MEDICAL ERRORS, URINARY TRACT INFECTIONS

Should Medical Errors Be Disclosed to

Pediatric Patients? Pediatricians’ Attitudes
Toward Error Disclosure
Irini N. Kolaitis, MD; Dana Aronson Schinasi, MD; Lainie Friedman Ross, MD, PhD
From the Division of Hospital Based Medicine, Department of Pediatrics (Dr Kolaitis), Division of Emergency Medicine, Department of
Pediatrics (Dr Schinasi), Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine,
Department of Pediatrics, University of Chicago (Dr Ross), and MacLean Center for Clinical Medical Ethics, University of Chicago (Dr Ross),
Chicago, Ill
The authors declare that they have no conflict of interest.
Address correspondence to Irini N. Kolaitis, MD, Division of Hospital Based Medicine, Department of Pediatrics, Ann & Robert H. Lurie
Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, 225 E Chicago Ave, Box 152, Chicago, IL 60611-2605
(e-mail: ikolaitis@luriechildrens.org).
Received for publication May 6, 2015; accepted June 25, 2015.

ABSTRACT
OBJECTIVE: Limited data exist on medical error disclosure in
pediatrics. We sought to assess physicians’ attitudes toward
error disclosure to parents and pediatric patients.
METHODS: An anonymous survey was distributed to 1200
members of the American Academy of Pediatrics. Surveys
included 1 of 4 possible cases that only varied by patient age
(16 or 9 years old) and by whether the medical error resulted
in reversible or irreversible harm. Statistical analyses included
chi-square, Bonferroni-adjusted P values, Fisher’s exact test,
Wilcoxon signed rank test, and logistic regressions including
key demographic factors, patient age, and error reversibility.
RESULTS: The response rate was 40% (474 of 1186). Overall,
98% of respondents believed it was very important to disclose
medical errors to parents versus 57% to pediatric patients (P
< .0001). Respondents believed that medical errors could be
disclosed to developmentally appropriate pediatric patients at
a mean age of 12.15 years old (SD 3.33), but not below a
mean age of 10.25 years old (SD 3.55). Most respondents
(72%) believed that physicians and parents should jointly
decide whether to disclose to pediatric patients. When
disclosing to pediatric patients, 88% of respondents believed
that physicians should disclose with the parents present. Logis-
tic regressions found only patient age (odds ratio 18.65, 95%
confidence interval 9.20–37.8) and error reversibility (odds ratio
2.90, 95% confidence interval 1.73–4.86) to affect attitudes to-
ward disclosure to pediatric patients. Respondent sex, year of
medical school graduation, and area of practice had no effect
on disclosure attitudes.
CONCLUSIONS: Most respondents endorse disclosing medical
errors to parents and older pediatric patients, particularly when
irreversible harm occurs.
KEYWORDS: clinical bioethics; error disclosure; patient safety;
pediatrics
ACADEMIC PEDIATRICS 2016;16:482–488

WHAT’S NEW
Pediatricians strongly believe that medical errors
should be disclosed to older pediatric patients, particu-
larly when irreversible harm occurs. Most prefer collab-
orating with parents about whether and when to disclose
to the pediatric patient and to have parents present when
disclosing.
IN NOVEMBER 1999, the Institute of Medicine issued a
report, To Err is Human: Building a Safer Health System,
which discussed the prevalence of medical errors in the
United States and presented comprehensive strategies for
the reduction of medical errors.1 The report led to
increased research in the field of patient safety and medical
error disclosure. Research has found that when a medical
error occurs, both patients and physicians endorse full
and timely disclosure, especially when an error results
in serious or permanent harm.2–7 For patients, full
disclosure means that they are told that a medical error
occurred, what the error was, why the error occurred, and
what changes will be made to prevent similar errors in
the future; finally, they are given a full apology.8–11
Despite support by patients and physicians, several
barriers to full disclosure exist including lack of training,
fear of litigation, fear of blame, fear of damage to the
physicians’ reputation, and fear of making patients
anxious or causing them to lose trust in their physician.
