This article is more than 5 years old. Information may no longer be current.

Primary care physicians reluctant to disclose oncology treatment errors

Survey results published in BMJ Quality and Safety demonstrated that a majority of primary care physicians would provide only partial disclosure of a medical error related to a patient’s cancer diagnosis.

The researchers indicated that perceived value of patient-centered communication, seriousness of events and personal responsibility were possible considerations primary care physicians make when deciding to tell a patient with cancer a mistake was made in their treatment.

“This limited approach to disclosure by physicians in this study falls far short of patient expectations and national standards,” Kathleen Mazor, EdD, from the Meyers Primary Care Institute in Worcester, Mass., and colleagues wrote. “Our study, which used challenging but realistic cases of oncology error involving multiple providers, demonstrates the need to develop a more robust and nuanced understanding of the factors affecting disclosure at the level of the event, the provider and the organization. Such an understanding will be important to make meaningful headway in meeting patients’ and families’ needs when care has gone wrong.”

Mazor and colleagues evaluated 297 survey responses from primary care doctors who were presented with two different scenarios: one involved a patient with a delayed cancer diagnosis; the second involved a patient whose care coordination broke down.

Researchers reported most respondents said they would not be fully forthcoming in either scenario, providing only limited or no apologies, explanations and information about the cause of the error. Overall, physicians said they would be more forthcoming with the patient who experienced the care coordination breakdown, and more than half of the physicians reported they would offer only a vague expression of regret and not volunteer an apology.

Of those surveyed, 77% said they would offer no information or would only make obscure references to ‘miscommunications’ when the delayed cancer diagnosis patient asked about the error’s cause, compared to 58% of those in the care coordination breakdown scenario.

“Organizations should consider using vignette-based surveys to measure how physician-level and organization-level factors, similar to those we measured and which are measured in surveys of safety climate, might be related to error disclosure,” the researchers wrote, adding these surveys could be tweaked to many different situations. The findings could then be used to improve practice environment, promote proactive approaches to error disclosure and, as literature suggests, mitigate risk of litigation in the event of medical error when disclosure falls short. — by Janel Miller

Disclosure: The researchers report no relevant financial disclosures.