Disclosure Training Research Articles

The Role of Paramedics in Disclosure of Patient Safety Incidents: A Mixed Methods Study

ObjectiveCritical care transport is a high-risk environment ripe for patient safety incidents (PSIs). Disclosure is the process by which a PSI is communicated to a patient or substitute decision maker. Little is known on paramedic perceptions on disclosure PSIs. This study evaluated the impact of a disclosure training program on the perceptions of paramedics on disclosing PSIs. MethodsThis was a before-and-after mixed methods survey study on paramedic disclosure training at Ornge, the provincial critical care transport organization for Ontario, Canada. A paramedic disclosure training program was implemented at Ornge between 2020 and 2022. All paramedics were eligible for participation through pre- and posttraining surveys. ResultsIn total, 54 and 69 paramedics completed the pretraining and posttraining surveys, respectively, representing 25% to 30% of all active paramedics. All of the paramedics (100%) expressed a moral and professional responsibility to disclose PSIs. All paramedics felt disclosure training was somewhat to extremely useful. After training, more paramedics felt comfortable disclosing PSIs, and more paramedics felt disclosure could occur at the time of transport. ConclusionA training program on PSIs can improve paramedics’ perceptions on disclosure. This study shows its feasible for paramedics to feel comfortable and participate in disclosure of PSIs within a critical care environment.

Experiences and Perceptions of Healthcare Stakeholders in Disclosing Errors and Adverse Events to Historically Marginalized Patients.

We sought to assess the experiences and perceptions of healthcare stakeholders involved in the response to historically marginalized patients who have been harmed in healthcare. We investigated the challenges in disclosing errors and adverse events and the types of tools and resources that would better address the needs of historically marginalized patient populations. We conducted separate focus groups with two healthcare stakeholder groups: (1) frontline clinicians directly involved in the clinical care of historically marginalized patients and (2) risk and patient safety professionals involved in the hospital response to care breakdowns. We conducted an inductive analysis of the qualitative data to identify thematic clusters. We interviewed 7 clinicians and 5 risk safety professionals, with a total sample size of 12 participants. Participants shared multilevel challenges in responding to historically marginalized patients after harm (system-, organizational-, and patient-level), such as fragmentation of care, lack of standardized protocols, and patient mistrust. Participants also identified their desired tools and resources for disclosure to meet the needs of historically marginalized patients, which included culturally appropriate toolkits, disclosure training, and the inclusion of multidisciplinary healthcare team members in the disclosure process. Our results suggest that multiple interventions will be needed to achieve the goal of prompt disclosure of errors and adverse events across all populations engaged in health care. Future studies should investigate the perspectives of historically marginalized patients and their family members on how error and adverse event disclosure conversations should unfold.

Predictors of perceived poor social support status of pregnant women attending antiretroviral therapy clinics in south west Ethiopia, 2021

BackgroundTo improve pregnancy outcomes, a pregnant mother living with HIV/AIDS requires a high level of social and emotional support. However, women from low-income countries were subjected to low social support status despite adequate counseling and health messages to increase their social support. Therefore, this study aimed to investigate the predictors of the perceived poor social support status among pregnant women attending ART clinics in Southwest Ethiopia. MethodsA hospital-based cross-sectional study with consecutive sampling was conducted to enroll 265 pregnant women on antiretroviral therapy (ART) from December 1 to 30, 2021. The data were collected using an interviewer-administered questionnaire. Epidata was used for data entry and analyzed after it was exported to a statistical package for the social sciences. Binary logistic regression was used and the level of significance was declared at P-value <0.05 using Adjusted odds ratio at 95% CI after candidate variables were identified in binary logistic regression at a P-value of <0.25. ResultsFinding from the study figured out that low level of poor social support is found to be 47.2%. Study revealed that income level[AOR = 5.1 95% CI [1.9,13.6]], disclosure status[AOR: 1.9 95% CI [1.1,3.3]], unwanted pregnancy [AOR = 2.3 CI; [ 1.4,3.9]], and low adherence level[AOR: 2.1 95% CI [1.1,3.1]] were strong predictors. ConclusionThis study identified high levels of poor social support. Increasing access to information education and communications focusing on stigma, disclosure & refresher training that boosts the counseling skills of health care providers to enhance adherence level is strongly recommended.

Disclosing medical errors: how do we prepare our students?

