Wu Albert W, Boyle Dennis J, Wallace Gordon, Mazor Kathleen M
Johns Hopkins University, Bloomberg School of Public Health , Baltimore, MD, USA.
University of Colorado School of Medicine, Denver Health Medical Center Denver , CO, USA.
J Public Health Res. 2013 Dec 1;2(3):e32. doi: 10.4081/jphr.2013.e32.
There is consensus that physicians, health professionals and health care organizations should discuss harm that results from health care delivery (adverse events), including the reasons for harm, with patients and their families. Thought leaders and policy makers in the USA and Canada support this goal. However, there are gaps in both countries between patients and physicians in their attitudes about how errors should be handled, and between disclosure policies and their implementation in practice. This paper reviews the state of disclosure policy and practice in the two countries, and the barriers to full disclosure. Important barriers include fear of consequences, attitudes about disclosure, lack of skill and role models, and lack of peer and institutional support. The paper also describes the problem of the second victim, a corollary of disclosure whereby health care workers are also traumatized by the same events that harm patients. The presence of multiple practical and personal barriers to disclosure suggests the need for a comprehensive solution directed at multiple levels of the health care system, including health departments, institutions, local managers, professional staff, patients and families, and including legal, health system and local institutional support. At the local level, implementation could be based on a translating-evidence-into-practice framework. Applying this framework would involve the formation of teams, training, measurement and identification of local barriers to achieving universal disclosure of adverse events. Significance for public healthIt is inevitable that some patients will be harmed rather than helped by health care. There is consensus that patients and their families must be told about these harmful events. However, there are gaps between patient and physician attitudes about how errors should be handled, and between disclosure policies and their implementation. There are important barriers that impede disclosure, including fear of consequences, attitudes about disclosure, lack of skill, and lack of institutional support. A related problem is that of the second victim, whereby health care workers are traumatized by the same harmful events. This can impair their performance and further compromise safety. The problem is unlikely to be solved by focusing solely on increasing disclosure. A comprehensive solution is needed, directed at multiple levels of the health care system, including health departments, institutions, local managers, professional staff, patients and families, and including legal, health system and local institutional support.
人们普遍认为，医生、卫生专业人员和医疗保健机构应与患者及其家属讨论医疗保健服务所导致的伤害（不良事件），包括伤害产生的原因。美国和加拿大的思想领袖及政策制定者都支持这一目标。然而，在这两个国家，患者和医生在如何处理医疗差错的态度上存在差距，在信息披露政策及其实际执行之间也存在差距。本文回顾了这两个国家信息披露政策与实践的现状以及全面披露的障碍。重要障碍包括对后果的担忧、对信息披露的态度、缺乏技能和榜样，以及缺乏同行和机构支持。本文还描述了“第二受害者”问题，这是信息披露的一个必然结果，即医护人员也会因伤害患者的同一事件而受到创伤。存在多种阻碍信息披露的实际和个人障碍，这表明需要针对医疗保健系统的多个层面制定全面解决方案，包括卫生部门、机构、地方管理人员、专业人员、患者及其家属，同时还需要法律、卫生系统和地方机构的支持。在地方层面，实施可以基于一个将证据转化为实践的框架。应用这个框架将涉及组建团队、培训、衡量以及识别在实现不良事件全面披露方面的地方障碍。对公共卫生的意义不可避免地，一些患者会因医疗保健而受到伤害而非得到帮助。人们普遍认为必须告知患者及其家属这些有害事件。然而，患者和医生在如何处理差错的态度上存在差距，在信息披露政策及其执行之间也存在差距。存在阻碍信息披露的重要障碍，包括对后果的担忧、对信息披露的态度、缺乏技能以及缺乏机构支持。一个相关问题是“第二受害者”问题，即医护人员会因同样的有害事件而受到创伤。这可能会影响他们的工作表现并进一步危及安全。仅专注于增加信息披露不太可能解决这个问题。需要一个全面的解决方案，针对医疗保健系统的多个层面，包括卫生部门、机构、地方管理人员、专业人员、患者及其家属，同时还需要法律、卫生系统和地方机构的支持。
