Can patients contribute to safer care in meetings with healthcare professionals? A crosssectional survey of patient perceptions and beliefs

Care partner engagement in patient safety at the direct care level in hospital: a qualitative systematic review protocol

OBJECTIVE

The objective of this systematic review is to understand the experiences of care partner engagement in patient safety at the direct care level from the perspective of care partners, patients, and health care professionals.

INTRODUCTION

Care partner engagement is a strategy for promoting patient safety in hospitals at the direct care level (ie, at the point where patient care is delivered). When present, care partners can increase safety by watching, listening, and taking action to protect admitted patients. To improve care partner presence policies and safety engagement strategies within hospitals, a comprehensive understanding of the current qualitative evidence about the breadth of experiences of care partner engagement in patient safety is required.

INCLUSION CRITERIA

This review will include qualitative studies that consider the experiences of care partners, adult patients, and health care professionals. The engagement of care partners in patient safety within pediatric hospital settings will not be considered.

METHODS

This review will follow the JBI methodology for systematic reviews of qualitative evidence. A preliminary literature search was conducted in MEDLINE and a full search strategy was developed for MEDLINE, Embase, CINAHL, and PsycINFO (all via Ovid), as well as the Cochrane Database of Systematic Reviews and JBI Evidence Synthesis . The JBI approach to study selection, critical appraisal, data extraction, data synthesis, and assessment of confidence will be followed. Two reviewers will test the screening criteria and data extraction protocol.

REVIEW REGISTRATION

PROSPERO CRD42023476286.

The experiences, needs and expectations of patients regarding participation at home: an explorative study in Belgium

BACKGROUND

Patients have an important role in the improvement of their health. Patient participation is a key component to achieving this. Some form of patient participation is already present in home care, but this needs to be optimised.

AIM

Gaining insight into the expectations, experiences and needs of patients regarding patient participation in home care.

DESIGN

A qualitative design was used.

SETTING

The study was conducted in the Flemish part of Belgium, in a purposeful sample of patients who have already received nursing care at home for at least 6 weeks.

METHODS

Semi-structured face-to-face in-depth interviews were conducted and analysed using the Qualitative Analyse Guide of Leuven.

RESULTS

Patient participation in home care is a dynamic process. A total of six components, which interact with each other, were identified that explain this process.

CONCLUSION

Patient participation in home care is the interaction of different components of a whole mechanism. Within this mechanism, home nurses play a key role to facilitate participation for patients.

Engaging patients in patient safety: a qualitative study examining healthcare managers and providers' perspectives

BACKGROUND

Patients can play an essential role in improving patient safety by becoming actively involved in their health care. The present study aimed to qualitatively explore healthcare providers' (HCPs) and managers' perceptions on patient participation in patient safety processes.

METHODS

This qualitative study carried out in three teaching hospitals in Tehran, Iran. The data were collected through semi-structured interviews with 31 HCPs and managers working at public teaching hospitals, medical universities and the Ministry of Health. The data were analyzed using thematic analysis.

RESULTS

Three main themes and 21 sub-themes emerged from the interviews. Participants believed that patients and their families can play an effective role in maintaining and improving patient safety through different roles. However, a variety of barriers were identified at patients, providers, and system levels hindering patient participation in delivering safe care.

CONCLUSION

The participants identified facilitators and barriers to patient engagement in safety-orientated activities at multiple patients, providers, and system levels, indicating that complex, multifaceted initiatives must be designed to address the issue. This study encourages further research to enhance the understating of the problems and solutions to patient involvement in safety initiatives in the Iranian healthcare setting.

ANÁLISE DO CONCEITO DE PACIENTE EXPERT SEGUNDO O MODELO DE WALKER E AVANT

RESUMO Objetivo: analisar o conceito de Paciente Expert no modelo de Walker e Avant. Método: análise teórica de conceito realizada em novembro de 2019 em bases de dados nacionais e internacionais com amostra final de 21 estudos, nos quais investigaram-se o país, ano de publicação, área da saúde, participantes, conceito, atributos, antecedentes e consequentes. Os dados quantitativos foram analisados de forma descritiva simples e os qualitativos organizados em figuras. Os conceitos identificados foram processados com apoio do software Interface de R pour Analyses Multidimensionnelles de Textes et de Questionnaires. Resultados: destacaram-se o Reino Unido (10, 47,6%); o ano de 2015 (04; 19,1%); a enfermagem como área de conhecimento mais evidenciada (05; 23,8%); e pacientes como participantes (18; 72,0%). A respeito dos elementos teóricos, a autogestão do cuidado (04;19,5%) foi o atributo que mais sobressaiu; evidenciaram-se, ainda, o aumento de pessoas com doenças crônicas (10;18,5%) como antecedente, a integração social/comunitária (14;24,5%) em meio aos consequentes, e os vocábulos patient expert, condition e health mediante o processamento dos conceitos apresentados pelos estudos incluídos na amostra final. Conclusão: a análise conceitual permitiu determinar a origem do conceito Paciente Expert, os diferentes campos de atuação desse sujeito, as habilidades desenvolvidas em prol do autocuidado e o seu real significado, o qual é definido como um indivíduo ativo no seu autocuidado com habilidades necessárias para gerenciar sua condição clínica e auxiliar outros em situação semelhante.