For these reasons, medical error disclosure has not yet
become standard practice universally.5–9,12
To date, only 2 studies have explored parental prefer-
ences on medical error disclosure in pediatrics.13,14 In

ACADEMIC PEDIATRICS Volume 16, Number 5

Copyright ª 2016 by Academic Pediatric Association 482 July 2016

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ACADEMIC PEDIATRICS
2005, Hobgood et al13 investigated parental preferences for
error disclosure by surveying 500 parents of children pre-
senting to an emergency department with non-life-
threatening complaints. In the event an error occurs, 99%
of the parents surveyed wanted full disclosure, regardless
of severity. This preference was not affected by the child’s
age, sex, race/ethnicity, and/or insurance status. In 2010,
Matlow et al14 surveyed 431 parents in inpatient and ambu-
latory settings and similarly found that the majority of par-
ents wanted full disclosure of errors affecting their
children. The majority also wanted their children to be
informed about the error. This was the first published study
to address parental preferences for disclosure of medical
errors to their child, the pediatric patient.
Only 2 prior published studies have evaluated medical
error disclosure practices among pediatricians.15,16 Both
studies addressed how and when pediatricians disclosed
medical errors to parents but did not address error
disclosure to the pediatric patient. To our knowledge,
no prior studies have assessed if and how physicians
disclose medical errors to pediatric patients, when a
medical error should be disclosed to a pediatric patient,
and what information should be disclosed to a pediatric
patient after a medical error occurs.
The objective of this study was to assess physician atti-
tudes toward medical error disclosure in pediatrics, and
specifically toward the disclosure of medical errors to pedi-
atric patients. We hypothesized that 1) pediatricians would
endorse the full and timely disclosure of all medical errors
to parents; 2) pediatricians would endorse the full and
timely disclosure of all medical errors to older children
and when irreversible harm occurs; 3) pediatricians would
accede to parental requests not to disclose to the child
although they would not lie to the child directly; and 4)
pediatricians would be more likely to disclose if they had
received training in error disclosure.
METHODS
STUDY DESIGN
An anonymous survey was distributed between March
and August 2014 to 1200 pediatricians practicing in the
United States who were members of 1 of 3 sections of
the American Academy of Pediatrics: Hematology/
Oncology, Critical Care, and Hospital-Based Medicine.
These sections were chosen because more research has
been published on errors (including medication errors) on
the inpatient side, and because errors are more common
in patients who receive multiple medications or have com-
plex medical needs.1,17,18 To confirm area of practice,
respondents were asked for a self-reported area of practice
in the demographics section. The self-reported area of
practice was used in statistical analyses assessing for dif-
ferences between these 3 groups. Those who identified as
still in training or general pediatrics were excluded from
statistical analyses involving area of practice comparisons.
The survey was designed by the authors and reviewed by a
group of peers for question clarity and comprehension.
Respondents completed either a Web-based or a mail-in
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TOWARD ERROR DISCLOSURE 483
anonymous survey. The survey was first distributed by
e-mail, with 2 reminder e-mails sent at 2-week intervals.
Participants were excluded from the study if their e-mails
bounced back as undeliverable or if they requested not to
participate in the study. A mailed version of the survey
was distributed after completion of 3 rounds of e-mail
distribution to remaining nonrespondents with a valid
mailing address.
This study was exempted by both the Ann & Robert H.
Lurie Children’s Hospital of Chicago and the University of
Chicago institutional review boards.
