Rural patients' experiences of the open disclosure of adverse events

Objective: To analyse rural patients' and their families' experiences of open disclosure and offer recommendations to improve disclosure in rural areas. Design: Retrospective qualitative study based on a subset of 13 semistructured, in-depth interviews with rural patients from a larger dataset. The larger data set form a nationwide, multisite, retrospective-qualitative study that included 100 semistructured, in-depth interviews with 119 patients and family members who were involved in high-severity health care incidents and incident disclosure. The larger study is known as the '100 Patient Stories' study. Interviews were transcribed verbatim and analysed by one analyst (D. P.) for recurrent experiences and concerns. Setting: Acute care. Participants: A sub-set of 13 of the 100 participants from the '100 Patient Stories' study who identified as experiencing an adverse incident in a rural or regional area. Main outcome measures: Patients' and family members' perceptions and experiences of health care incident disclosure, as expressed in interviews. Results: Rural patients and clinicians experience additional challenges to metropolitan patients and clinicians in their experiences of health care incidents. These additional barriers include: a lack of resources at small hospitals; delays in diagnosis and transfer; distance between services; and a lack of communication between providers. These challenges impact not only upon how patients and their families experience incidents, but also how open disclosure is implemented. Conclusions: This analysis of 13 of the 100 Patient Stories interviews provides guidance to rural health services on how to conduct open disclosure.