PurposeDespite patient safety initiatives, medical errors remain common and devastating. Disclosing errors is not only ethical, but also promotes restoration of the doctor-patient relationship. However, studies show active avoidance of error disclosure and the need for explicit training. In the South African setting, sparse information exists in terms of undergraduate medical training in error disclosure. To address this knowledge gap, the training of error disclosure in an undergraduate medical programme was examined, against the background of the available literature. The objective was to formulate a strategy to improve error disclosure teaching and practice, with the goal of improving patient care.MethodsFirstly, the literature was reviewed regarding the training of medical error disclosure. Secondly, the undergraduate medical training in error disclosure was probed, by looking at the pertinent findings from a broader study on undergraduate communication skills training. The design of the study was descriptive and cross-sectional. Anonymous questionnaires were distributed to all fourth- and fifth-year undergraduate medical students. Data were predominantly analysed quantitatively. Open-ended questions were analysed qualitatively using grounded theory coding.ResultsOut of 132 fifth-year medical students, 106 participated (response rate 80.3%), while 65 out of 120 fourth-year students participated (response rate 54.2%). Of these participants, 48 fourth-year students (73.9%) and 64 fifth-year students (60.4%) reported infrequent teaching in the disclosure of medical errors. Almost half of the fourth-year students (49.2%) considered themselves novices in error disclosure, while 53.3% of fifth-year students rated their ability as average. According to 37/63 (58.7%) fourth-year students and 51/100 (51.0%) fifth-year students, senior doctors seldom or never modelled patient-centred care in the clinical training setting. These results resonated with the findings of other studies that showed lack of patient-centredness, as well as insufficient training in error disclosure, with resultant low confidence in this skill.ConclusionThe study findings confirmed a dire need for more frequent experiential training in the disclosure of medical errors, in undergraduate medical education. Medical educators should view errors as learning opportunities to improve patient care and model error disclosure in the clinical learning environment.

Effects of Practicing With and Obtaining Crowdsourced Feedback From the Video-Based Communication Assessment App on Resident Physicians' Adverse Event Communication Skills: Pre-post Trial.

BackgroundUS residents require practice and feedback to meet Accreditation Council for Graduate Medical Education mandates and patient expectations for effective communication after harmful errors. Current instructional approaches rely heavily on lectures, rarely provide individualized feedback to residents about communication skills, and may not assure that residents acquire the skills desired by patients. The Video-based Communication Assessment (VCA) app is a novel tool for simulating communication scenarios for practice and obtaining crowdsourced assessments and feedback on physicians’ communication skills. We previously established that crowdsourced laypeople can reliably assess residents’ error disclosure skills with the VCA app. However, its efficacy for error disclosure training has not been tested.ObjectiveWe aimed to evaluate the efficacy of using VCA practice and feedback as a stand-alone intervention for the development of residents’ error disclosure skills.MethodsWe conducted a pre-post study in 2020 with pathology, obstetrics and gynecology, and internal medicine residents at an academic medical center in the United States. At baseline, residents each completed 2 specialty-specific VCA cases depicting medical errors. Audio responses were rated by at least 8 crowdsourced laypeople using 6 items on a 5-point scale. At 4 weeks, residents received numerical and written feedback derived from layperson ratings and then completed 2 additional cases. Residents were randomly assigned cases at baseline and after feedback assessments to avoid ordinal effects. Ratings were aggregated to create overall assessment scores for each resident at baseline and after feedback. Residents completed a survey of demographic characteristics. We used a 2×3 split-plot ANOVA to test the effects of time (pre-post) and specialty on communication ratings.ResultsIn total, 48 residents completed 2 cases at time 1, received a feedback report at 4 weeks, and completed 2 more cases. The mean ratings of residents’ communication were higher at time 2 versus time 1 (3.75 vs 3.53; P<.001). Residents with prior error disclosure experience performed better at time 1 compared to those without such experience (ratings: mean 3.63 vs mean 3.46; P=.02). No differences in communication ratings based on specialty or years in training were detected. Residents’ communication was rated higher for angry cases versus sad cases (mean 3.69 vs mean 3.58; P=.01). Less than half of all residents (27/62, 44%) reported prior experience with disclosing medical harm to patients; experience differed significantly among specialties (P<.001) and was lowest for pathology (1/17, 6%).ConclusionsResidents at all training levels can potentially improve error disclosure skills with VCA practice and feedback. Error disclosure curricula should prepare residents for responding to various patient affects. Simulated error disclosure may particularly benefit trainees in diagnostic specialties, such as pathology, with infrequent real-life error disclosure practice opportunities. Future research should examine the effectiveness, feasibility, and acceptability of VCA within a longitudinal error disclosure curriculum.

