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Toward a Theoretical and Empirical Conceptualization of Medical Error Disclosure Competence (MEDC)

Applicant Hannawa Annegret
Number 146977
Funding scheme Project funding (Div. I-III)
Research institution Istituto di comunicazione pubblica (ICP) Facoltà di comunicazione, cultura e società
Institution of higher education Università della Svizzera italiana - USI
Main discipline Communication sciences
Start/End 01.11.2013 - 31.10.2016
Approved amount 238'807.00
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Keywords (2)

Medical error disclosure; Doctor-patient communication

Lay Summary (German)

Lead
Das Projekt beschäftigt sich mit der Thematik medizinischer Behandlungsfehler. Es beinhaltet drei empirische kommunikationswissenschaftliche Studien, welche theoretisch fundierte Richtlinien für die kompetente Offenbarung von Fehlern im Gespräch zwischen Arzt und Patient vorschlagen sollen.
Lay summary
Medizinische Behandlungsfehler haben in den letzten Jahren erhebliches Forschungsinteresse erweckt. Anfangs haben sich diesbezügliche Untersuchungen in erster Linie auf die Konzeptualisierung, Ursachen, und Prävention von Fehlern konzentriert. Vor kurzem verlagerte sich dieser Forschungsschwerpunkt auf die Offenbarung kritischer Ereignisse vor dem Patienten. In der Schweiz wurden diese Ansätze hauptsächlich in der Umsetzung anonymer Critical Incident Reporting-Systeme sichtbar (CIRS; Scheidegger, 2005).

Jüngste Untersuchungen in den USA haben eine Forschungslücke in der Fehlermitteilungspraxis belegt: Ärzte erfüllen in dieser Hinsicht oft nicht die Erwartungen der Patienten. Einige Studien haben inzwischen Richtlinien für eine kompetente Fehleroffenbarung empfohlen. Diese Untersuchungen sind jedoch methodologisch limitiert: sie basieren hauptsächlich auf Patientenbefragungen und auf Korrelationsanalysen, und sie vernachlässigen jegliche theoretische Ansätze. Außerdem wurden die relationalen Mitteilungsinhalte kompetenter Fehlermitteilungen bisher noch nicht systematisch untersucht. Dies ist problematisch, da genau diese Inhalte die Patienteninterpretationen der Fehleroffenbarung grundlegend beeinflussen.

Dieses Projekt integriert vier theoretische Grundlagen, um kompetente Behandlungsfehleroffenbarungen zu konzeptualisieren und zu messen. Innerhalb dieses Rahmens stellen die drei Studien dieses Projekts eine systematische, theoretisch fundierte, empirische Untersuchung dar, die eine wichtige Lücke in der aktuellen internationalen Literatur zu diesem Thema füllt.
Direct link to Lay Summary Last update: 24.10.2013

Responsible applicant and co-applicants

Employees

Publications

Publication
“It Matters What I Think, Not What You Say”Scientific Evidence for a Medical Error Disclosure Competence (MEDC) Model
Hannawa Annegret F., Frankel Richard M. (2018), “It Matters What I Think, Not What You Say”Scientific Evidence for a Medical Error Disclosure Competence (MEDC) Model, in Journal of Patient Safety, 1-1.
What constitutes “competent error disclosure”? Insights from a national focus group study in Switzerland
HannawaAnnegret (2017), What constitutes “competent error disclosure”? Insights from a national focus group study in Switzerland, in Swiss Medical Weekly, 147(1112), 1-13.

Collaboration

Group / person Country
Types of collaboration
Texas Tech University (TTU) United States of America (North America)
- in-depth/constructive exchanges on approaches, methods or results
- Publication

Scientific events

Active participation

Title Type of contribution Title of article or contribution Date Place Persons involved
Annual meeting of the European Association for Communication in Healthcare (EACH) Poster Communication skills after a medical error II: An experimental study. 07.09.2016 Heidelberg, Germany Hannawa Annegret;
Annual meeting of the European Association for Communication in Healthcare (EACH) Talk given at a conference Communication skills after a medical error I: A national focus group study. 07.09.2016 Heidelberg, Germany Hannawa Annegret; Kostova Zlatina; Rosset Damian;


Abstract

Medical errors have attracted significant interdisciplinary attention over the past two decades. Until recently, studies have primarily focused on conceptualizations, causes, and the prevention of medical mistakes. A few years ago, this focus shifted toward an examination of competent responses to critical events. In Switzerland, these efforts are reflected in the implementation of anonymous critical incident reporting systems (CIRS), which encourage institutions to learn from the human factors that contribute to medical mistakes (Scheidegger, 2005). Recent investigations in the United States have evidenced a disclosure gap, implying that phy-sicians often fail to meet patients’ disclosure expectations. Although studies have empirically identified a set of messages physicians should communicate during error disclosures, they are likely flawed because the investigations that generated them had severe methodological limita-tions. For example, most of the study designs relied on patient samples, used correlational data, and failed to utilize predictive frameworks. Furthermore, most existing studies to this date have predominantly examined informational disclosure contents, neglecting important relational messages that can influence patients’ interpretations of the error disclosure content. The proposed project is designed to fill these voids. It integrates communication competence theory (Spitzberg & Cupach, 2002), a relational message perspective (Burgoon & Hale, 1987), and typologies of symptomology and coping tactics (Spitzberg, 2002) into a conceptualization of Medical Error Disclosure Competence (MEDC). Based on these theoretical frameworks, it pro-poses a program of studies that systematically conceptualizes and operationalizes MEDC as a construct that entails three components: (1) Medical error disclosure skills (MEDS), (2) patient-perceived medical error disclosure appropriateness (PMEDA), and (3) medical error disclosure effectiveness (MEDE), which is measured by the effects of MEDS and PMEDA on theorized dis-closure outcomes. Thus, the proposed studies reflect a systematic, theoretically organized em-pirical inquiry that fills an important gap in the current international literature on critical events.This project proposal involves three empirical data collections in two stages. The first stage de-velops and empirically validates a theoretically grounded, comprehensive operationalization of medical error disclosure skills (MEDS) and their patient-perceived appropriateness (PMEDA). Two studies will be conducted to achieve this goal. The first study derives qualitative empirical data from eight focus groups with patients to identify the communicative elements that consti-tute MEDS. The second study aims to validate the focus groups’ conceptualizations of the MEDS criteria in a controlled experiment, measuring the PMEDA in respect to eight manipulated video vignettes. The second stage of the proposed research program aims to measure the effectiveness (MEDE) of PMEDA in a retrospective survey design. Assuming a successful validation of the disclosure skills construct and confirmed causal associations among the three hypothesized components of MEDC, this project lays the theoretical groundwork for an empirically based error disclosure intervention with the potential to improve patients’ and physicians’ health and quality of life.
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