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Preferences and Perceptions of Medical Error Disclosure Among Marginalized Populations: A Narrative Review

      Background

      Disclosure of medical errors, in which a health care provider informs the patient/family of the error and takes responsibility, is an ethical imperative. Little is known about how medical error disclosure preferences or perceptions may vary for patients who are people of color, are older, or have lower educational attainment.

      Methods

      The researchers conducted a narrative review on medical errors and disclosure. Included were studies in high-income countries that included a predominantly marginalized population, defined by any one of the following: older age adults (mean age > 65 years); low educational attainment (> 55% of participants with less than a high school education); and/or racial/ethnic minority (< 55% of participants identifying as non-Hispanic white for US studies).

      Results

      The literature search yielded 3,050 articles, resulting in 6 studies included for analysis. Four studies used hypothetical vignettes; 1 used focus groups, and 1 used a survey. Three studies met the marginalized population criteria based on education; 3 met the criteria based on race/ethnicity. No study met the inclusion criteria for age. All 6 articles examined patient preferences for disclosure, and 2 studies also examined patient perceptions of disclosure. Overall, participants preferred that medical errors be disclosed to them. Most of the studies lacked multiple regression analysis to investigate differences in disclosure preferences by race/ethnicity, age, and education.

      Conclusion

      Participants from marginalized populations may have similar disclosure preferences to white and highly educated participants. Future studies should aim to examine differences in error disclosure preferences among patients who have experienced adverse events across race/ethnicity, educational attainment, and age.
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      References

        • Wachter R
        • Gupta K.
        Understanding Patient Safety.
        3rd ed. McGraw-Hill, New York2018
        • Institute of Medicine
        To Err Is Human: Building a Safer Health System.
        National Academy Press, Washington, DC2000
      1. World Health Organization. Patient Safety. Sep 13, 2019. Accessed Jun 26, 2022. https://www.who.int/news-room/fact-sheets/detail/patient-safety.

      2. American Medical Association. Promoting Patient Safety: Code of Medical Ethics Opinion 8.6. Accessed Jun 26, 2022. https://www.ama-assn.org/delivering-care/ethics/promoting-patient-safety.

        • Liang BA.
        A system of medical error disclosure.
        Qual Saf Health Care. 2002; 11: 64-68
        • Vincent CA
        • Pincus T
        • Scurr JH
        Patients’ experience of surgical accidents.
        Qual Health Care. 1993; 2: 77-82
        • Gallagher TH.
        Medical errors in the outpatient setting: ethics in practice.
        J Clin Ethics. 2002; 13: 291-300
        • Hingorani M
        • Wong T
        • Vafidis G.
        Patients’ and doctors’ attitudes to amount of information given after unintended injury during treatment: cross sectional, questionnaire survey.
        BMJ. 1999 Mar 6; 318: 640-641
        • Witman AB
        • Park DM
        • Hardin SB.
        How do patients want physicians to handle mistakes? A survey of internal medicine patients in an academic setting.
        Arch Intern Med. 1996; 156 (Dec 9–23): 2565-2569
        • Gallagher TH
        • Levinson W.
        Disclosing harmful medical errors to patients: a time for professional action.
        Arch Intern Med. 2005 Sep 12; 165: 1819-1824
        • Gallagher TH
        • et al.
        Patients’ and physicians’ attitudes regarding the disclosure of medical errors.
        JAMA. 2003 Feb 26; 289: 1001-1007
        • Berlinger N.
        After Harm: Medical Error and the Ethics of Forgiveness.
        Johns Hopkins University Press, Baltimore2005
        • Berlinger N.
        Avoiding cheap grace: medical harm, patient safety, and the culture(s) of forgiveness.
        Hastings Cent Rep. 2003; 33: 28-36
        • Berlinger N.
        Resolving harmful medical mistakes—is there a role for forgiveness?.
        Virtual Mentor. 2011 Sep 1; 13: 647-654
        • Mazor KM
        • et al.
        More than words: patients’ views on apology and disclosure when things go wrong in cancer care.
        Patient Educ Couns. 2013; 90: 341-346
        • Moore J
        • Bismark M
        • Mello MM.
        Patients’ experiences with communication-and-resolution programs after medical injury.
        JAMA Intern Med. 2017 Nov 1; 177: 1595-1603
        • Searight HR
        • Gafford J.
        Cultural diversity at the end of life: issues and guidelines for family physicians.
        Am Fam Physician. 2005 Feb 1; 71: 515-522
        • Mazor KM
        • et al.
        Health plan members’ views about disclosure of medical errors.
        Ann Intern Med. 2004 Mar 16; 140: 409-418
        • Chauhan A
        • et al.
        The safety of health care for ethnic minority patients: a systematic review.
        Int J Equity Health. 2020 Jul 8; 19: 118
        • Piccardi C
        • et al.
        Social disparities in patient safety in primary care: a systematic review.
        Int J Equity Health. 2018 Aug 7; 17: 114
        • Sivashanker K
        • Gandhi TK.
        Advancing safety and equity together.
        N Engl J Med. 2020 Jan 23; 382: 301-303
        • Sattar R
        • Johnson J
        • Lawton R.
        The views and experiences of patients and health-care professionals on the disclosure of adverse events: a systematic review and qualitative meta-ethnographic synthesis.
        Health Expect. 2020; 23: 571-583
        • Mazor KM
        • Simon SR
        • Gurwitz JH.
        Communicating with patients about medical errors: a review of the literature.
        Arch Intern Med. 2004; 164 (Aug 9–23): 1690-1697
        • O'Connor E
        • et al.
        Disclosure of patient safety incidents: a comprehensive review.
        Int J Qual Health Care. 2010; 22: 371-379
      3. Covidence. Home page. Accessed Jun 26, 2022. https://www.covidence.org.

