Hobgood Cherri, Tamayo-Sarver Joshua H, Elms Andrew, Weiner Bryan
Department of Emergency Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.
Pediatrics. 2005 Dec;116(6):1276-86. doi: 10.1542/peds.2005-0946.
No data exist on parental preferences for disclosure, reporting, and seeking legal action after errors in the care of their children are disclosed. This study examined parental preferences for error disclosure and reporting; responses to error disclosure; and preferences and responses by race/ethnicity, gender, age, and insurance.
A 4-scenario survey instrument portraying a range of medical error was provided to a convenience sample of parents who presented with children to an emergency department. Parents were asked to categorize the error, express preferences for disclosure and reporting, and then report how they expected to respond with and without disclosure. Basic demographics were collected also. Bivariate analyses of demographics were performed with Fisher's exact tests, analysis of scenario responses was performed with Somers' D, and the independent effects of the study variables were assessed with a generalized estimating equation.
Research assistants approached 661 parents; 499 participated (75% response rate). Of all scenarios presented to the parents, they judged 54% of the scenarios as severe, 99% wanted disclosure, 39% wanted the error reported to a disciplinary body, and 36% were less likely to seek legal action if the error was disclosed by the physician. In multivariate modeling, severity was associated with desire for disclosure, reporting, and change in likelihood of legal action with disclosure.
Regardless of severity, parents want to be informed of error. Educational interventions to improve error disclosure should emphasize the uniformity of parental preferences for disclosure, reporting, and the decreased likelihood of legal action when errors are disclosed than if discovered through other means.
关于儿童医疗护理出现差错后，父母对于差错披露、报告及采取法律行动的偏好，目前尚无相关数据。本研究调查了父母对于差错披露和报告的偏好；对差错披露的反应；以及不同种族/族裔、性别、年龄和保险类型的偏好及反应。
向带孩子前往急诊科的父母便利样本提供一份描绘一系列医疗差错的包含4种场景的调查问卷。要求父母对差错进行分类，表达对披露和报告的偏好，然后报告他们在有差错披露和无差错披露情况下的预期反应。同时收集基本人口统计学数据。对人口统计学数据进行双变量分析，采用费舍尔精确检验；对场景反应进行分析，采用索莫斯D统计量；使用广义估计方程评估研究变量的独立效应。
研究助手接触了661名父母；499人参与（回应率75%）。在向父母展示的所有场景中，他们将54%的场景判定为严重，99%希望披露，39%希望将差错报告给纪律机构，36%表示如果医生披露了差错，他们采取法律行动的可能性会降低。在多变量建模中，严重程度与披露意愿、报告意愿以及差错披露后采取法律行动可能性的变化相关。
无论差错严重程度如何，父母都希望被告知差错情况。旨在改善差错披露的教育干预措施应强调，父母对于披露、报告的偏好具有一致性，并且差错披露后采取法律行动的可能性低于通过其他方式发现差错时的可能性。
