title: More than words: patients' views on apology and disclosure when things go wrong in cancer care.
abstract: OBJECTIVE
  Guidelines on apology and disclosure after adverse events and errors have been in place for over 5 years. This study examines whether patients consider recommended responses to be appropriate and desirable, and whether clinicians' actions after adverse events are consistent with recommendations.
  
  
  METHODS
  Patients who believed that something had gone wrong during their cancer care were identified. During in-depth interviews, patients described the event, clinicians' responses, and their reactions.
  
  
  RESULTS
  78 patients were interviewed. Patients' valued apology and expressions of remorse, empathy and caring, explanation, acknowledgement of responsibility, and efforts to prevent recurrences, but these key elements were often missing. For many patients, actions and evidence of clinician learning were most important.
  
  
  CONCLUSIONS
  Patients' reports of apology and disclosure when they believe something has gone wrong in their care suggest that clinicians' responses continue to fall short of expectations.
  
  
  CONCLUSIONS
  Clinicians preparing to talk with patients after an adverse event or medical error should be aware that patients expect their actions to be congruent with their words of apology and caring. Healthcare systems need to support clinicians throughout the disclosure process, and facilitate both system and individual learning to prevent recurrences.
authors.affiliation: Meyers Primary Care Institute, University of Massachusetts Medical School, Fallon Clinic, Fallon Community Health Plan, Department of Medicine, Worcester, MA, USA. Kathy.mazor@meyersprimary.org
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Mazor
authors.forename: Sarah M
authors.initials: SM
authors.lastname: Greene
authors.forename: Douglas
authors.initials: D
authors.lastname: Roblin
authors.forename: Celeste A
authors.initials: CA
authors.lastname: Lemay
authors.forename: Cassandra L
authors.initials: CL
authors.lastname: Firneno
authors.forename: Josephine
authors.initials: J
authors.lastname: Calvi
authors.forename: Carolyn D
authors.initials: CD
authors.lastname: Prouty
authors.forename: Kathryn
authors.initials: K
authors.lastname: Horner
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Gallagher
mesh_terms: D000328:Adult; D000368:Aged; D003142:Communication; D004645:Empathy; D005260:Female; D006801:Humans; D008297:Male; D019300:Medical Errors; D008875:Middle Aged; D005791:Patient Care / Q000009:adverse effects* / Q000592:standards; D010817:Physician-Patient Relations; D014342:Truth Disclosure