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Nat Rev Urol. 2013 Jul;10(7):425-8. doi: 10.1038/nrurol.2013.76. Epub 2013 Apr 23.

The Kubler-Ross model, physician distress, and performance reporting.

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Division of Urologic Oncology, Department of Surgery, Fox Chase Cancer Center-Temple University Health System, 333 Cottman Avenue, Pennsylvania, PA 19111, USA.


Physician performance reporting has been proposed as an essential component of health-care reform, with the aim of improving quality by providing transparency and accountability. Despite strong evidence demonstrating regional variation in practice patterns and lack of evidence-based care, public outcomes reporting has been met with resistance from medical professionals. Application of the Kubler-Ross 'five stages of grief' model--a conceptual framework consisting of a series of emotional stages (denial, anger, bargaining, depression, and acceptance) inspired by work with terminally ill patients--could provide some insight into why physicians are reluctant to accept emerging quality-reporting mechanisms. Physician-led quality-improvement initiatives are vital to contemporary health-care reform efforts and applications in urology, as well as other medical disciplines, are currently being explored.

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