Association of open communication and the emotional and behavioural impact of medical error on patients and families: state-wide cross-sectional survey

Abstract

BackgroundHow openly healthcare providers communicate after a medical error may influence long-term impacts. We sought to understand whether greater open communication is associated with fewer persisting emotional impacts, healthcare avoidance and loss of trust.MethodsCross-sectional 2018 recontact survey assessing experience with medical error in a 2017 random digit dial survey of Massachusetts residents. Two hundred and fifty-three respondents self-reported medical error. Respondents were similar to non-respondents in sociodemographics confirming minimal response bias. Time since error was categorised as <1, 1–2 or 3–6 years before interview. Open communication was measured with six questions assessing different communication elements. Persistent impacts included emotional (eg, sadness, anger), healthcare avoidance (specific providers or all medical care) and loss of trust in healthcare. Logistic regressions examined the association between open communication and long-term impacts.ResultsOf respondents self-reporting a medical error 3–6 years ago, 51% reported at least one current emotional impact; 57% reported avoiding doctor/facilities involved in error; 67% reported loss of trust. Open communication varied: 34% reported no communication and 24% reported ≥5 elements. Controlling for error severity, respondents reporting the most open communication had significantly lower odds of persisting sadness (OR=0.17, 95% CI 0.05 to 0.60, p=0.006), depression (OR=0.16, 95% CI 0.03 to 0.77, p=0.022) or feeling abandoned/betrayed (OR=0.10, 95% CI 0.02 to 0.48, p=0.004) compared with respondents reporting no communication. Open communication significantly predicted less doctor/facility avoidance, but was not associated with medical care avoidance or healthcare trust.ConclusionsNegative emotional impacts from medical error can persist for years. Open communication is associated with reduced emotional impacts and decreased avoidance of doctors/facilities involved in the error. Communication and resolution programmes could facilitate transparent conversations and reduce some of the negative impacts of medical error.

The impact that family members’ health care experiences have on patients’ trust in physicians

“…Another study that included the family members of patients who had suffered medical errors described a decrease in the family member’s trust in healthcare at the time, but the study did not quantify the extent to which such negative past experiences affected the family member’s trust in their current physicians and physicians in general. [ 14 ] Second, whereas previous reports have indicated that physicians’ image is generally constructed by the media and informal public opinion, [ 1 , 3 ] we were able to show, for the first time, that the individual experience of dissatisfaction with a family member’s medical care is an important factor in reducing the individual’s trust in general physicians. Third, our finding that dissatisfaction is associated with a milder decline in trust toward personal physicians than toward physicians in general confirms that interpersonal physician trust is more resilient than trust in the medical profession generally.…”

“…For example, some bereaved children of cancer patients have a long-standing distrust toward the medical care provided to cancer patients [ 5 ]. A study involving family members of patients who had experienced medical errors found that family members reported a loss of trust in healthcare and avoidance of medical care in general [ 14 ]. This system-level loss of trust in healthcare can include a loss of general physician trust [ 3 , 15 ].…”

Dissatisfaction with family members’ medical care: the relationship with trust in personal physicians and physicians generally in Japan

“…However, that study did not examine whether dissatisfaction with the family's medical care resulting from poor outcomes lowered the children's trust in their current physicians. Another study that included the family members of patients who had suffered medical errors described a decrease in trust in healthcare at the time, but the study did not quantify the extent to which such negative past experiences affect their current trust in their own physicians and physicians in general (Prentice et al, 2020).…”

“…For example, some bereaved children of cancer patients have a long-standing distrust toward the medical care provided to cancer patients (Beernaert et al, 2017). Another study involving family members of patients who had experienced medical errors found that they reported a loss of trust in healthcare and avoidance of medical care in general (Prentice et al, 2020). This system-level loss of trust in healthcare can include a loss of general physician trust (Blendon and Benson, 2001;Hall et al, 2002).…”

Improving self-reported empathy and communication skills through harm in healthcare response training

“…Delayed and inadequate responses to harm events negatively impact health-seeking behaviors and cause psychological scarring in one-third of patients and produces guilt, distress and feelings of inadequacy in clinicians, while open communication after medical harm has been linked to reduced sadness, depression and feelings of betrayal by patients and their loved ones. 3–6…”