EFFECT OF CAREGIVERS’ HIV DISCLOSURE TRAINING ON PEDIATRIC HIV STATUS DISCLOSURE AND ART ADHERENCE IN HOMABAY COUNTY, KENYA: A COMPARATIVE LONGITUDINAL STUDY.

Purpose: The study objective was to establish the effect of HIV disclosure training on children’s HIV status disclosure and on ART adherence.&#x0D; Methodology:This was a comparative longitudinal study in ten health facilities in Homabay County with 860 non-disclosed HIV positive children on ART aged 6-10 years between 2016 to 2018.A randomized sample of 430 caregivers was trained on HIV status disclosure while another 430 caregivers not trained. All caregivers then performed HIV status disclosure to their HIV positive children, and children’s disclosure and adherence to ART status established. We used semi structured questionnaires, FGDs and KIIs for data collection and IBM SPSS version 20, logistic regression, chi-square and Nvivo software for data analysis.&#x0D; Results: Mean child age was 8 years for both groups, 35 and 37years for caregivers in control and intervention respectively. 409(95%) interventional caregivers had good overall knowledge on disclosure process compared to control (116(27%). Longitudinal viral suppression increased in both groups; intervention group 345(80.2%) to 384(90.1%), control (279(64.9%) to 296(70.1%). Trained caregivers were 2 times (OR-2.369) likely to disclose children’s HIV status. Disclosure training had significant effect (P&lt;0.05) on child’s adherence. Children of trained caregivers were nine times (OR-9.145) likely to have good adherence. Level of education of caregivers (p=0. 035) and knowledge of care givers on the disclosure process (p=0.05) were significantly associated with ART adherence. Disclosure knowledge and lack of disclosure skills were cited in FGDs and KIIs as the major facilitator and barrier to disclosure and ART adherence respectively.&#x0D; Unique contribution to theory, practice and policy: The findings provide evidence – based interventions that will guide caregivers, the Ministry of Education and Ministry of Health on how and when to disclose to a child his own HIV status. Disclosure culminates into behavior change which is anticipated to enhance the reduction in the spread of HIV to the next generation and it is one way of sustaining the fight against HIV and AIDS.The study recommends all children in the age bracket of 6-10 years be disclosed to their own HIV status in order to increase their level of adherence to ART.

The emotional burden of caregiving for patients with cirrhosis.

Caregivers for patients with cirrhosis face immense physical and psychological strain that negatively impact quality of life and ability to care for oneself. The aim is to explore the caregiver experience for patients with cirrhosis, identify prominent stressors, and understand the multidimensional contributors to caregiver burden, to help tailor effective interventions. The caregivers of 25 patients with decompensated cirrhosis underwent semistructured in‐person interviews and completed written exercises targeting emotional disclosure or resilience training that were analyzed for dominant emotions and themes. Burden was quantified using the Zarit Burden Interview‐12 (ZBI, range 0–48), Distress Thermometer (0–10), and Caregiver Captivity Index (0–4). Quality of life was assessed with a visual analog scale (0–100). Median ZBI was moderate (14 [10–19]), as was distress (5 [2–7]), and captivity (2 [1–4]). Quality of life was fair (80 [70–85]). Dominant emotions included anxiety, guilt, fear, frustration, captivity, and resentment. Prominent themes included lack of time for self‐care, hierarchy of caregiver role, support from versus frustration with medical professionals, social support, spirituality and religion, and disease‐related restrictions. Hepatic encephalopathy, and need to follow strict nutrition and diet recommendations, are frequent sources of disease‐related caregiver burden. The health care system confers some degree of burden, especially when doubts arise regarding physician competence. Conclusion: Caregiver burden is significant. The impact of interventions to alleviate caregiver burden should be explored, so that their appreciated efforts do not have such detrimental effects on their quality of life.

Telling Children with Perinatal HIV About Their HIV Serostatus: Healthcare Workers' Practices and Barriers to Disclosing in a South African Rural Health District.

