This study examines the impact of medical error from the perspective of the family members of the injured and addresses the questions: Are family members at increased risk of experiencing symptoms of trauma following the medical error injury of a loved one? ; Does disclosure of the medical error mitigate family member response?
Participants in this retrospective case-controlled study represent a population of individuals that report loved ones harmed by a medical error, an affiliation with a patient safety organization, and a desire to participate in research. One hundred twenty-eight family members self-selected to participate in an online survey in response to invitations emailed to the members of six patient safety organizations: Consumers Advancing Patient Safety (CAPS); Persons United Limiting Substandards and Errors (PULSE); Medically Induced Trauma Support Services (MITSS); Consumer's Union (CU) Safe Patient Project (SPP); Agency for Healthcare Research and Quality (AHRQ) Patient Safety Network (PSNet); and the National Family Caregivers Association (NFCA). The survey incorporated quantitative and qualitative measures; specifically, the Detailed Assessment of Posttraumatic Stress (DAPS; Briere, 2001), Physician Communication scale (PCOM; Heisler, Cole, Weir, Kerr, & Hayward, 2007), a measure for quality of disclosure used by COPIC Insurance (COPIC, 2004, 2007), the Wake Forest Trust in Medicine scale (Dugan, Trachtenberg, & Hall, 2005), and two open response questions.
Results indicate that these family members suffer from enduring, emotional duress that diminishes their ability to enjoy life and are at increased risk of PTSD. In this group, 37.5% (n = 48) of family members report experiencing symptoms of PTSD with 4.7% (n = 6) reporting mild symptoms of trauma, 11.7% (n = 12) moderate symptoms of trauma, and 21.1% (n = 21) severe symptoms of trauma. Greater income and more education serve as buffers to trauma and medical errors resulting in more serious injury increase trauma. Trust was greatly diminished as indicated by this group's mean trust score of 9.88 (SD 4.21, range 5.00 - 25.00, Cronbach's á = .84) as compared to a mean trust score of 15.00 in another study of a large patient population. More than two-thirds of these family members did not take legal action. No significant correlation was found for any of the communication measures (PCOM, Disclosure Strategies, or Quality of Disclosure) and taking legal action. This finding indicates that there is not an increased risk of litigation when healthcare professionals communicate with family members and that there is little reason for healthcare professionals to provide anything less than adequate communication. Still, disclosure rarely occurred with 66% (n = 85) of the family members reporting no disclosure strategies put into practice by healthcare providers. Overall, 72% (n = 92) family members rated the quality of the healthcare professionals' disclosure of the medical error as fair and the Quality of Disclosure was negatively correlated with the measures for symptoms of trauma. Specifically, family member reports of Hyperarousal, Posttraumatic Impairment, and Reexperiencing (r = -.32, p .001; r = -.31, p .001; r = -.30, p .001; respectively) are most influenced by poor quality of disclosure. Qualitative findings supported the quantitative findings. The Harvard Medical Practice Study (1990) found that between 44,000 and 98,000 patients die in hospitals each year as a result of medical errors. Given that each patient likely has two family members that must deal with the consequences of the ordeal, the psychological, social, moral, and personal impact of medical error on the family is significant.||