The survey contained 3 sections. The first section ad-
dressed general attitudes toward error disclosure, including
the importance of disclosing medical errors at varying
levels of harm and the age at which a medical error could
be disclosed to a developmentally appropriate pediatric pa-
tient. In the second section of the survey, 300 participants
(100 from each discipline) randomly received 1 of 4
possible cases of a medication-related medical error. The
cases varied only by the age of the patient (16 or 9 years
old) and whether the medical error resulted in reversible
or irreversible harm, referred to here as “reversible error”
and “irreversible error,” respectively (Appendix 1). All sur-
vey versions then had a series of questions that addressed
the relevance of a variety of factors when disclosing this er-
ror to the parents or pediatric patient. Respondents were
also asked who should decide whether to disclose, who
should disclose, how to disclose, what to disclose, and
when to disclose this error to the parents or pediatric pa-
tient. Finally, respondents were asked how to proceed if
the parents insisted that the medical team not disclose
this error to the pediatric patient and if the pediatric patient
asked directly why this happened. One question was inad-
vertently omitted in all mailed surveys: question 5e, which
read, “The relevance of how responsible the physician feels
for the error when disclosing to a pediatric patient.” The
third part of the survey asked for demographic information.
All questions that involved an importance rating utilized
the same 4-point Likert scale (1 ¼ not important, 2 ¼
somewhat important, 3 ¼ important, 4 ¼ very important).
Most questions had an empty field for respondents to pro-
vide comments. Appendix 2 provides a copy of one version
of the survey (16-year-old reversible error).
STATISTICAL ANALYSES
Descriptive statistics were computed for all questions,
including means and standard deviations for continuous
variables and percentages for categorical variables.
z tests were used to assess for statistically significant differ-
ences between respondent groups. Questions involving a
4-point Likert scale were analyzed both as 4 independent
variables and dichotomously by grouping variables of
comparable quality (“low importance,” which combined
1 ¼ not important and 2 ¼ somewhat important, compared
to “high importance,” which combined 3 ¼ important and
4 ¼ very important). Survey responses were assessed as a
complete aggregate and by survey version (1: 16-year-old
reversible error; 2: 16-year-old irreversible error; 3:
9-year-old reversible error; 4: 9-year-old irreversible
484 KOLAITIS ET AL
error). Subsequent analyses were conducted by aggre-
gating patient age (all surveys with questions about 16-
year-olds and all surveys with questions about 9-year-
olds) and error type (all surveys with questions about
reversible errors and all surveys with questions about irre-
versible errors) to explore trends, and then comparisons
were explored for patient age and error type by the chi-
square test or Fisher’s exact test where appropriate. To ac-
count for multiple comparisons, Bonferroni-adjusted P
values of .0014 were used unless otherwise noted. The
nonparametric Wilcoxon signed rank test was used to
assess differences in the ranked importance scores for
questions 1 and 4. A 1-way ANOVA was used to explore
differences in mean ages reported for questions addressing
the age at which errors could be disclosed to a pediatric pa-
tient.
Multivariable logistic regression modeling was used to
calculate odds ratios (ORs) and corresponding 95% confi-
dence intervals (CIs) for factors significantly associated
with the importance of disclosing directly to pediatric pa-
tients on univariate analysis. Regression models utilized
the dichotomized importance score of “low importance”
versus “high importance.” Using a model entry P value cri-
terion of <.10, a series of manual stepwise selections were
used to build a final multivariate model. This model was
used to determine which factors, including patient age, er-
ror reversibility, and demographics, demonstrated a statis-
tically significant association with a “high importance” of
disclosing directly to pediatric patients. Demographic fac-
tors included in the full model for this regression were:
respondent sex, respondent year of graduation from medi-
cal school, patient age, and error reversibility. Multinomial
logistic regression was used to explore the association be-
tween demographic characteristics and when an error
should be disclosed to a pediatric patient and again used
stepwise selection of inclusion criteria meeting a model
entry P value criterion of <.10. Demographic factors
included in the full model for this regression were respon-
dent sex, existence of a system for reporting errors in the
respondent’s hospital or clinic, patient age, and error
reversibility. P values of <.05 were considered to be statis-
tically significant in multivariable and multinomial
modeling procedures. All statistical analyses were per-
formed by SAS 9.4 (SAS Institute, Cary, NC).
Qualitative comments were analyzed and coded inde-
pendently by 2 authors (IK and LFR). A total of 10 coding
themes were developed and utilized. Individual comments
could generate multiple coding themes. For each comment,
all coding themes were compared until agreement was
reached.
