Head of Safety and Learning, Health Information and Quality Authority, George's Court, George's Lane, Smithfield, Dublin 7, Ireland.
Int J Qual Health Care. 2010 Oct;22(5):371-9. doi: 10.1093/intqhc/mzq042. Epub 2010 Aug 13.
Adverse events are increasingly recognized as a source of harm to patients. When such harm occurs, problems arise in communicating the situation to patients and their families. We reviewed the literature on disclosure across individual and international boundaries, including patients', healthcare professionals' and other stakeholders' perspectives in order to ascertain how the needs of all groups could be better reconciled.
A systematic review of the literature was carried out using the search terms 'patient safety', 'medical error', 'communication', 'clinicians', 'healthcare professionals' and 'disclosure'. All articles relating to either patients' or healthcare professionals' experiences or attitudes toward disclosure were included.
Both patients and healthcare professionals support the disclosure of adverse events to patients and their families. Patients have specific requirements including frank and timely disclosure, an apology where appropriate and assurances about their future care. However, research suggests that there is a gap between ideal disclosure practice and reality. Although healthcare is delivered by multidisciplinary teams, much of the research that has been conducted has focused on physicians' experiences. Research indicates that other healthcare professionals also have a role to play in the disclosure process and this should be reflected in disclosure policies.
This comprehensive review, which takes account of the perspectives of the patient and members of the care team across multiple jurisdictions, suggests that disclosure practice can be improved by strengthening policy and supporting healthcare professionals in disclosing adverse events. Increased openness and honesty following adverse events can improve provider-patient relationships.
不良事件越来越被认为是对患者造成伤害的一个原因。当这种伤害发生时，在向患者及其家属传达情况时就会出现问题。我们回顾了跨越个人和国际边界的披露文献，包括患者、医疗保健专业人员和其他利益相关者的观点，以确定如何更好地协调所有群体的需求。
使用“患者安全”、“医疗错误”、“沟通”、“临床医生”、“医疗保健专业人员”和“披露”等术语对文献进行了系统回顾。所有与患者或医疗保健专业人员对披露的经验或态度有关的文章都被包括在内。
患者和医疗保健专业人员都支持向患者及其家属披露不良事件。患者有具体的要求，包括坦诚和及时的披露、适当的道歉以及对未来护理的保证。然而，研究表明，理想的披露实践与现实之间存在差距。尽管医疗保健是由多学科团队提供的，但许多已经进行的研究都集中在医生的经验上。研究表明，其他医疗保健专业人员在披露过程中也有作用，这应该反映在披露政策中。
这项全面的综述考虑了来自多个司法管辖区的患者和护理团队成员的观点，表明通过加强政策和支持医疗保健专业人员披露不良事件，可以改善披露实践。在发生不良事件后增加开放性和诚实性可以改善医患关系。
