A view from the sender side of feedback: anticipated receptivity to clinical feedback when changing prior physicians' clinical decisions-a mixed methods study.

When physicians transition patients, the physician taking over may change the diagnosis. Such a change could serve as an important source of clinical feedback to the prior physician. However, this feedback may not transpire if the current physician doubts the prior physician's receptivity to the information. This study explored facilitators of and barriers to feedback communication in the context of patient care transitions using an exploratory sequential, qualitative to quantitative, mixed methods design. Twenty-two internal medicine residents and hospitalist physicians from two teaching hospitals were interviewed and data were analyzed thematically. A prominent theme was participants' reluctance to communicate diagnostic changes. Participants perceived case complexity and physical proximity to facilitate, and hierarchy, unfamiliarity with the prior physician, and lack of relationship to inhibit communication. In the subsequent quantitative portion of the study, forty-one hospitalists completed surveys resulting in 923 total survey responses. Multivariable analyses and a mixed-effects model were applied to survey data with anticipated receptivity as the outcome variable. In the mixed-effects model, four factors had significant positive associations with receivers' perceived receptivity: (1) feedback senders' time spent on teaching services (ß = 0.52, p = 0.02), (2) receivers' trustworthiness and clinical credibility (ß = 0.49, p < 0.001), (3) preference of both for shared work rooms (ß = 0.15, p = 0.006), and (4) receivers being peers (ß = 0.24, p < 0.001) or junior colleagues (ß = 0.39, p < 0.001). This study suggests that anticipated receptivity to feedback about changed clinical decisions affects clinical communication loops. Without trusting relationships and opportunities for low risk, casual conversations, hospitalists may avoid such conversations.