In South Africa, caregivers and healthcare workers (HCWs) lack confidence and skills to disclose to children with perinatal HIV (PHIV). Moreover, existing disclosure guidelines do not provide strategies on how to approach disclosure. Although the caregiver has been endorsed as a responsible person to disclose to the child, the involvement of HCWs in the process is critical. Yet research suggests that many HCWs are reluctant to perform disclosure. This study examines the involvement in, practices of, and barriers against HCWs’ disclosing to children with PHIV.Methods:We conducted 8 focus group discussions with a total of 51 HCWs comprising nurses, lay counsellors, social workers, and dieticians. The HCWs were selected from 23 health facilities in a rural South African health district by purposive sampling. Data were transcribed verbatim, and data analysis followed qualitative thematic analysis.Results:A high proportion of HCWs had no formal training in pediatric disclosure and some had never disclosed to children. Those who routinely disclosed approached disclosure as an ongoing process that unfolded over time. They ensured caregiver readiness as a necessary step in the disclosure process. The main barriers for HCWs to participate fully in the disclosure process were the lack of relevant disclosure guidelines, inadequate disclosure skills, and a shortage of skilled staff. Inadequate skills affected the confidence of the HCWs to disclose, while a lack of standardized disclosure guidelines and HCWs’ reliance on personal experience during disclosure resulted in confusion and uncertainty among them due to the inconsistencies in their approach to disclosure.Conclusion:This study confirms the urgent need to train HCWs to attain skills and confidence in disclosure. Training HCWs in standardized disclosure counselling would lead to an increase in the rate of disclosure to children. It is essential that the district adapt the disclosure guidelines to the local context for use in health facilities.

What Should Clinicians Tell Patients about Placebo and Nocebo Effects? Practical Considerations Based on Expert Consensus

Introduction: Clinical and laboratory studies demonstrate that placebo and nocebo effects influence various symptoms and conditions after the administration of both inert and active treatments. Objective: There is an increasing need for up-to-date recommendations on how to inform patients about placebo and nocebo effects in clinical practice and train clinicians how to disclose this information. Methods: Based on previous clinical recommendations concerning placebo and nocebo effects, a 3-step, invitation-only Delphi study was conducted among an interdisciplinary group of internationally recognized experts. The study consisted of open- and closed-ended survey questions followed by a final expert meeting. The surveys were subdivided into 3 parts: (1) informing patients about placebo effects, (2) informing patients about nocebo effects, and (3) training clinicians how to communicate this information to the patients. Results: There was consensus that communicating general information about placebo and nocebo effects to patients (e.g., explaining their role in treatment) could be beneficial, but that such information needs to be adjusted to match the specific clinical context (e.g., condition and treatment). Experts also agreed that training clinicians to communicate about placebo and nocebo effects should be a regular and integrated part of medical education that makes use of multiple formats, including face-to-face and online modalities. Conclusions: The current 3-step Delphi study provides consensus-based recommendations and practical considerations for disclosures about placebo and nocebo effects in clinical practice. Future research is needed on how to optimally tailor information to specific clinical conditions and patients’ needs, and on developing standardized disclosure training modules for clinicians.

A Call to Include Death Disclosure Training Alongside Cardiopulmonary Resuscitation Training

A Call to Include Death Disclosure Training Alongside Cardiopulmonary Resuscitation Training

Adverse Event Disclosure Training for Nursing Students: Peer Role-Play and Simulated Patients.

Background Simulation has proven valuable in nursing communication training, but there are limited studies comparing the effectiveness of different training methods, especially in the area of adverse event disclosure (AED) training. Therefore, this study aimed to examine the impact of two training methods, peer role-play (PRP) and simulated patients (SP) on the self-efficacy and performance of nursing students in AED in a simulated environment. Methods Forty-four nursing students participated. Students' self-efficacy toward AED was assessed using the pre/post-test method. Also, students' performance was evaluated after the simulation encounter. Results It showed a significant difference in self-efficacy between the groups. However, no significant difference emerged between the groups in performance. Conclusion This study provides a basis for comparison of these two methods in patient communication training. Educators should consider their resources and expected learning outcomes in designing the emotionally draining adverse event disclosure training.

