Training Doctors to Disclose Unanticipated Outcomes to Patients: Randomized Trial

描述（由申请人提供）：背景：医疗护理不可避免地会产生意想不到的后果和伤害。向患者披露这些结果的期望和要求越来越多，但这种做法仍然不常见，很少有医生接受过披露培训。未能持续和良好地进行信息披露是对以患者为中心的护理的根本威胁。许多人断言，改善信息披露可以提高患者满意度，减少医疗事故索赔，但缺乏这些索赔的经验证据。此前没有研究评估过实际披露的质量，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的随机试验，其具体目的如下：1)确定医生沟通培训是否涉及向患者披露意外结果

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.