More than words? Patient insights on the impact of medical apology

Co-leads:

  • Fiona MacDonald
    University of the Fraser Valley
  • Tannis Driedger
    Patient partner

Trainee:

  • Dempsey Wilford
    University of Victoria
  • Julie Morden 
    University of the Fraser Valley

Increasingly, jurisdictions are adopting “apology legislation” that allows clinicians to apologize to patients when an adverse event occurs while disallowing the introduction of the apology in a liability case as evidence of fault or liability.

Apology legislation exists in Canada, Australia, the USA and the UK. In Canada, nine provinces and two territories have adopted apology legislation (BC first adopted in 2006). An apology is defined in Canadian legislation as “Encompassing an expression of sympathy and regret and a statement that one is sorry, or any other words or actions indicating contrition or commiseration, whether or not the words or actions admit or imply an admission of fault” (CMPA website). While apology legislation is established in Canada, little is known about the impact of apologies on various stakeholders, or the impact the legislation has on health care more generally. The existing literature on medical apologies is largely focused on the American context and is often limited to the potential impacts rather than the actual impacts as they are experienced by stakeholders. It is unknown whether impacts are differentiated for specific patient groups, such as Indigenous populations whom, research consistently shows, often experience highly differentiated processes and outcomes in health care.

Data was collected in two provinces (BC and MB) from qualitative interviews with patients who experienced a medical error and who did or did not receive an apology. Data was also collected via interviews with patient safety experts, clinicians, health care administrators, and medical school administrators. There is rich data providing original insight into how and whether giving/receiving an apology improves learning, accountability, patient safety, and healing (for both the patient and clinician). With this data, YouTube videos, op-eds and blog posts will be developed to share the findings with patients, clinicians, and administrators. The dissemination products will emphasize these themes: 1) Various traumas associated with medical errors/mistreatment; 2) The components of a meaningful medical apology for clinicians and administrators; 3) Impacts of apology on both patient and clinician; 4) Indigenous perspectives on medical apologies.

The findings will be presented at the 2019 BCPSQC Quality Forum. Participants at this event include physicians, nurses, pharmacists, allied health professionals and students. 

A holistic approach to mental health and community wellbeing: Exploring historical trauma with Indigenous youth and families through the use of Indigenous and qualitative research methods

In Canada, poor mental health among Indigenous youth is an ongoing issue. This leads to high rates of suicide, addiction, violence, chronic diseases and chronic pain. A potential reason for these challenges is historical trauma linked to government policies intended to eliminate Indigenous cultures, including residential schools, the 'sixties scoop' and the child welfare system.

With Indigenous families in the Fraser Valley and Lower Mainland, British Columbia, Dr. Cooper will explore how people understand historical trauma, mental health and abuse. With participants, she will also explore experiences with current mental health programs and interventions. The focus will be on strengths and challenges experienced by First Nations parents and youth aged 11-14.

Indigenous and qualitative arts-based approaches will be used to unpack key themes related to mental health and community wellbeing, and participants will help guide the creation of resources that will aim to improve health within Indigenous families and communities.

Implementing land-based resiliency in First Nations youth: The ‘This is Who We Are’ Program

Dr. Adrienne Chan’s work is funded through the Canadian Institutes of Health Research (CIHR) Pathways to Health Equity for Aboriginal Peoples Initiative. MSFHR is providing match funding, with additional support provided by the Fraser Health Authority and Vancouver Coastal Health. The goal of the Pathways Initiative is to facilitate research on the design, implementation and scale-up of effective programs and policies that address pressing Aboriginal health issues in four priority areas, including suicide.

Suicide among Aboriginal youth – estimated to be five to six times higher than non-Aboriginal youth – has been occurring at an alarming rate in recent years.

Dr. Adrienne Chan, Associate Vice-President of Research, Engagement and Graduate studies at the University of the Fraser Valley, is leading a team of researchers working on a suicide prevention strategy targeted to First Nations youth. Implementing Land-Based Resiliency in First Nations Youth: The 'This is Who We Are' Program, continues Chan’s earlier work with the Seabird Island Band – part of the Stó:lõ Nation, in the Upper Fraser Valley – which explored the benefits and positive outcomes of reconnecting Aboriginal youth to the land to build resiliency that comes from a foundation of culture, community and place.

The work of Chan’s team over three years will be grounded in an Indigenous research approach to examine the implementation of a suicide prevention program in four new communities: Mission Friendship Centre, Sumas First Nation, Scowlitz First Nation, located within Stó:lõ territory, and Nuxalk Nation (Bella Coola). The focus is on primary prevention of suicide: promotion of health, community connection, building and maintaining culture and family resilience.

Drawing on Indigenous ways of knowing as they are lived in the four communities, a guiding group of elders, youth and community members will inform the research team on how to adapt the pilot land-based resiliency program to the individual aspects of each community.

Youth will be instrumental in telling their stories, identifying needs, and providing input on how the prevention program unfolds. They will also be engaged in forums and participate in land-based (traditional land use and land stewardship) activities to explore and connect with their culture – past, present and future, as an act of healing and empowerment.

Community agencies working with children, youth, and families as well as health authorities will be involved to ensure a comprehensive perspective on what makes implementation of the resiliency model successful. Ongoing collaboration, knowledge seeking and knowledge exchange will allow for lessons about implementation to be shared between communities and to identify opportunities for broader expansion of the program.