Tell Me Straight: Teaching Residents to Disclose Adverse Events in Surgery

The purpose of this effort was to create an educational experience that provided learners a realistic disclosure experience and improved resident confidence discussing an adverse outcome with a patient and family. Residents practiced disclosing a surgical complication to a patient/family with simulated patients (SPs). We paired professional SPs with former patient SPs to present a realistic case. Junior residents were given extra training time before their disclosure of a laparoscopic cholecystectomy conversion to an open procedure; senior residents disclosed a bile duct injury. Residents rated pre and post-module confidence levels, and skills performance using the Disclosure of a Complication Checklist. 900-bed tertiary care hospital with surgical residency program and simulation center. General surgery residents (PGY 1-5). Eighteen residents participated in the disclosure module. Analysis of the medians and interquartile ranges of pre and post-module confidence scores showed significant improvement for each individual item and mean score of learners. Residents assessed their completion rates of individual Checklist tasks positively. For example, 94% self-endorsed completion of "explanation of facts," 89% self-endorsed "took responsibility," and 78% self-endorsed "apologized sincerely." Self-rated competence scores from the Checklist were low: 7% indicated they would be "extremely comfortable" entrusting their loved one's care to themselves, 11% rated their ability to explain the facts as "outstanding," and 12% felt they were "outstanding" in their "ability to disclose a complication in a professional manner." Residents received important skills practice in our disclosure training; disclosure confidence increased after participation. Residents scored high on completion of disclosure tasks and low on comfort and proficiency of those tasks. The Checklist provided a useful set of tasks to review and complete in the exercise. Separating residents by PGY level enabled senior residents to experience a more complex scenario and junior residents extra time to practice.

A Cross-Specialty Examination of Resident Error Disclosure and Communication Skills Using Simulation.

Disclosure of medical errors is important to patients and physicians, but formal disclosure training during the graduate medical education curriculum is limited. We examined resident competence related to error disclosure, using standardized patient (SP) ratings of resident communication skills. All first-year residents from medicine, radiology, emergency medicine, orthopedic surgery, and neurological surgery completed a 20-minute simulated session in which they were provided background information on a medical error they had made and were asked to disclose the error to an SP acting as a family member. Residents were then debriefed and completed a postscenario questionnaire. The SPs completed an 11-item communication assessment and 3 milestone rating tools on professionalism (PROF-1, PROF-3) and interpersonal and communication skills (ICS-1). Ninety-six residents from a single institution participated toward the end of the intern year. Communication assessment scores ranged from 23% to 100% (mean [SD], 80.6 [17.0]). Mean (SD) milestone ratings across specialties were 2.80 ± 0.92 for PROF-1, 2.48 ± 0.92 for PROF-3, and 2.45 ± 0.92 for ICS-1. One-way analysis of variance revealed no significant differences among specialties on milestone or communication ratings. Residents who accepted personal responsibility for the error (84.55 [14.06]) received significantly higher communication ratings from SPs compared with residents who did not (66.67 [19.52], P < .001). This SP assessment of error disclosure by first-year residents from multiple specialties was feasible and acceptable. It revealed areas of improvement as well as considerable variation in communication skills and professionalism among residents.

Healthcare workers\u2019 perspectives and practices regarding the disclosure of HIV status to children in Malawi: a cross-sectional study

BackgroundIn 2011 the World Health Organisation recommended that children with a diagnosis of HIV be gradually informed about their HIV status between the ages of 6 and 12 years. However, to date, literature has focused mainly on primary caregiver and child experiences with HIV disclosure, little is known about healthcare workers’ perspectives and practices of HIV status disclosure to children. The aim of this study was to assess healthcare workers’ perspectives and practices regarding the disclosure of HIV status to children aged between 6 and 12 years in Malawi.MethodsA cross-sectional survey was used to collect data from 168 healthcare providers working in antiretroviral clinics in all government District and Tertiary Hospitals in Malawi. Participants were asked questions regarding their knowledge, practice, and barriers to HIV disclosure. Data were analysed using binary logistic regression.ResultsAlmost all healthcare workers (98%) reported that it was important to disclose HIV status to children. A significant proportion (37%) reported that they had never disclosed HIV status to a child and about half estimated that the rate of HIV disclosure at their facility was 25% or less. The main barriers to disclosure were lack of training on disclosure (85%) and lack of a standard tool for disclosure (84%). Female healthcare workers (aOR) 2.4; 95% CI: 1.1–5.5) and lack of training on disclosure (aOR 7.7; 95% CI: 3.4–10.7) were independently associated with never having disclosed HIV status to a child.ConclusionsThis study highlights the need for providing appropriate training in HIV disclosure for healthcare workers and the provision of standardised disclosure materials.

