Strategies for Disclosing an Unanticipated Outcome
Disclosing an unanticipated outcome to a patient and/or their family members can be daunting and stressful. Healthcare providers may worry about the possibility of litigation, damage to their reputations, workplace consequences, or even just upsetting patients/families.
In recent years, however, many professional associations and organizations have endorsed the concept of disclosure as part of patient-centered care, and studies show that communication-and-response techniques that include early disclosure may reduce malpractice suits and litigation costs.1
Preparing for a disclosure conversation might help reduce some of the anxiety and uncertainty that healthcare providers feel in these situations. The following tips for disclosing an unanticipated outcome can help frame the conversation and provide useful reminders about essential disclosure information.
- Arrange to have the discussion in a quiet, comfortable location that is conducive to privacy. Avoid distractions such as staff interruptions, phone calls, texts, etc. Sit during the discussion, if possible.
- Use compassion, empathy, and good communication skills, including mindfulness of body language and eye contact.
- Use "I" instead of "we," and speak slowly using terms the patient/family will understand.
- Clearly communicate the facts as they are known at the time of the disclosure, such as the nature of the event, the proximal cause, the known consequences, and actions that are being taken to address the consequences.
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Offer an apology for the occurrence of the event if all of the facts and causes are not known. Offer an apology for the error if an obvious error occurred or a full investigation reveals that an error occurred.
- Acknowledge the emotions observed in the patient/family. For example, "This must be very frightening (or upsetting, scary, overwhelming, sad, difficult, etc.) for you." Avoid statements like "I know how you feel."
- Explain the plan of action relative to either continued investigation or changes being implemented to prevent similar future events.
- Pause periodically to ask whether the patient/family has questions or whether any information needs clarification.
- Avoid absolute statements, commitments, or assurances, such as "We'll take care of everything" or "You don't need to worry." These types of statements might seem dismissive and can be difficult to honor.
- Offer to help with any additional counseling needs, and provide the patient/family with the names of agencies they can contact to address their concerns or complaints.
- Provide assurance that as more information becomes available, it will be shared with the patient/family.
- Identify a contact person who will have primary responsibility for continued follow-up with the patient/family. This is a critical element in restoring trust and confidence.
- Establish a date and time for follow-up communication as more information becomes available based on developments from investigating the event, changes in the patient's condition, or modifications in the treatment plan.
Be mindful that the disclosure may not be well received, and the encounter could potentially be volatile. Further, the existing clinical relationships might not be sustainable. If so, or if the patient/family requests a different provider, create a plan for transitioning the patient's care.
For more information about acknowledging unanticipated outcomes, preparing for disclosure conversations, and following up after a disclosure conversation, see MedPro's Disclosure of Unanticipated Outcomes guideline.
Endnote
1 Agency for Healthcare Research and Quality. (2019, September). Patient safety primer: Error disclosure. Patient Safety Network. Retrieved from https://psnet.ahrq.gov/primers/primer/2
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