Duty Of Candour Research Articles

Application of Duty of Candour legislation in post-colonoscopy colorectal cancer: a prospective cohort study.

Background & Study Aims The study investigates the application of Duty of Candour (DoC) legislation in the context of post-colonoscopy colorectal cancers (PCCRCs). DoC mandates transparent disclosure of notifiable safety incidents to patients in the English National Health Service, including those leading to severe or moderate harm. This study aims to analyse the application of DoC in PCCRCs, improve understanding of the legislation and identify challenges in its implementation. Patients & Methods A national audit of PCCRCs was conducted between September 2021 to May 2022. PCCRCs were identified using linked administrative datasets and root-cause analyses were performed using a structured template. 1,724 PCCRCs were included. 'Avoidability' and harm categorised into specific levels, with guidance provided to improve consistency in judgments. Results 16% of PCCRCs resulted in major harm or death, of which 27%(75) were at least probably avoidable. Hospitals deemed DoC discharge necessary in only 53% of these cases. When including moderate harm, 11% of all PCCRCs would trigger DoC discharge, yet this was deemed necessary in only 41% of these cases. Conclusions There is inconsistent application of DoC in PCCRC cases. Challenges include determining 'avoidability' and harm, particularly when there is a delay in diagnosis. Clearer guidance and definitions of harm are needed to improve adherence to regulations.

701 Do We Shy Away from Issuing Duty of Candour?

Abstract Aim Transparency and openness are the key elements that clinicians must offer. Certain events mandate a duty of candour (DOC). An apology must be provided to the patient/family/carer, providing a factual account of events. Francis Enquiry, 2013 recommended that a statutory DOC should be introduced. Numerous Trusts have been fined by CQC for failing to comply with statutory DOC. The aim of this audit was to study the compliance of our department in issuing a DOC for unexpected return to theatre following an acute laparotomy. Method We carried out two retrospective audits between January 2022 – March 2023 in general surgery department at St. James University hospital, Leeds. Approval was gained locally, and audit was conducted by reviewing electronic notes of each patient for evidence of issuance of DOC. All initial operations were acute laparotomies. Results A total of 46 patients were identified during second cycle of audit as compared to 21 patients during first who had unexpected return to theatres. 4 out of 46 had written evidence of DOC following their return to theatre; 8.7% compliance rate with Statutory Duty of Candour Guidelines which is 2.3% lesser than the first cycle. (P=0.193). Conclusions There appears to be poor compliance in performing a DOC or if provided, evidence of its documentation. Providing verbal and written DOC should become normative behaviour. There needs to exist an automated alert system for those incidences that requires a DOC and appropriate time in the job plan to accomplish this.

How did whistleblowing and the duty of candour get onto the agenda of the British national health service

PurposeThis paper compares how the two interacting themes of “Whistleblowing” or “Speaking Up” and the duty of candour (DoC), which are both concerned with safety and quality improvement in health care, got onto the agenda of the British National Health Service (NHS).Design/methodology/approachIt uses the approach of multiple streams and the methodology of interpretive content analysis in a deductive approach that focusses on both manifest and latent content. It examines official documents that discuss the DoC or whistleblowing or cognate terms in connection with the British NHS from 1999 to 2019.FindingsThe main conceptual finding, which mirrors many previous studies, is that it seems difficult to operationalise many of the sub-components of the multiple streams approach. The main empirical finding points to the “focusing event” of the Francis Report into the Mid Staffordshire Trust of 2013 and the importance of its Chair, Sir Robert Francis, as a policy entrepreneur.Originality/valueThis is one of the first studies to focus on both issues of whistleblowing and the DoC and the first to compare them through the lens of the multiple streams approach. It has two main conceptual advantages over most previous studies in the field: it compares whistleblowing and the duty of candour rather than the dominant approach of a single case study and explores the different outcomes of failed as well as successful couplings of the streams.

