Training Doctors to Disclose Unanticipated Outcomes to Patients: Randomized Trial

描述(申请人提供)：背景：医疗护理造成的意外结果和伤害是不可避免的。越来越多的人期望和要求向患者披露这些结果，但这种做法仍然不常见，很少有医生接受过披露培训。未能始终如一地进行良好的披露是对以患者为中心的护理的根本威胁。许多人声称，改善信息披露可以提高患者满意度，减少医疗事故索赔，但这些说法缺乏经验证据。此前没有任何研究对实际披露的质量进行评估，这阻碍了改进披露过程的努力。目的：我们提出了一项培训医生披露信息的随机试验，具体目的如下：1)确定医生在向患者披露非预期结果时是否接受沟通培训 目的：1)研究意外结果披露对患者满意度的影响；2)探讨向患者披露意外结果的医生沟通培训是否会影响医疗事故索赔；3)探讨事件的特征(伤害的严重性、是否存在错误)、医生、患者和环境是否独立影响意外结果披露培训与患者满意度之间的关系。方法：参与者将是科罗拉多州(通过COPIC获得责任保险)和华盛顿(UW医学)的400名外科医生和介入医生。干预措施包括：a)2小时的披露培训网络广播；b)与两名标准化患者进行练习和反馈；以及c)项目中期的复习培训网络广播。主要结果将是患者对他们所经历的披露的满意度，这是通过患者披露质量评估来衡量的，这是一种心理测量学工具。次要结果将是在接下来的24个月内发生的医疗事故索赔。多元回归分析也将被用来检验患者、事件和医生特征对患者披露满意度的影响。影响和影响：这项研究将第一次衡量实际披露的质量，并评估医生培训是否改善了披露过程。拟议的项目将医疗差错、医疗事故和沟通技能培训方面的领先研究人员与两个行业合作伙伴--一家主要的医疗事故保险公司和基于网络的安全教育领先者TMIT--聚集在一起。这一发现将广泛适用于培训医生，以满足日益增长的有效披露要求。

DESCRIPTION (provided by applicant): Background: Unanticipated outcomes and harms resulting from medical care are inevitable. Disclosure of those outcomes to patients is increasingly expected and required, but this practice remains uncommon and few physicians have had disclosure training. Failure to conduct disclosure consistently and well represents a fundamental threat to patient-centered care. Many have asserted that improving disclosure could increase patient satisfaction and reduce malpractice claims, but empirical evidence for these claims is lacking. No prior studies have assessed the quality of actual disclosures, hampering efforts to improve the disclosure process. Objectives: We propose a randomized trial of training physicians in disclosure with the following specific aims: 1) to determine whether physician communication training in disclosing unanticipated outcomes to patients affects patient satisfaction with disclosure; 2) to explore whether physician communication training in disclosing unanticipated outcomes to patients affects malpractice claims; 3) to explore whether characteristics of the event (severity of harm, presence of error), the physician, patient, and the environment independently affect the relationship between unanticipated outcome disclosure training and patient satisfaction. Methods: Participants will be 400 surgeons and interventional physicians in Colorado (who obtain liability insurance through COPIC) and in Washington (UW Medicine). The intervention includes: a) 2-hour disclosure training webcast; b) practice and feedback with two standardized patients; and c) a refresher training webcast mid-project. The primary outcome will be patient satisfaction with a disclosure they experience, as measured with the Patient Assessment of Disclosure Quality, a psychometrically sound instrument. The secondary outcome will be the incidence of malpractice claims in the subsequent 24 months. Multivariate regression analysis will also be used to examine the effects of patient, event, and physician characteristics on patient satisfaction with disclosure. Implications and Impact: This study will be the first to measure the quality of actual disclosures and assess whether physician training improves the disclosure process. The proposed project brings together leading researchers in medical error, malpractice, and communication skills training with two industry partners--a major malpractice insurance company and TMIT, a leader in web-based safety education. The findings will be widely applicable to training physicians to meet the increasing demands for effective disclosure.