Being open about unanticipated problems in health care: the challenges of uncertainties

作者：Birks Y, Entwistle V, Harrison R, Bosanquet K, Watt I, Iedema R · 发表于：Journal of health services research & policy · 年份：2015 · DOI：10.1177/1355819614558100 · 研究领域：Attitude of Health Personnel、Communication、Truth Disclosure、England、Family、Health Personnel、Health Services Research、Humans、Policy、State Medicine、Uncertainty

Discussion of unanticipated problems in care with patients and their families ('open disclosure') is now widely advocated. Despite international efforts and the introduction of a range of policies and guidance to promote such discussions, the expectations of policy makers and patients are often not matched in practice. We consider some reasons for the persistence of shortfalls in the occurrence and quality of open disclosure. We draw on research conducted to investigate the implementation of a 'Being open' policy in England, reflecting particularly on insights derived from interviews with health care professionals. Health care professionals were broadly supportive of the idea of open disclosure. Some expressed well-recognized concern about punishment and being blamed, but this did not appear to be the main driver of their communication practices. Their accounts of what happened around particular problems in health care indicated that they brought a complex range of considerations to bear on questions of whether and how these were discussed with patients and relatives. Guidance about open disclosure based on assessments of levels of harm to patients can complicate and perhaps distort health care professionals' approaches, particularly when the extent and/or cause of harm was uncertain. Health care professionals who engage in open disclosure must be able to negotiate appropriate ways through complex and sensitive discussions. The responses of patients and relatives are not alwa...