A duty of candour in the dental setting

A duty of candour in the dental setting

The influence of the Business Judgment Rule on the accountability of the Board of Directors for their errors or negligence based on Eisenberg's theory of Director's Accountability

<table border="0" cellspacing="0" cellpadding="0"><tbody><tr><td valign="top" width="406"><p class="TableParagraph"><em>In the business world, the Business Judgment Rule (BJR) is a legal principle that provides protection to directors when making risky business decisions, as long as those decisions are made in good faith, with sufficient care, and without personal interest. Although BJR is not explicitly regulated in Indonesian law, this principle is reflected in the Limited Liability Company Law and considered in the theory of director liability proposed by Melvin Aron Eisenberg. The purpose of this research is to analyze the application of the Business Judgment Rule principle in Indonesian corporate law to protect directors from liability for their mistakes or negligence, and to evaluate its influence on Eisenberg's theory of director liability. This study uses a normative legal research method that examines legal norms to analyze and interpret legal provisions related to the application of the Business Judgment Rule and director liability in Indonesia, as well as examining the influence of Eisenberg's theory on that doctrine. A conceptual approach is used to study the concept of the Business Judgment Rule and Eisenberg's theory of director liability in depth. The research results show that the Limited Liability Company Law in Indonesia regulates the application of the Business Judgment Rule (BJR), which provides protection to directors from liability for risky business decisions as long as they meet the requirements of good faith, due care, no conflict of interest, and efforts to prevent loss. However, BJR protection is not absolute, and directors can be held accountable if they violate corporate governance principles. Melvin A. Eisenberg's theory of director liability provides clearer boundaries, where directors can lose BJR protection if they violate the duty of care, duty of loyalty, duty of good faith, and duty of candor, making them accountable for their mistakes or negligence in business decision-making.</em><strong></strong></p></td></tr></tbody></table>

A duty of candour: a recognised (consented) complication vs a breach of duty

A duty of candour: a recognised (consented) complication vs a breach of duty

A80Simulation: a tool to improve the confidence of International Medical Graduates transitioning into working in the NHS

International medical graduates (IMGs) are doctors that have graduated from a medical university outside of the UK and subsequently employed by the NHS. The transition to working within the NHS presents them with many new challenges including communication, cultural differences, healthcare system differences, NHS policies and UK legal frameworks, and the expectations attributed to a doctor practicing in the UK. They often commence work with little training about these practical challenges and as a result encounter a steep learning curve. IMGs are significantly more likely to receive complaints and face fitness to practice investigation [1]. Therefore, developing educational opportunities to help them adapt to working in the NHS is a necessity. Simulation has been shown to improve the confidence, knowledge and provides an ethically and educationally safe setting for doctors to develop their practice [2,3]. We therefore created an IMG oriented simulation programme that focussed on some of the key challenges they face. We delivered simulation sessions on four separate days with 6-8 IMG candidates at each. Sessions consisted of two clinical scenarios divided into sections, approximately 20 minutes long, each targeting a key educational outcome. We used a combination of a computerized simulation manikin (SimMan Essential) and live actors. Key educational outcomes included managing an acutely deteriorating patient, escalating to a senior, obtaining a collateral history, breaking bad news and duty of candour. Each candidate had the opportunity to participate in a part of the simulation whilst the others observed. The candidates were then debriefed and learning objectives explored by a trained faculty member. The candidates were asked to complete pre-simulation, immediate post-simulation and 3-month post-simulation feedback forms using a nominal Likert scale. They scored 1-10 (10 being ‘strongly agree’) on their confidence around each component of the educational outcomes. We had 21 candidates complete the simulation day, with 19 responses to the immediate post simulation survey and 9 responses to the 3-month post simulation survey. The results showed a significant increase in the confidence of the candidates for each educational outcome, with mean scores increasing from 6-7 to >9. We also demonstrated that the candidate’s confidence remained and they were still using the skills they had learned 3 months later. We have demonstrated that IMG oriented simulation is a valuable educational tool for doctors transitioning into working within the NHS. Confidence around a variety of difficult topics increases and the lessons learned have a lasting impact. Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

Human factors in dentistry: Part 2. Whose fault is a mistake?

This two-part series introduces the concept of human factors, how and why mistakes happen and how we can minimize the risks of them occurring. Part 2 of the series explores ‘never events, near misses and duty of candour’ within the NHS. It also provides four clinical case scenarios of clinical errors that have resulted in actual or potential harm to a patient, identifying the human factors involved in each scenario. CPD/Clinical Relevance: There may be merit in the dental profession moving away from the blame culture when things go wrong..

