Health professionals' perceptions and experiences of open disclosure: a systematic review of qualitative evidence

BACKGROUND Open disclosure in healthcare refers to an open, consistent approach to communicating with patients following an adverse event that has occurred during the course of their care. Internationally, there is a move towards open disclosure as a standard for professional health care practice. Open disclosure promotes a high level of quality of healthcare and patient safety, as transparency and discussion about errors builds trust between the patient, the health professional and the health system. However, studies suggest that there is a significant gap between the high level of endorsement of open disclosure of medical errors to patients by health professionals in principle and the actual level experienced by patients. OBJECTIVES The objective of this systematic review was to synthesize the best available qualitative evidence exploring health professionals’ perceptions and experiences of the barriers and facilitators of open disclosure of medical errors to patients. INCLUSION CRITERIA POPULATION OF INTEREST This review considered studies that included registered health professionals working in the primary, secondary and tertiary settings. This review excluded student health professionals and excluded study settings involving alternative and complementary therapy. PHENOMENA OF INTEREST This review considered studies that investigated health professionals’ perceptions and experiences of open disclosure of medical errors to patients. TYPES OF STUDIES This review considered original qualitative research including phenomenology, ethnography and grounded theory. CONTEXT This review considered studies that focused on qualitative data based on health professionals’ perceptions and experience of open disclosure of medical errors to patients. SEARCH STRATEGY The search strategy aimed to find both published and unpublished studies in the English language between 1995 and September 2012. The following sources were searched: PubMed, CINAHL, PsycINFO, Embase, Mednar, World Wide Science, ProQuest Dissertations and Theses Database. METHODOLOGICAL QUALITY Qualitative papers selected for retrieval were assessed by two independent reviewers for methodological validity prior to inclusion in the review, using a standardized critical appraisal instrument from the Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI). DATA COLLECTION Qualitative data was extracted from papers included in the review using the standardized data extraction tool from JBI-QARI. DATA SYNTHESIS Qualitative research findings were pooled using JBI-QARI; the process of meta-aggregation involved pooling of findings into categories on the basis of similarity of meaning. These categories were then subjected to a meta-synthesis to produce a comprehensive set of synthesized findings. RESULTS Following the search, a total of 41 full text papers were retrieved; of which 22 studies matched the eligibility criteria for the review. Following critical appraisal by two reviewers, nine papers were included. A total of 131 findings were extracted and aggregated into 33 categories. A final meta-synthesis generated two key findings. Barriers to open disclosure included personal fears, professional factors, error factors, patient factors, cultural factors, system-related and uncertainties. Facilitators to open disclosure included professional factors, error factors, system factors, cultural factors and personal needs. CONCLUSIONS The factors impacting on open disclosure by health professionals are varied and complex. Guidelines aim to improve the current practice of open disclosure, to establish a consistent approach to facilitate the management of open disclosure in a timely, supportive and effective manner for patients, family members and all health professionals. Efforts to remove the barriers and promote the facilitators should continue through effective education, role modeling and promoting cultures of honesty and transparency. The views and experiences of patients and their families regarding open disclosure impacts on the success or failure of an open disclosure process. Therefore, a systematic review on the patients’ perspective of open disclosure to investigate if open disclosure is meeting the needs of patients and their family members would be ideal to further inform policy and decision makers to work towards ensuring the disclosure of medical errors is patient-centered.Jacinta Byrth, Edoardo Aromatari