RESULTS
STUDY POPULATION
Of the 1200 eligible respondents, 5 opted out of partici-
pating in this study and 9 were ineligible because their
e-mails bounced. A total of 374 partial or complete survey
responses were received from the Web-based survey. Of
the 812 eligible participants remaining after e-mail distri-
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ACADEMIC PEDIATRICS
bution, 785 had a mailing address listed, and from that
group, we received 100 partial or complete survey re-
sponses by mail. The overall survey response rate was
40% (474 of 1186). There was no statistically significant
difference between the response rates of each version of
the survey (data not shown). Demographic characteristics
of respondents are provided in Table 1. Slightly more
than half of the respondents were female (53%, 226 of
427), and the mean year of graduation from medical school
was 1994. Most respondents (69%, 297 of 429) reported
that they had not received formal training in error disclo-
sure, even though 93% (396 of 426) noted the existence
of a system for error reporting in their hospital or clinic
and 90% (382 of 423) reported a prior personal experience
with error disclosure. For each survey question, no differ-
ences in attitudes toward error disclosure were found be-
tween respondent sex, respondent year of graduation
from medical school, area of practice, prior training or
experience with error disclosure, or existence of system
for error reporting in the respondent’s hospital or clinic
(data not shown). There were no demographic or substan-
tive differences between e-mail and postal respondents
(data not shown).
GENERAL ATTITUDES TOWARD ERROR DISCLOSURE
Respondents rated the importance of disclosing medical
errors resulting in varying levels of harm (minimal and
serious) and duration (temporary and permanent) using a
4-point Likert scale (Table 2). Overall, respondents rated
it more important to disclose serious errors and errors re-
sulting in permanent harm than minor or near-miss errors.
All categories were significantly different than the other
except “minimal but permanent” and “serious but tempo-
rary,” which had a mean importance of 3.91 and 3.93,
respectively (using Bonferroni-adjusted P values of .005).
Table 1. Respondent Demographics
Characteristic Value
Sex (n ¼ 427), n (%)
Female 226 (53)
Male 201 (47)
Year of graduation from medical school (n ¼ 419), 1994 (11.7)
mean (SD)
Area of practice (n ¼ 424), n (%)
Critical care 167 (39)
Hospital-based medicine 109 (26)
Hematology/oncology 108 (26)
Other* 40 (9)
Formal training in error disclosure (n ¼ 429), n (%)
Yes 132 (31)
No 297 (69)
System for error-reporting in hospital or clinic
(n ¼ 426), n (%)
Yes 396 (93)
No 30 (7)
Personal experience with error disclosure (n ¼ 423),
n (%)
Yes 382 (90)
No 41 (10)
*Other indicates respondents who were still in training or who
identified general pediatrics as their primary area of practice.
ACADEMIC PEDIATRICS TOWARD ERROR DISCLOSURE 485

Table 2. Importance of Disclosing Medical Errors Causing Varying
Levels of Harm
Type of Harm (n ¼ 469)
Minimal and temporary
Minimal but permanent
Serious but temporary
Serious and permanent
Does not occur because error is caught and action
averted (near miss)†
*Scale: 1 ¼ not important; 2 ¼ somewhat important; 3 ¼ impor-
tant; 4 ¼ very important.
†n ¼ 467.
The mean age above which respondents thought that a
medical error could be disclosed to a developmentally
appropriate pediatric patient was 12.15 years old (SD
3.33), and the mean age below which our respondents
thought that a developmentally appropriate pediatric
patient was too young to have a medical error disclosed
was 10.25 years old (SD 3.55).
CASE STUDY RESULTS
Respondents rated the importance of disclosing the
hypothetical medical error provided in the survey directly
to the parents and pediatric patients. Overall, 98% (421
of 429) of respondents believed it was very important to
disclose medical errors to the parents, but only 57% (246
of 429) believed it was very important to disclose medical
errors to pediatric patients (P < .0001).
