Gallagher Thomas H, Cook Andrea J, Brenner R James, Carney Patricia A, Miglioretti Diana L, Geller Berta M, Kerlikowske Karla, Onega Tracy L, Rosenberg Robert D, Yankaskas Bonnie C, Lehman Constance D, Elmore Joann G
Department of Medicine, and Division of General Internal Medicine, University of Washington, 4311 11th Ave NE, Suite 230, Seattle, WA 98105, USA.
Radiology. 2009 Nov;253(2):443-52. doi: 10.1148/radiol.2532082320. Epub 2009 Aug 25.
To assess radiologists' attitudes about disclosing errors to patients by using a survey with a vignette involving an error interpreting a patient's mammogram, leading to a delayed cancer diagnosis.
We conducted an institutional review board-approved survey of 364 radiologists at seven geographically distinct Breast Cancer Surveillance Consortium sites that interpreted mammograms from 2005 to 2006. Radiologists received a vignette in which comparison screening mammograms were placed in the wrong order, leading a radiologist to conclude calcifications were decreasing in number when they were actually increasing, delaying a cancer diagnosis. Radiologists were asked (a) how likely they would be to disclose this error, (b) what information they would share, and (c) their malpractice attitudes and experiences.
Two hundred forty-three (67%) of 364 radiologists responded to the disclosure vignette questions. Radiologists' responses to whether they would disclose the error included "definitely not" (9%), "only if asked by the patient" (51%), "probably" (26%), and "definitely" (14%). Regarding information they would disclose, 24% would "not say anything further to the patient," 31% would tell the patient that "the calcifications are larger and are now suspicious for cancer," 30% would state "the calcifications may have increased on your last mammogram, but their appearance was not as worrisome as it is now," and 15% would tell the patient "an error occurred during the interpretation of your last mammogram, and the calcifications had actually increased in number, not decreased." Radiologists' malpractice experiences were not consistently associated with their disclosure responses.
Many radiologists report reluctance to disclose a hypothetical mammography error that delayed a cancer diagnosis. Strategies should be developed to increase radiologists' comfort communicating with patients.
通过一项包含病例 vignette（涉及对患者乳房 X 光检查结果解读错误导致癌症诊断延迟）的调查，评估放射科医生向患者披露错误的态度。
我们在七个地理位置不同的乳腺癌监测联盟站点对 364 名放射科医生进行了一项经机构审查委员会批准的调查，这些放射科医生在 2005 年至 2006 年期间解读乳房 X 光检查结果。放射科医生收到一个病例 vignette，其中对比筛查乳房 X 光片的顺序放错，导致一名放射科医生得出钙化数量在减少的结论，而实际上钙化数量在增加，从而延迟了癌症诊断。放射科医生被问及：（a）他们披露此错误的可能性有多大；（b）他们会分享哪些信息；（c）他们的医疗事故态度和经历。
364 名放射科医生中有 243 名（67%）回复了关于披露病例 vignette 的问题。放射科医生对于是否会披露错误的回答包括“绝对不会”（9%）、“只有在患者询问时才会”（51%）、“可能会”（26%）和“肯定会”（14%）。关于他们会披露的信息，24%的人会“不再向患者透露任何信息”，31%的人会告诉患者“钙化更大了，现在怀疑是癌症”，30%的人会说“在您上次乳房 X 光检查中钙化可能增加了，但当时它们的外观不像现在这么令人担忧”，15%的人会告诉患者“在解读您上次乳房 X 光检查时发生了错误，钙化数量实际上增加了，而不是减少了”。放射科医生的医疗事故经历与他们的披露回复没有始终如一的关联。
许多放射科医生表示不愿披露导致癌症诊断延迟的假设性乳房 X 光检查错误。应制定策略以提高放射科医生与患者沟通时的舒适度。