Duty of candour and keeping patients safe

Duty of candour and keeping patients safe

Recent Judicial Perspectives on the Duty of Candour

Recent Judicial Perspectives on the Duty of Candour

Duties of Candour in Healthcare: The Truth, the Whole Truth, and Nothing but the Truth? (III)

Duties of Candour in Healthcare: The Truth, the Whole Truth, and Nothing but the Truth? (III)

Duties of Candour in Healthcare: The Truth, the Whole Truth, and Nothing but the Truth? (II)

Duties of Candour in Healthcare: The Truth, the Whole Truth, and Nothing but the Truth? (II)

Using the Duty of Candour as a Judicial Review Caseworker

Using the Duty of Candour as a Judicial Review Caseworker

Duties of Candour in Healthcare: The Truth, the Whole Truth, and Nothing but the Truth? (I)

Duties of Candour in Healthcare: The Truth, the Whole Truth, and Nothing but the Truth? (I)

Introduction of an internal medical trainee high-fidelity simulation course programme

The Trust felt that a targeted programme was needed to help further prepare Internal Medical Trainees’ (IMT) for their current duties and forthcoming roles as registrars. We wanted to provide them with the opportunity to boost their confidence and practice working alongside junior medical colleagues, in order to enhance patient safety [1]. These programmes could also work alongside the regional THRIVE and STRIVE sessions. A three-year programme was introduced. For IMT year 1, it is a half-day of 3 scenarios following a patient’s journey through an admission with key objectives being around difficult decision-making and communication. For IMT year 2, this includes a day of 5 challenging scenarios based around situations the IMT’s are called for. They look at non-technical aspects of their job in the context of complex clinical situations including bradycardia, supraventricular tachycardia, cardiac arrests, mental capacity, and duty of candour. IMT year 3, includes two days with the IMT3A course involving trainees working with Foundation Year Doctors over 5 scenarios where they are escalated to as the senior on call. The focus is developing skills such as prioritisation, leadership and communication. All candidates take part in the debriefing. The IMT3B course is a day of 5 extremely challenging scenarios in difficult settings such as out of hours or with limited senior presence. These scenarios are devised to push the IMT3 candidates in order to help prepare them for working under pressure. Scenarios include difficult ethical decision-making, litigation issues, and complex patients (e.g. pregnancy). The sessions were positively evaluated by the IMT who expressed how they will help change their practice and enhance patient safety (see Feedback from the internal medical trainees We feel that as the IMT work through the programme prepares them for what is a difficult transition. Over their IMT simulation training they will take part in 18 scenarios either as a candidate or in the debriefing. It has given the IMT the chance to have high quality training in a high-fidelity environment thus promoting enhanced care and patient safety. 1. Wayne D, Didwania A, Feinglass J, Fudala M, Barsuk J,McGaghie W. Simulation-based education improves quality of care during cardiac arrest team responses at an academic teaching hospital: A case controlled study. Chest. 2008;133(1):6–9.

Implementation of a high-fidelity simulation programme for year 3 internal medicine trainees (IMT3)

Year 3 Internal Medicine Trainee (IMT3) is a new (in 2021) grade of medical trainee intended to bridge the chasm between the supported environment of being a senior house officer and the more independent role of a medical registrar. We identified an unmet need for simulation experience to develop skills in emergency management, team leadership, and medicolegal/ethical judgement needed by the medical registrar [1]. Medical simulation and human factors training are essential for the development of IMT3s [2]. We created a novel high-fidelity simulation programme to address this training requirement and support this new grade of junior registrars. We designed five scenarios according to current curriculum guidance and Trust human factors framework. These scenarios were: (i) managing a Jehovah’s witness with an upper gastrointestinal tract bleed but lacking capacity, (ii) tricyclic antidepressant overdose, (iii) cardiac arrest in pregnancy, (iv) duty of candour after a fatal medical error, and (v) a hypoxic COVID-19 patient refusing treatment. The scenarios were piloted to a focus group with iterative improvements made. Participants responded to a Likert-type scale on both pre- and post-course questionnaires regarding their perceived confidence in managing difficult clinical and ethical conundrums, and their ability to share decision-making and communicate effectively during these situations. 23 out of 30 (77%) of the Trust’s IMT3s attended the programme which ran from January to May 2022, 22 (96%) of whom have completed both pre- and post-course questionnaires across the six sessions held. Mean course satisfaction and subjective knowledge gained ratings amongst participants following attendance at the course was 4.9/5. There was a 34.9% increase in mean confidence rating towards the management of challenging ethico-legal dilemmas (pre- versus post-course: 6.6/10 versus 8.9/10). Similarly, the average confidence towards the delivery of effective resuscitation in acutely deteriorating patients rose from 7.3 to 8.8/10 (20.5%), while average confidence in sharing decision-making and effective communication increased from 7 to 9/10 (28.6%) amongst the participants. Unclear audio system and lack of handouts were reported as limitations. Pauses in study leave access due to COVID-19 surges posed a challenge to the delivery of sessions and additional sessions were instituted to limit this impact. This is a novel programme for a new grade of doctors. The pilot data suggested that the implementation of a high-fidelity simulation programme appeared to be an effective modality to support the progression of this junior medical registrar cohort. 1. Joint Royal Colleges of Physicians Training Board (JRCPTB). Internal Medicine Training (IMT) Stage 1 ARCP Decision Aid. 2019 (last updated 2022). [Accessed on 4/06/2022]. 2. Joint Royal Colleges of Physicians Training Board (JRCPTB). Rough Guide to Internal Medicine Training: Guidance for training programme directors, supervisors and trainees. 2019 (last updated June 2019) guide to IMT June 2019.docx %282%29.pdf [Accessed on 17/05/2022].