        • DeVoe JE
        • Wallace LS
        • Fryer Jr., GE
        Patient age influences perceptions about health care communication.
        Fam Med. 2009; 41: 126-133
        • Elmontsri M
        • Banarsee R
        • Majeed A.
        Improving patient safety in developing countries—moving towards an integrated approach.
        JRSM Open. 2018 Nov 12; 92054270418786112
        • Wilson RM
        • et al.
        Patient safety in developing countries: retrospective estimation of scale and nature of harm to patients in hospital.
        BMJ. 2012 Mar 13; 344: e832
        • Ginsburg LR
        • Dhingra-Kumar N
        • Donaldson LJ.
        What stage are low-income and middle-income countries (LMICs) at with patient safety curriculum implementation and what are the barriers to implementation? A two-stage cross-sectional study.
        BMJ Open. 2017 Jun 15; 7e016110
        • Carpenter KB
        • et al.
        Measures of patient safety in developing and emerging countries: a review of the literature.
        Qual Saf Health Care. 2010; 19: 48-54
      4. Agency for Healthcare Research and Quality, Patient Safety Network. Patient Safety in Frail Older Patients. Nov 26, 2019. Accessed Jun 26, 2022. https://psnet.ahrq.gov/perspective/patient-safety-frail-older-patients.

      5. Centers for Disease Control and Prevention. Medication Safety Program: Adverse Drug Events in Adults. Oct 11, 2017. Accessed Jun 26, 2022. https://www.cdc.gov/medicationsafety/adult_adversedrugevents.html.

      6. National Institute on Aging. The National Institute on Aging: Strategic Directions 2020–2025. Accessed Jun 26, 2022. https://www.nia.nih.gov/about/aging-strategic-directions-research.

        • Centers for Disease Control and Prevention
        Public health and aging: trends in aging—United States and Worldwide.
        MMWR Morb Mortal Wkly Rep. 2003 Feb 14; (EpubAccessed Jun 26, 2022)
        • Cheraghi-Sohi SG
        • et al.
        Patient safety in marginalised groups: a narrative scoping review.
        Int J Equity Health. 2020 Feb 12; 19: 26
        • Hobgood C
        • Tamayo-Sarver JH
        • Weiner B.
        Patient race/ethnicity, age, gender and education are not related to preference for or response to disclosure.
        Qual Saf Health Care. 2008; 17: 65-70
        • Buscemi N
        • et al.
        Single data extraction generated more errors than double data extraction in systematic reviews.
        J Clin Epidemiol. 2006; 59: 697-703
        • von Elm E
        • et al.
        The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: guidelines for reporting observational studies.
        J Clin Epidemiol. 2008; 61: 344-349
        • Vandenbroucke JP
        • et al.
        Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration.
        PLoS Med. 2007; 4: e297
        • Hobgood C
        • et al.
        Medical errors—what and when: what do patients want to know?.
        Acad Emerg Med. 2002; 9: 1156-1161
        • Antunez AG
        • et al.
        Patient preferences in cases of inter-system medical error discovery (IMED).
        Ann Surg. 2021 Mar 1; 273: 516-522
        • Cleopas A
        • et al.
        Patient assessments of a hypothetical medical error: effects of health outcome, disclosure, and staff responsiveness.
        Qual Saf Health Care. 2006; 15: 136-141
        • Schneider AK
        • et al.
        Public perceptions and preferences for patient notification after an unsafe injection.
        J Patient Saf. 2013; 9: 8-12
        • Wu AW
        • et al.
        Disclosing medical errors to patients: it's not what you say, it's what they hear.
        J Gen Intern Med. 2009; 24: 1012-1017
        • Armstrong K
        • et al.
        Racial/ethnic differences in physician distrust in the United States.
        Am J Public Health. 2007; 97: 1283-1289
        • Bibbins-Domingo K
        • Petersen M
        • Havlir D.
        Taking vaccine to where the virus is—equity and effectiveness in coronavirus vaccinations.
        JAMA Health Forum. 2021; 2e210213