10 years after Cameron: have we made gains in improving disclosure practices in Newfoundland and Labrador?
Notice bibliographique
Résumé
Purpose:On 3 July 2007, the Government of Newfoundland and Labrador established the Commission of Inquiry on Hormone Receptor Testing with the Honourable Margaret A. Cameron as Commissioner.The Cameron Inquiry exposed a systems failure in which hundreds of mistakes with hormone receptor tests were made, but the health authority had no crisis management plan and failed to communicate effectively with patients, the public, or government.Significant improvements have been made since the Cameron Inquiry.Cameron recommended training in disclosure for health professionals and the regional health authorities invested in such training opportunities.However, disclosing an adverse event to a patient or patient's family remains one of the most difficult professional tasks that physicians perform.Physicians do not have enough training or practice in having these difficult conversations, and therefore are often not confident with their communication skills.This lack of training and confidence are significant barriers to respectful and effective disclosure.In addition, many disclosures occur without guidance from an organizational expert, such as a representative from Quality and Risk Management (QRM).This project explores current disclosure process from the perspectives of the multiple players involved, including QRM personnel, practicing physicians, and physicians in leadership positions, as well as the potential role of trainees in disclosure processes.Methods: This research project involved a cross-sectional survey and two focus groups (one with QRM personnel and one with physicians in leadership).Questions focused on the barriers and facilitators of disclosure, the process of disclosure, the quality of disclosure discussions, and knowledge of regulatory guidelines and resources.The survey was sent to approximately 15 QRM personnel and 1260 physicians throughout Newfoundland and Labrador (NL).The focus groups involved 10 QRM personnel and 12 physicians in leadership.Results: 11 QRM personnel (73.3%) and 165 physicians (13.1%) completed the surveys.For the QRM survey, 0% of respondents reported feeling very comfortable disclosing adverse events and 55.6% reported feeling very uncomfortable, even with their extensive preparation for these conversations (81.8% received orientation on disclosure, 90.9% received formal training, and 100% are aware of regulatory guidelines and regulations).For the physician survey, 11.3% reported feeling very comfortable disclosing adverse events and 8.6% reported feeling very uncomfortable, despite being less prepared for these conversations than QRM personnel (30.9% received orientation about disclosure, 49.4% received formal training, and 49.1% are aware of regulatory guidelines and regulations).In the focus groups, QRM personnel and physician leaders noted improved performance among all staff who have been involved in disclosure discussions.However, there is still a level of discomfort with disclosure among frontline staff.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,011 | 0,027 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,007 | 0,005 |
| Communication savante | 0,006 | 0,004 |
| Science ouverte | 0,002 | 0,003 |
| Intégrité de la recherche | 0,003 | 0,005 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,005 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».