Improving compliance with the duty of candour: 5-year experience within an endoscopy department

Background and aimsDuty of candour (DoC) is the requirement for timely and transparent disclosure after significant healthcare-related harm. We describe the experience of DoC following patient safety incidents (PSI) related...

Improving patient communication through the duty of candour and shared decision-making.

John Tingle, Lecturer in Law, Birmingham Law School, University of Birmingham, discusses some recent reports on the duty of candour and shared decision-making.

Invasive cervical cancer audit: What lessons can we learn locally and where would we stand with regard to duty of candour?

To identify lessons learned locally from the invasive cervical cancer audit. To estimate the impact that the application of 'Duty of Candour' may have upon our future service provision. Retrospective cohort study with interval analysis of all women diagnosed with cervical cancer at Sheffield Teaching Hospitals NHS Foundation Trust between 1 April 2007 to 31 December 2019. Data were collected prospectively with retrospective categorisation by screening history and invasive cervical cancer audit outcomes as satisfactory, satisfactory with learning points, and unsatisfactory. Statistical analysis was performed using the chi-squared test and paired t-test. Cervical cancer was diagnosed in 344 women. Seventy-eight (23%) had no record of prior cervical cytology, 108 (31%) had delayed attendance to the screening programme, 102 (30%) were detected by routine screening, and 56 (16%) were screening programme compliant. Satisfactory management was undertaken in 301 (87.5%) cases, 26 cases (7.5%) were satisfactory with learning points, and 17 cases (5%) were considered as unsatisfactory. Seventeen cases were applicable to the Duty of Candour process equating to 1.3 cases per year, incurring minimal impact upon future service provision. Invasive audit categorisation is subject to bias, however, with the potential for considerable intra- and inter-observer variation; the authors accordingly recommend that a further study be conducted to investigate both the consistency and reproducibility of the invasive cervical cancer audit categorisation.

Looking at Patent Law: Patenting an Electrochemical Invention for Eradication of Microbes from the Surfaces of Implants—A Case Study

In this installment of the “Looking at Patent Law” series, we present a case study of the prosecution of U.S. Patent No. 9,616,142 directed towards “Electrochemical Eradication of Microbes on Surfaces of Objects” jointly assigned to The Research Foundation for the State University of New York and Syracuse University. This case was chosen to coincide with the focus of this issue of Interface on diversity and inclusion in electrochemical technology, science and engineering. Notably, several of the inventors are female, including Dr. Esther S. Takeuchi who is a prolific inventor with numerous awards, honors and recognitions. The case study begins with a brief synopsis of the background of the invention followed by 1) a discussion of the patent applications associated with the invention, 2) inventor assignment and power of attorney designations, 3) submission of an information disclosure statement and duty of candor, 4) summary of office actions, 5) summary of applicant response to non-final rejection, and 6) allowance of the patent application. With this case study, we hope to de-mystify the patent prosecution process and better prepare electrochemical and solid-state scientists, engineers and technologists to interact with their patent counsel regarding their inventions.