Mean importance scores for several factors affecting the
decision to disclose medical errors to the parents and pedi-
atric patient are listed in Table 3. For both the parents and
pediatric patient, error severity and reversibility were rated
highly. For disclosing to parents, most other factors received
lower mean importance scores. When disclosing to a pedi-
atric patient, respondents rated the pediatric patient’s age,
cognitive level, and potential for the pediatric patient to
not understand what is being disclosed or why the disclo-
Importance, sure is taking place as important factors affecting the deci-
Mean (SD)* sion to disclose a medical error to a pediatric patient.
3.24 (0.91) When disclosing to the parents, the majority of respon-
3.91 (0.33) dents indicated that 1) the error should always be disclosed
3.93 (0.28) (69%); 2) the error should be disclosed by the physician
3.98 (0.20)
(87%); 3) all 5 components of full disclosure (stating that
2.02 (1.11)
an error occurred, what the error was, why the error
occurred, what changes will be made to prevent such errors
in the future, and giving an apology) should be included
(80%); and 4) the error should be disclosed within 24 to
48 hours of discovery (90%) (Table 4).
The majority of respondents believed that the decision to
disclose to a pediatric patient should be made jointly by the
physician and the parents (72% or 305 of 423). When
disclosing to the pediatric patient, most respondents
believed that the error should be disclosed by the physician
with the parents in the room (88% or 362 of 411). Only
57% (239 of 422) of respondents wanted all 5 components
of full disclosure shared with the pediatric patient. Respon-
dents believed it was significantly more important to
disclose all 5 components of full disclosure to a 16-year-
old patient compared to a 9-year-old patient (69%, 42 of
206, vs 45%, 97 of 216; P <.0001). Most respondents indi-
cated that omitting why the error occurred or what changes
will be made to prevent such errors in the future was appro-
priate. In terms of the timing of the disclosure, 49% (205 of
419) of respondents thought that the error should be dis-
closed to the pediatric patient only after parents were
informed, while 41% (170 of 419) thought that the disclo-
sure conversation should take place only when the parents
decided it was the right time.
If the parents insisted that the medical team not disclose
to the pediatric patient, 55% (214 of 391) indicated that
they would always defer to the parents, and another 39%
(152 of 391) indicated that they would defer depending

Table 3. Relative Importance of Factors Affecting Decision to Disclose Medical Errors

Parent Pediatric Patient
Importance, Importance,
Factor n Mean (SD)† n Mean (SD)† P
Error severity 427 3.44 (1.06) 418 3.18 (1.19) <.001*
Error reversibility 428 2.83 (1.27) 417 2.71 (1.28) .0261
Physician responsibility for the error 425 2.08 (1.25) 316‡ 1.76 (1.09) <.001*
Physician training in disclosure 426 2.06 (1.16) 414 1.99 (1.12) .985
Physician comfort in disclosure 425 1.84 (1.11) 415 1.84 (1.10) .9305
Potential for damaging physician’s reputation 426 1.54 (0.94) 413 1.46 (0.87) .0059*
Potential for losing trust in the physician 427 2.11 (1.15) 414 2.25 (1.09) .009*
Potential for a lawsuit 413 1.79 (1.10) 409 1.57 (0.99) <.001*
Pediatric patient’s age NA NA 413 3.36 (0.92) NA
Pediatric patient’s cognitive level NA NA 417 3.55 (0.85) NA
Potential for pediatric patient to become anxious NA NA 416 2.74 (0.97) NA
Potential for pediatric patient not to understand what is being disclosed NA NA 418 3.18 (0.91) NA
Potential for pediatric patient not to understand why disclosure is taking place NA NA 414 2.93 (0.99) NA
NA indicates not applicable.
*Significant difference between mean importance scores using Bonferroni-adjusted P values of .00625.
†Scale: 1 ¼ not important; 2 ¼ somewhat important; 3 ¼ important; 4 ¼ very important.
‡Fewer responses due to inadvertent omission of this question on mailed version of survey.