Disclosure Coaching: An Ask-Tell-Ask Model to Support Clinicians in Disclosure Conversations.

Error disclosure is a high-stakes, emotionally charged interaction for patients and families as well as clinicians. A failed disclosure can result in emotional distress, reduced patient and family trust, litigation, and lost opportunities to learn from and prevent subsequent errors. However, many clinicians have little expertise in handling these challenging interactions and can inadvertently make a bad situation worse. Even those clinicians who have had formal disclosure training may have trouble remembering what they were taught when faced with the need to actually discuss an error with patients. Providing just-in-time coaching to clinicians is recommended by national standards. However, there is scant training material to guide error disclosure coaches. Therefore, we developed an "Ask-Tell-Ask" model and materials to guide the disclosure coaching process. The Ask-Tell-Ask model is well-suited to provide clinicians with targeted interactive teaching immediately before a disclosure without overwhelming them with lecture-style facts that they are unlikely to retain. Such teaching would ideally be provided by trained disclosure coaches, available for just-in-time support of clinicians throughout the disclosure process. The Ask-Tell-Ask model can also help risk managers, department heads, clinical managers, attending physicians, service chiefs, and others who assist clinicians with error disclosure. Here, we describe a comprehensive approach to coaching developed over years of coaching experience that incorporates the model, its rationale, step-by-step coaching strategies and guidance (including sample scripts), and organizational considerations regarding implementation of a coaching program to support patient-centered transparent communication after harmful events.

The Effects of Organisational Culture on IFRS Adoption: Evidence from Nigerian’ Companies

This study investigates the underlying factors contributing to the International Financial Reporting Standards (IFRS) adoption in Nigeria. The diversity of responses to IFRS adoption is a phenomenon that requires empirical investigation to understand the reasons why some companies adopt IFRS other do not. Previous studies have investigated preparers of financial statements’ compliance with IFRS. However, there is a dearth of research on the influence of cultural factors on IFRS adoption. Little has heretofore has been done to examine cultural variables as determinants of IFRS adoption. This study applies a self-administered survey instrument to elicit data from four major cities in Nigeria. The analysis involves applied logistic regression to estimate the relationship between the covariates and the companies’ decisions to adopt IFRS. The results indicate companies’ professionalism, transparency, flexibility, secrecy, uniformity and statutory control are significant factors impacting IFRS adoption at different magnitudes. For example, a company that considers IFRS will increase the level of financial statements transparency is more likely to maintain some levels of secrecy. The study identifies that IFRS adoption can only be successful when accountants develop the relevant technical expertise in IFRS requirements prior to the implementation. Consequently, there is a need for more practical training in IFRS accounting valuation, recognition, measurement and disclosure of financial information to users of financial statements. The diversity in responses to IFRS adoption, where some companies adopt and others show resistance to IFRS requirements has been a phenomenon that requires empirical investigation to understand the rationale. Though some studies have investigated companies’ compliance with accounting regulations in Nigeria, there is limited research on factors influencing IFRS adoption. A consequence is that efforts to come up with effective policies to enhance IFRS adoption and obtain compliance status for Nigerian companies are constrained. The objective is to contribute to initiatives aimed at assuring foreign investors of reliability of IFRS financial statements prepared by Nigerian companies.

Disclosure of Medical Errors: A Literature Review and the Situation in Turkey

Evaluating the efficacy and accuracy of clinical reasoning and distinguishing between complications and medical errors is a difficult task. However, it seems to be an even more difficult task to provide models for systematically reporting and reducing those errors through improvements in the entire web of healthcare delivery.The report “To Err Is Human: Building a Safer Health System” published in 1999 highlighted the importance of patient safety and proposed some interventions. However, a follow up by the authors of the report in 2005 stated that progress in matters of safer care delivery and improved communications was slow. The interventions proposed include “pay for performance” incentives, implementation of electronic health records, diffusion of safe practices and team training for full disclosure of medical errors to patients following injury.As patients increasingly are consumers, customers and regulatory actors in their own healthcare, it becomes harder to hide medical mistakes in clinical encounters. Explaining why and how the medical error happened, giving informed assurance that the mistake will be avoided in the future and offering sincere apologies to patients and families are skills that need to be taught to medical students as early as the undergraduate level. Those skills are very difficult to teach in the university environment and would be learned more effectively with years of experience. However, structured educational programs focusing in the necessity and components of a good medical error disclosure would improve awareness in the importance of an effective and honest doctor–patient relationship.In this review paper, we compare international literature and examples from Turkey with regard to disclosure of medical errors. The Turkish literature on malpractice cases is rich and most of them point out that medical errors occur because of heavy workloads, insufficient infrastructure and lack of high quality medical education. However, the lack of any papers on medical disclosure to patients in Turkey seems to point out to the big communication gap between patients and doctors, among other reasons. We will address some of the reasons for such lack in Turkey and present recommendations about how to disclose medical errors to patients such as implementation of electronic medical error disclosure systems, education and training, and legislation.

