Abstract
Objective
Limited data exist on medical error disclosure in pediatrics. We sought to assess
physicians' attitudes toward error disclosure to parents and pediatric patients.
Methods
An anonymous survey was distributed to 1200 members of the American Academy of Pediatrics.
Surveys included 1 of 4 possible cases that only varied by patient age (16 or 9 years
old) and by whether the medical error resulted in reversible or irreversible harm.
Statistical analyses included chi-square, Bonferroni-adjusted P values, Fisher's exact test, Wilcoxon signed rank test, and logistic regressions
including key demographic factors, patient age, and error reversibility.
Results
The response rate was 40% (474 of 1186). Overall, 98% of respondents believed it was
very important to disclose medical errors to parents versus 57% to pediatric patients
(P < .0001). Respondents believed that medical errors could be disclosed to developmentally
appropriate pediatric patients at a mean age of 12.15 years old (SD 3.33), but not
below a mean age of 10.25 years old (SD 3.55). Most respondents (72%) believed that
physicians and parents should jointly decide whether to disclose to pediatric patients.
When disclosing to pediatric patients, 88% of respondents believed that physicians
should disclose with the parents present. Logistic regressions found only patient
age (odds ratio 18.65, 95% confidence interval 9.20–37.8) and error reversibility
(odds ratio 2.90, 95% confidence interval 1.73–4.86) to affect attitudes toward disclosure
to pediatric patients. Respondent sex, year of medical school graduation, and area
of practice had no effect on disclosure attitudes.
Conclusions
Most respondents endorse disclosing medical errors to parents and older pediatric
patients, particularly when irreversible harm occurs.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Academic PediatricsAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- To Err Is Human: Building a Safer Health System.National Academies Press, Washington, DC2000
- How do patients want physicians to handle mistakes? A survey of internal medicine patients in an academic setting.Arch Intern Med. 1996; 156: 2565-2569
- Medical errors—what and when: what do patients want to know?.Acad Emerg Med. 2002; 9: 1156-1161
- Health plan members' views about disclosure of medical errors.Ann Intern Med. 2004; 140: 409-418
- Facilitating and impeding factors for physicians' error disclosure: a structured literature review.Jt Comm J Qual Patient Saf. 2006; 32: 188-198
- Disclosing medical errors to patients: attitudes and practices of physicians and trainees.J Gen Intern Med. 2007; 22: 988-996
- The attitudes and experiences of trainees regarding disclosing medical errors to patients.Acad Med. 2008; 83: 250-256
- Patients' and physicians' attitudes regarding the disclosure of medical errors.JAMA. 2003; 289: 1001-1007
- Communicating with patients about medical errors: a review of the literature.Arch Intern Med. 2004; 164: 1690-1697
- The Sorry Works! Coalition: making the case for full disclosure.Jt Comm J Qual Patient Saf. 2006; 32: 344-350
- Disclosing harmful medical errors to patients.N Engl J Med. 2007; 356: 2713-2719
- Disclosing harmful medical errors to patients: a time for professional action.Arch Intern Med. 2005; 165: 1819-1824
- Parental preferences for error disclosure, reporting, and legal action after medical error in the care of their children.Pediatrics. 2005; 116: 1276-1286
- Disclosure of medical error to parents and paediatric patients: assessment of parents' attitudes and influencing factors.Arch Dis Child. 2010; 95: 286-290
- Reporting and disclosing medical errors: pediatricians' attitudes and behaviors.Arch Pediatr Adolesc Med. 2007; 161: 179-185
- Medical error disclosure among pediatricians: choosing carefully what we might say to parents.Arch Pediatr Adolesc Med. 2008; 162: 922-927
- Medication error prevention by clinical pharmacists in two children's hospitals.Pediatrics. 1987; 79: 718-722
- Medication errors and adverse drug events in pediatric inpatients.JAMA. 2001; 285: 2114-2120
- Children's contributions to pediatric outpatient encounters.Pediatrics. 1998; 102: 563-568
- Partnerships with children.BMJ. 1999; 319: 778
- Managing communication with young people who have a potentially life threatening chronic illness: qualitative study of patients and parents.BMJ. 2003; 326: 305
- Doctor–parent–child communication. A (re)view of the literature.Soc Sci Med. 2001; 52: 839-851
- Doctor–parent–child relationships: a “pas de trois”.Patient Educ Couns. 2002; 48: 5-14
- The Private Worlds of Dying Children.Princeton University Press, Princeton, NJ1980
- Communicating with children and families: from everyday interactions to skill in conveying distressing information.Pediatrics. 2008; 121: e1441-e1460
- Adolescent end of life preferences and congruence with their parents' preferences: results of a survey of adolescents with cancer.Pediatr Blood Cancer. 2015; 62: 710-714
- Pediatric residents' decision-making around disclosing and reporting adverse events: the importance of social context.Acad Med. 2010; 85: 1619-1625
- Bioethics for clinicians: 23. Disclosure of medical error.CMAJ. 2001; 164: 509-513
- Talking With Patients and Families About Medical Error: A Guide for Education and Practice.Johns Hopkins University Press, Baltimore, Md2011
- Simulation-based medical error disclosure training for pediatric healthcare professionals.J Healthc Qual. 2007; 29: 12-19
- Three scenarios to teach difficult discussions in pediatric emergency medicine: sudden infant death, child abuse with domestic violence, and medication error.Simul Healthc. 2009; 4: 114-130
- Assessing residents' communication skills: disclosure of an adverse event to a standardized patient.J Obstet Gynaecol Can. 2011; 33: 262-268
- Teaching medical error disclosure to physicians-in-training: a scoping review.Acad Med. 2013; 88: 884-892
- Teaching medical error disclosure to residents using patient-centered simulation training.Acad Med. 2014; 89: 136-143
- Physician response to surveys: a review of the literature.Am J Prev Med. 2001; 20: 61-67
Article Info
Publication History
Published online: August 29, 2015
Accepted:
June 25,
2015
Received:
May 6,
2015
Footnotes
The authors declare that they have no conflict of interest.
Identification
Copyright
Copyright © 2016 by Academic Pediatric Association
