Table 1.

Example of disclosure support program activities along CERC stage.

CERC Stage	Description of VA Large-Scale Disclosure Activities
Initial Event Stage	Following determination at a Clinical Episode Review Team (CERT) meeting that a facility would be required to disclose a large-scale adverse event, the HSR&D research team was asked to follow up with the facility to provide communications planning and support. On a follow-up phone call with facility leadership and the research team, edits were made to a draft script for communication with patients. The facility originally developed the script, and the research team, along with the VA Ethics Office and CERT leadership, provided edits on this call, as well as on an additional follow-up call and via email. Three days later, the research team met virtually via videoconferencing with the facility to present the toolkit process, including the description of the five teams needed to implement the disclosure activities, and support that could be provided by the research team. The research team provided a disclosure tracking spreadsheet for local use and discussed use of apology in communication in response to facility leadership questions. After a week, the research team and facility leadership met again by phone to discuss the planning for disclosure and follow-up with patients. The research team provided some insights and updates about the communications plan approval process from VHA Communications. Following this call, the facility made disclosures and conducted the necessary follow-up care with patients to whom disclosures were made.
Maintenance Stage	The research team conducted email follow-up with the facility team to check in on number of disclosures made, efforts to reach unresponsive patients, responses from patients, and any follow-up support needed.
Resolution Stage	Two months after disclosures began, the research team again followed up to debrief as part of the resolution stage. The research team asked about what went well with the disclosure process, and what could be improved for future communications.
Evaluation Stage	Two members of the research team, not involved in the disclosure training process, scheduled time with the facility participants in the disclosure process to conduct telephone interviews to evaluate the disclosure support program. Feedback from those interviews and from the resolution stage discussions were integrated into the toolkit stages, and in the pre-crisis planning for the facility and the research team.

CERC: Crisis and Emergency Risk Communication.