Table 2

Categorisation of level of disclosure, disclosure items, response options and percentage within each category

Disclosure categorisationQuestion
Response options
Delayed cancer diagnosis (%)Care coordination breakdown (%)
What would you most likely say regarding an apology or to express regret?
 Non-disclosure
  • I would not volunteer that I was sorry or apologise.

  • ‘I am sorry about what happened to you’.

53.161.4
 Partial disclosure
  • ‘I am sorry you were not diagnosed sooner’ (delayed cancer diagnosis).

  • ‘I am so sorry that you were harmed by this failure in our system’ (care coordination breakdown).

24.86.8
 Full disclosure
  • ‘I am sorry that I did not examine your breast sooner’ (delayed diagnosis).

  • ‘I am sorry I did not follow up with you sooner’ (care coordination breakdown).

22.131.7
Which of the following most closely resembles what you would volunteer to the patient (what would you most likely say) about what happened?
 Non-disclosure
  • I would not volunteer any specific information about the event unless asked by the patient.

  • ‘Breast cancer can be difficult to diagnose in younger women like you, whose breasts have lots of lumps’ (delayed cancer diagnosis).

  • ‘It can be very difficult over the phone to get a good sense of how serious a patient's symptoms are. However, in your case our system for responding to our patients’ concerns did not work as well as it should have’ (care coordination breakdown).

54.633.2
 Partial disclosure
  • ‘Breast cancer can be difficult to diagnose in younger women like you, whose breasts have lots of lumps. However, in your case an error happened that potentially delayed your diagnosis’ (delayed cancer diagnosis).

  • ‘It can be very difficult over the phone to get a good sense of how serious a patient's symptoms are. However, in your case our system for responding to our patient's symptoms did not work as well as it should have’ (care coordination breakdown).

26.429.8
 Full disclosure
  • ‘Breast cancer can be difficult to diagnose in younger women like you, whose breasts have lots of lumps. However, in your case the fact that I did not re-examine your breasts potentially delayed your diagnosis’ (delayed cancer diagnosis).

  • ‘It can be very difficult over the phone to get a good sense of how serious a patient's symptoms are. However, in your case I should have asked you to come in sooner’ (care coordination breakdown).

19.037.0
What would you most likely say about the cause of the event?
 Non-disclosure
  • I would not volunteer a cause of the event unless the patient asked me.

51.223.5
 Partial disclosure
  • This occurred because of miscommunication between your regular doctor and me about when your breast lump needed to be re-examined (delayed cancer diagnosis).

  • ‘This occurred because of miscommunication about how serious your symptoms were’ (care coordination breakdown).

26.134.5
 Full disclosure
  • ‘I failed to review your chart thoroughly and so was not aware that your breast lump needed to be re-examined’ (delayed cancer diagnosis).

  • ‘We should have followed up with you more promptly when you initially reported your symptoms to us’ (care coordination breakdown).

22.742.1
What would you most likely say about how similar events would be prevented in the future?
 Non-disclosure
  • I would not volunteer anything about how similar events will be prevented in the future unless the patient asked me.

19.917.4
 Partial disclosure
  • ‘We are looking into what happened to you and will try to make changes to prevent this from happening in the future’.

35.225.9
 Full disclosure
  • ‘We will use our peer review process, in which expert clinicians not connected with this case review what happened and determine how to keep this from happening to someone else. Once the review has been completed, we will meet with you about the results of the review. We will also share the lessons learned with the other doctors in our system to prevent problems like this in the future’ (delayed cancer diagnosis).

  • ‘We are looking into what happened to you and we let you know what changes we make to prevent this from happening to someone else’ (care coordination breakdown).

  • ‘Your experience has taught me that we need to be much more proactive in responding to patients who report symptoms like yours’ (care coordination breakdown).

45.056.7
Scale Mean (SD)
α
0.82 (0.58)
0.72
1.06 (0.64)
0.79