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486 KOLAITIS ET AL
Table 4. How to Disclose Medical Errors to Parents and Pediatric Patients
Parent
Question Answer
Who decides to disclose No decision; it should always be disclosed
Who should disclose Physician
What to disclose All 5 components of full disclosure*
When to disclose Within 24–48 h of discovering that error
occurred
*Five components are: 1) stating that error occurred; 2) what error was; 3) why error occurred; 4) what changes will be made to prevent such
errors in future; and 5) giving apology.
on whether the parents plan to disclose at a later stage.
However, if the pediatric patient asked them directly why
this happened, 77% (316 of 413) of respondents would
disclose to the pediatric patient, but only after informing
the parents of their intention. None of these responses
was affected by patient age, error reversibility, or respon-
dent demographic characteristics (data not shown).
DISCLOSING TO PEDIATRIC PATIENTS: 16-YEAR-OLDS
VERSUS 9-YEAR-OLDS
Respondents believed it was significantly more impor-
tant to disclose errors directly to a 16-year-old patient
compared to a 9-year-old patient (95%, 196 of 206; mean
importance 3.70, SD 0.51 vs 54%, 120 of 223; mean impor-
tance 2.74, SD 1.04; P < .0001). When adjusting for error
reversibility, respondent sex, and year of graduation from
medical school, the final logistic regression model found
patient age to be significantly associated with the impor-
tance of disclosing an error to a pediatric patient such
that respondents were more likely to rank “high impor-
tance” when the patient was 16 years old versus 9 years
old (OR 18.65, 95% CI 9.20–37.8).
In addition, a significant difference between these
groups was found regarding the timing of disclosure.
For the 16-year-old patient, the majority (57%, 116 of
204) of respondents wanted the error to be disclosed after
the parents were informed, but for the 9-year-old patient,
the majority (51%, 110 of 215) wanted the error to be
disclosed when the parents decided it was the right time
(P < .0001). In the final multinomial regression model,
when adjusting for respondent sex and existence of a sys-
tem for error reporting in the respondent’s hospital or
clinic, surveys involving 9-year-olds were 4 times more
likely than those involving 16-year-olds to state, “When
the parents(s) decide the time is right” compared to “At
the same time that the parents are being informed”
(95% CI 1.84–8.70).
DISCLOSING TO PEDIATRIC PATIENTS: REVERSIBLE VERSUS
IRREVERSIBLE ERRORS
Overall, respondents believed it was important to
disclose both irreversible and reversible errors directly to
pediatric patients, with disclosure of irreversible errors
significantly more important than reversible errors (82%,
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ACADEMIC PEDIATRICS
Pediatric Patient
N/n (%) Answer N/n (%)
292/423 (69) Joint decision between parents 305/423 (72)
and physician
366/423 (87) Physician with parents in the room 362/411 (88)
342/426 (80) All 5 components of full disclosure* 239/422 (57)
375/417 (90) After parents are informed 205/419 (49)
When parents decide it is the right 170/419 (41)
time
177 of 217; mean importance 3.45, SD 0.90; vs 66%,
139 of 212; mean importance 3.05, SD 1.02; P < .0001).
When adjusting for patient age, respondent sex, and year
of graduation from medical school, the final logistic regres-
sion model also found error reversibility to be significantly
relevant when disclosing an error to a pediatric patient such
that respondents were more likely to rank “high impor-
tance” when error was irreversible versus reversible (OR
2.90, 95% CI 1.73–4.86).
QUALITATIVE COMMENTS
A total of 136 respondents (29%) provided 278 com-
ments. The 10 coding themes appeared 397 times within
the 278 comments. There was no statistically significant
difference in the number of comments provided based on
survey type or area of practice. The Online Supplemental
Table provides coding themes and sample comments.
