], one example would be when it comes to cancer patients. Cancer care can be complex and integrative; the use of many medications, the tendency for cancer patients to be enrolled in clinical trials, the long follow up period, and the involvement of multidisciplinary teams. The aforementioned factors make it healthcare especially challenging for physicians and may add to the risk of medical errors and to the difficulty of disclosing them to patients [27]. Examples include the pediatric oncology services, which deals with a particular vulnerable group. Disclosing medical errors to pediatric cancer patients is of a particular challenge, as they may especially face diagnostic delays given the nature of disease in pediatric population [28], chemotherapy infusion errors [29], and outpatient adverse events [30]. Given the complexity of error disclosure in cancer patients, ethical professional practice in KHCC is driven by its' six 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. This includes decision making at the Hospital Ethics Committee [31] 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 [32] 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.