Improving alcohol and mental health treatment for lesbian, bisexual and queer women: Identity matters

Objective:Lesbian, bisexual and queer (LBQ) women experience substantial unmet alcohol and mental health treatment needs. This paper explores the way in which sexual identity shapes experience, and needs, in relation to alcohol and mental health treatment, and presents key messages for improving treatment. Methods:Twenty‐five in‐depth interviews were undertaken with same‐sex attracted Australian women, aged 19–71. Interview transcripts were analysed thematically. Results:Key messages offered by participants focused on language, disclosure and practitioner training. Variation in sexual identity did not alter treatment expectations or needs; however, we noted an important difference with respect to identity salience, with high LBQ identity salience linked with preference for disclosure and acknowledgement of sexual identity in treatment interactions, and low identity salience linked with a preference not to disclose and for sexual identity not to require acknowledgement in treatment. Conclusions:Treatment providers may find it useful to gather information about the centrality of sexual identity to LBQ women as a means of overcoming treatment barriers related to heteronormative conventions and discrimination, language and disclosure. Implications for public health:Treatment providers should adopt more inclusive language, seek information about identity salience and the importance of sexual identity to the current treatment, and regularly pursue LBQ‐related professional development upskilling.

The Effects of Organisational Culture on IFRS Adoption: Evidence from Nigerian’ Companies

This study investigates the underlying factors contributing to the International Financial Reporting Standards (IFRS) adoption in Nigeria. The diversity of responses to IFRS adoption is a phenomenon that requires empirical investigation to understand the reasons why some companies adopt IFRS other do not. Previous studies have investigated preparers of financial statements’ compliance with IFRS. However, there is a dearth of research on the influence of cultural factors on IFRS adoption. Little has heretofore been done to examine cultural variables as determinants of IFRS adoption. This study applies a self-administered survey instrument to elicit data from four major cities in Nigeria. The analysis involves applied logistic regression to estimate the relationship between the covariates and the companies’ decisions to adopt IFRS. The results indicate companies’ professionalism, transparency, flexibility, secrecy, uniformity and statutory control are significant factors impacting IFRS adoption at different magnitudes. For example, a company that considers IFRS will increase the level of financial statements transparency is more likely to maintain some levels of secrecy. The study identifies that IFRS adoption can only be successful when accountants develop the relevant technical expertise in IFRS requirements prior to the implementation. Consequently, there is a need for more practical training in IFRS accounting valuation, recognition, measurement and disclosure of financial information to users of financial statements.

Interprofessional Error Disclosure Training for Medical, Nursing, Pharmacy, Dental, and Physician Assistant Students.

Errors that harm patients often have many contributing factors and ideally should be disclosed by a team rather than an individual provider. However, most health professions students learn about errors and error disclosure in a single-profession class. We developed a 2-hour small-group session in which our students practice discussing and disclosing a medical error that involves several professions, following a communication map. As they practice, students gain an understanding of the roles, skills, and perspectives of the other professions represented in the group. Over the last 5 years, student evaluations have been very positive. In 2016, our students strongly agreed that "The small group skills practice was a useful and interesting learning opportunity," "Learning with other professional students was valuable," and "Thinking about error disclosure from a team perspective was helpful." Student comments consistently indicated that they learned both about disclosing medical errors as well as other professionals' roles and perspectives. This activity has met both of our major goals. The first was to bring health professions students together to learn with, from, and about each other. The second was to practice a critical and challenging communication skill. This activity has been successfully implemented at other institutions, and can be adapted to fit other groups of students.