DISCUSSION
Three of our 4 hypotheses were supported by the data:
1) pediatricians strongly endorse the full and timely disclo-
sure of all medical errors to parents; 2) most pediatricians
also strongly endorse disclosing medical errors to older pe-
diatric patients, especially when irreversible harm occurs;
and 3) most pediatricians would defer to the parents if
they asked them not to disclose to the pediatric patient
but would disclose to the pediatric patient if the pediatric
patient asked them directly what happened. However, our
data did not find that attitudes toward disclosure were
affected by prior training. In fact, we found that no demo-
graphic characteristics impacted attitudes toward error
disclosure.
While pediatricians’ attitudes toward error disclosure
to parents have been explored previously,15,16 to our
knowledge, this is the first study to examine pediatricians’
attitudes toward error disclosure to pediatric patients. Our
study found that most pediatricians endorse disclosure
of medical errors to older pediatric patients, particularly
when serious harm occurs—findings that parallel
previously reported parental preferences for error
disclosure.13,14
Research on communication of medical errors, like
research on communication in medicine more generally,
has focused primarily on the dyadic relationship between
ACADEMIC PEDIATRICS
adult patients and their physicians. In pediatrics, the rela-
tionship is more complex, involving both the patient and
the patient’s parents. Communication between a physician
and parent is the norm, and depending on the nature of the
discussion, the age and developmental stage of the pediat-
ric patient, or parental preferences, communication be-
tween a physician and the pediatric patient may be
overlooked. In fact, studies of pediatric patients’ experi-
ences indicate that they are rarely active participants in
their care plan.19–21 However, several studies suggest that
pediatric patients understand more about their health and
illness than previously recognized.19,22,23 While pediatric
patient preferences on error disclosure have not been
explored previously, minors have expressed a preference
to be actively involved in health care discussions in the
setting of terminal illness.19,21,24–26 Sharing health
information with interested pediatric patients may serve
to improve their understanding of their condition and
to reduce the anxiety that their exclusion causes.24–26
The results of our study show that most pediatric
providers support an active role for the pediatric patient
in the physician–parent–patient triad and inclusion in
discussions about their health information. Medical
errors should be included within the scope of important
health information.
While many physicians endorse the full and timely
disclosure of medical errors, several barriers to disclosure
exist. The most common barrier reported by trainees and
attending physicians is lack of formal training.5–7,27
Our results parallel those in previous studies in showing
that although most respondents (90%) report having
experience with medical error disclosure, the majority
(69%) also report never having had prior formal training
with medical error disclosure. There is a rich literature
on how to disclose medical errors that can fill the
gap between training and practice and helps clinicians
feel better equipped to handle these challenging
conversations.28,29 Some hospitals have begun to use
simulation-based training to help prepare clinicians for er-
ror disclosure.30–34 The development of pediatric-specific
disclosure guidelines would be invaluable.
There were several limitations to this study. First, our
response rate was 40%, which is low but is within the
typical range for surveys of physicians.35 Nevertheless,
there is always the possibility of a nonresponse bias. Sec-
ond, the sensitive subject matter surveyed may have led
to an overestimation of positive responses based on
respondent-perceived desired responses. Third, the use
of a multiple-choice format may miss important nuances.
We did provide room for comments at 3 distinct points in
the survey. The qualitative analysis did not shed any light
on variables not considered in the development of the sur-
vey. Fourth, the surveys were only sent to physicians in
3 sections of the American Academy of Pediatrics.
Limiting the areas of practice surveyed challenges the
ability to generalize results to all pediatric providers,
although the lack of differences between physicians in
the 3 different areas of practice surveyed supports some
generalizability.
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TOWARD ERROR DISCLOSURE 487
CONCLUSIONS
Most respondents endorse disclosing medical errors to
parents and to older pediatric patients, particularly when
irreversible harm occurs. Further studies exploring
parent attitudes regarding when and how medical errors
should be disclosed to pediatric patients and general
attitudes of pediatric patients toward error disclosure
are needed.
ACKNOWLEDGMENT
We thank Hannah Louks Palac, MS, for her assistance with statistical
analyses.
SUPPLEMENTARY DATA
Supplementary data related to this article can be found at
http://dx.doi.org/10.1016/j.acap.2015.06.011.
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