Improving disclosure of medical errors: Including patients and family members in the disclosure process

Over the last decade, adverse events and medical errors have become a main focus of interest for the standards of quality and safety in the U.S. healthcare system (Weinstein & Henderson, 2009). Particularly when a medical error occurs, the disclosure of medical errors and its practices have become a focal point of the healthcare process. Patients and family members who have experienced a medical error might be able to provide knowledge and insight on how to improve the disclose process. However, patient and family member are not typically involved in the disclosure process, thus their experiences go unnoticed. ^ The purpose of this research was to explore how best to include patients and family members in the disclosure process regarding a medical error. The research consisted of 28 qualitative interviews from three stakeholder groups: Hospital Administrators, Clinical Service Providers, and Patients and Family Members. They were asked for their ideas and suggestions on how best to include patients and family members in the disclosure process. Framework Analysis was used to analyze this data and find prevalent themes based on the primary research question. A secondary aim was to index categories created based on the interviews that were collected. Data was used from the Texas Disclosure and Compensation Study with Dr. Eric Thomas as the Principal Investigator. Full acknowledgement of access to this data is given to Dr. Thomas. ^ The themes from the research revealed that each stakeholder group was interested and open to including patients and family members in the disclosure process and that the disclosure process should not be a "one-way" avenue. The themes gave many suggestions regarding how to best include patients and family members in the disclosure process of a medical error. Secondary aims revealed several ways to assess the ideas and suggestion given by the stakeholders. Overall, acceptability of getting the perspective of patients and family members was the most common theme. Comparison of each stakeholder group revealed that including patients and family members would be beneficial to improving hospital disclosure practices. ^ Conclusions included a list of recommendations and measureable appropriate strategies that could provide hospital with key stakeholders insights on how to improve their disclosure process. Sharing patients and family members experience with healthcare providers can encourage a shift in culture where patients are valued and active in participating in hospital practices. To my knowledge, this research is the very first of its kind and moves the disclosure process conversation forward in a patient-family member inclusion direction that will assist in improving disclosure practices. Future research should implement and evaluate the success of the various inclusion strategies.^

Predicting smokeless tobacco cessation in a blue -collar population

The use of smokeless tobacco products is undergoing an alarming resurgence in the United States. Several national surveys have reported a higher prevalence of use among those employed in blue-collar occupations. National objectives now target this group for health promotion programs which reduce the health risks associated with tobacco use.^ Drawn from a larger data set measuring health behaviors, this cross-sectional study tested the applicability of two related theories, the Theory of Reasoned Action (TRA) and the Theory of Planned Behavior (TPB), to smokeless tobacco (SLT) cessation in a blue-collar population of gas pipeline workers. In order to understand the determinants of SLT cessation, measures were obtained of demographic and normative characteristics of the population and specific constructs. Attitude toward the act of quitting (AACT) and subjective norm (SN) are constructs common to both models, perceived behavioral control (PBC) is unique to the TPB, and the number of past quit attempts is not contained in either model. In addition, a self-reported measure was taken of SLT use at two-month follow-up.^ The study population was comprised of all male SLT users who were field employees in a large gas pipeline company with gas compressor stations extending from Texas to the Canadian border. At baseline, 199 employees responded to the SLT portion of the survey, 118 completed some portion of the two-month follow-up, and 101 could be matched across time.^ As hypothesized, significant correlations were found between constructs antecedent to AACT and SN, although crossover effects occurred. Significant differences were found between SLT cessation intenders and non-intenders with regard to their personal and normative beliefs about quitting as well as their outcome expectancies and motivation to comply with others' beliefs. These differences occurred in the expected direction, with the mean intender score consistently higher than that of the non-intender.^ Contrary to hypothesis, AACT predicted intention to quit but SN did not. However, confirmatory of the TPB, PBC, operationalized as self-efficacy, independently contributed to the prediction of intention. Statistically significant relationships were not found between intention, perceived behavioral control, their interactive effects, and use behavior at two-month follow-up. The introduction of number of quit attempts into the logistic regression model resulted in insignificant findings for independent and interactive effects.^ The findings from this study are discussed in relation to their implications for program development and practice, especially within the worksite. In order to confirm and extend the findings of this investigation, recommendations for future research are also discussed. ^