title: Medical errors: Disclosure styles, interpersonal forgiveness, and outcomes.
abstract: BACKGROUND
  This study investigates the intrapersonal and interpersonal factors and processes that are associated with patient forgiveness of a provider in the aftermath of a harmful medical error.
  
  
  OBJECTIVE
  This study aims to examine what antecedents are most predictive of patient forgiveness and non-forgiveness, and the extent to which social-cognitive factors (i.e., fault attributions, empathy, rumination) influence the forgiveness process. Furthermore, the study evaluates the role of different disclosure styles in two different forgiveness models, and measures their respective causal outcomes.
  
  
  METHODS
  In January 2011, 318 outpatients at Wake Forest Baptist Medical Center in the United States were randomly assigned to three hypothetical error disclosure vignettes that operationalized verbally effective disclosures with different nonverbal disclosure styles (i.e., high nonverbal involvement, low nonverbal involvement, written disclosure vignette without nonverbal information). All patients responded to the same forgiveness-related self-report measures after having been exposed to one of the vignettes.
  
  
  RESULTS
  The results favored the proximity model of interpersonal forgiveness, which implies that factors more proximal in time to the act of forgiving (i.e., patient rumination and empathy for the offender) are more predictive of forgiveness and non-forgiveness than less proximal factors (e.g., relationship variables and offense-related factors such as the presence or absence of an apology). Patients' fault attributions had no effect on their forgiveness across conditions. The results evidenced sizeable effects of physician nonverbal involvement-patients in the low nonverbal involvement condition perceived the error as more severe, experienced the physician's apology as less sincere, were more likely to blame the physician, felt less empathy, ruminated more about the error, were less likely to forgive and more likely to avoid the physician, reported less closeness, trust, and satisfaction but higher distress, were more likely to change doctors, less compliant, and more likely to seek legal advice.
  
  
  CONCLUSIONS
  The findings of this study imply that physician nonverbal involvement during error disclosures stimulates a healing mechanism for patients and the physician-patient relationship. Physicians who disclose a medical error in a nonverbally uninvolved way, on the other hand, carry a higher malpractice risk and are less likely to promote healthy, reconciliatory outcomes.
authors.affiliation: Center for the Advancement of Healthcare Quality and Patient Safety, Faculty of Communication Sciences, Università della Svizzera italiana (USI Lugano), Via G. Buffi 13, 6900 Lugano, Switzerland. Electronic address: annegret.hannawa@usi.ch.
authors.forename: Annegret F
authors.initials: AF
authors.lastname: Hannawa
authors.affiliation: Psychology Department, Texas Tech University, Lubbock, TX 79409-2051, USA. Electronic address: yuki.shigemoto@ttu.edu.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Shigemoto
authors.affiliation: Institute for Measurement, Methodology, Analysis and Policy (IMMAP), Texas Tech University, Lubbock, TX 79409-2051, USA. Electronic address: todd.d.little@ttu.edu.
authors.forename: Todd D
authors.initials: TD
authors.lastname: Little
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001294:Attitude to Health; D036262:Empirical Research; D005260:Female; D061347:Forgiveness; D006801:Humans; D008297:Male; D008318:Malpractice / Q000331:legislation & jurisprudence; D019300:Medical Errors; D008875:Middle Aged; D009633:Nonverbal Communication / Q000523:psychology*; D010361:Patients / Q000523:psychology* / Q000706:statistics & numerical data; D010817:Physician-Patient Relations; D014342:Truth Disclosure; D014481:United States; D014743:Videotape Recording; D055815:Young Adult
keywords: Disclosure; Empathy; Forgiveness; Malpractice; Medical error; Patient safety; Provider-patient communication; Quality of care