title: Error disclosure and family members' reactions: does the type of error really matter?
abstract: OBJECTIVE
  To describe how Italian clinicians disclose medical errors with clear and shared lines of responsibility.
  
  
  METHODS
  Thirty-eight volunteers were video-recorded in a simulated conversation while communicating a medical error to a simulated family member (SFM). They were assigned to a clear responsibility error scenario or a shared responsibility one. Simulations were coded for: mention of the term "error" and apology; communication content and affect using the Roter Interaction Analysis System. SFMs rated their willingness to have the patient continue care with the clinician.
  
  
  RESULTS
  Clinicians referred to an error and/or apologized in 55% of the simulations. The error was disclosed more frequently in the clear responsibility scenario (p<0.02). When the "error" was explicitly mentioned, the SFM was more attentive, sad and anxious (p≤0.05) and less willing to have the patient continue care (p<0.05). Communication was more patient-centered (p<0.05) and affectively dynamic with the SFMs showing greater anxiety, sadness, attentiveness and respectfulness in the clear responsibility scenario (p<0.05).
  
  
  CONCLUSIONS
  Disclosing errors is not a common practice in Italy. Clinicians disclose less frequently when responsibility is shared and indicative of a system failure.
  
  
  CONCLUSIONS
  Training programs to improve disclosure practice considering the type of error committed should be implemented.
authors: Department of Health Science, University of Milan, San Paolo University Hospital, Milan, Italy. Electronic address: daniela.leone@unimi.it.
authors: Daniela
authors: D
authors: Leone
authors: Department of Health Science, University of Milan, San Paolo University Hospital, Milan, Italy. Electronic address: giulia.lamiani@unimi.it.
authors: Giulia
authors: G
authors: Lamiani
authors: Department of Health Science, University of Milan, San Paolo University Hospital, Milan, Italy. Electronic address: elena.vegni@unimi.it.
authors: Elena
authors: E
authors: Vegni
authors: Department of Public Health, John Hopkins University, Baltimore, USA. Electronic address: riasworks@comcast.net.
authors: Susan
authors: S
authors: Larson
authors: Department of Public Health, John Hopkins University, Baltimore, USA. Electronic address: droter@jhsph.edu.
authors: Debra L
authors: DL
authors: Roter
mesh_terms: D001291:Attitude of Health Personnel; D003142:Communication; D003657:Decision Making; D003661:Decision Support Techniques; D005190:Family / Q000523:psychology*; D006801:Humans; D008297:Male; D019300:Medical Errors; D010358:Patient Participation; D010361:Patients / Q000523:psychology; D010817:Physician-Patient Relations; D011795:Surveys and Questionnaires; D014342:Truth Disclosure
keywords: Apology; Medical error; RIAS; Simulation; Truth disclosure