ANALYSIS OF THE EXPERT PATIENT CONCEPT ACCORDING TO WALKER AND AVANT'S MODEL

ABSTRACT Objective: to analyze the Expert Patient concept in Walker and Avant's model. Method: theoretical concept analysis conducted in November 2019 on national and international databases with a final sample of 21 studies, in which the following data were investigated: country, year of publication, area of knowledge, participants, concept, attributes, antecedents, and consequences. The quantitative data were analyzed in a simple descriptive way and the qualitative data were organized in figures. The concepts identified were processed with the aid of the Interface de R pour Analyses Multidimensionnelles de Textes et de Questionnaires software program. Results: the United Kingdom (10; 47.6%) stood out, as well as the year 2015 (04; 19.1%), Nursing as the most evidenced area of knowledge (05; 23.8%), and patients as participants (18; 72.0%). With regard to the basic elements, care self-management (04;19.5%) was the most relevant attribute; in addition, the increase in the number of people with chronic diseases (10;18.5%) and social/community integration (14;24.5%) were evidenced as the most important antecedent and consequence, respectively. Additionally, the terms expert patient, condition and health stood out in the processing of the concepts presented in the studies included in the final sample. Conclusion: concept analysis allowed determining the origin of the Expert Patient concept, the different fields of action of this subject, the self-care skills developed and their actual meaning, which is defined as an individual actively engaged in self-care and with the required skills to manage their clinical condition and help others in a similar situation.

Developing the first pan-Canadian survey on patient engagement in patient safety

BACKGROUND

Patient safety is a worldwide problem, and the patient contribution to mitigate the risk of patient harm is now recognized as a cornerstone to its solution. In order to understand the nature of integrating patients into patient safety and healthcare organizations and to monitor their integration, a Canadian survey tool has been co-constructed by patients, researchers and the Canadian Patient Safety Institute (CPSI). This questionnaire has been adapted from the French version of the patient engagement (PE) in patient safety (PS) questionnaire created for the province of Quebec, Canada.

METHODOLOGY

The pan-Canadian PE in PS survey tool was developed in a five-step process: (1) a literature review and revision of the initial tool developed in the province of Quebec; (2) translation of the French questionnaire into an English version tool; (3) creation of a Canadian expert advisory group; (4) adaptation of the English version tool based on feedback from the expert advisory group (assessment and development of the construct's dimensions, wording assessment and adaptation for pan-Canadian use, technical testing of the online platform for the survey); and (5) pilot testing and pre-validation of the tool before pan-Canadian use.

RESULTS AND CONCLUSION

Eight pan-Canadian PE in PS surveys were completed from five Canadian provinces by the expert advisory group and six surveys were completed during the pilot project by participants from different provinces in Canada. This survey tool comprises 5 sections: (1) demographic identification of the participants (Q1 to Q5); (2) general questions (Q6 to Q17); (3) the patient engagement process (experience level of participants and organizational incentives for PE in general) (Q18 to Q33); (4) PE in PS processes, such as current activities, strategies, structures, resources and factors (Q34 to Q67); and (5) the context and impact of PE in PS initiatives in Canadian healthcare organizations (CHOs) (Q68 to Q75), including outcome identification, improvement mechanisms and strategies, evaluation mechanisms, and indicators.

Doctors' Attitudes to Patient Question Asking, Patient-Generated Question Lists, and Question Prompt Lists: A Qualitative Study

BACKGROUND

Participation by patients in their own health care improves quality and safety. Question prompt lists (QPLs) can improve participation, particularly with doctors' endorsement. Few data have explored doctors' attitudes on these tools. We sought the experiences and attitudes of general practitioners and other specialists toward patient question asking and QPLs in their practice.

METHODS

In-depth, semistructured interviews and focus groups with purposively selected Australian doctors were conducted. Interview guides were used to explore doctors' experiences of patient question asking, patients' lists, and a sample QPL created using an Australian government-funded online tool, "Question Builder." Recordings were transcribed verbatim and data analyzed thematically using the method by Braun and Clarke.

RESULTS

Focus groups with 3 to 9 participants and a further 17 individual interviews were conducted. There was a total of 40 participants, 23 general practitioners and 17 other specialists (e.g., physicians, surgeons, pediatricians). Our analysis was summarized into several themes. 1) The doctors expected, encouraged, and had significant experience of patient question asking and patients' lists. They described many barriers for patients and their efforts to ensure patients had the information they needed. 2) The doctors felt responsible for creating an environment conducive to patient question asking, the delivery of answers, having strategies for unanswered questions, and balancing the agendas of both parties in the consultation. 3) Structured QPLs that prepared patients and facilitated the consultation agenda were viewed positively. The degree of time pressures participating doctors experienced in their context had a strong influence on how they responded to the sample QPL.

CONCLUSION

Doctors in this study expected patients to ask questions and endorsed the benefits of QPLs. However, there were more diverse views about the feasibility of implementing them in practice. Designing QPLs to fit within current workflows, via more succinct and tailored designs, may result in wider doctor acceptance and endorsement, hence maximizing the benefits of QPLs with improved patient participation and patient safety.

Identifying Factors Leading to Harm in English General Practices: A Mixed-Methods Study Based on Patient Experiences Integrating Structural Equation Modeling and Qualitative Content Analysis

OBJECTIVE

The aim of the study was to identify the main factors leading to harm in primary care based on the experiences reported by patients.

METHODS

We conducted a mixed-methods, cross-sectional study in 45 primary care centers in England. A random sample of 6736 patients was invited to complete the Patient-Reported Experiences and Outcomes of Safety in Primary Care questionnaire. We fitted structural equation modeling on the quantitative data (n = 1244 respondents) to identify contributory factors and primary incidents leading to harm. We conducted content analyses of responses to seven open-ended questions (n = 386) to obtain deeper insight into patient perceptions of the causes of harm experienced. Results from quantitative and qualitative analyses were triangulated.

RESULTS

Patients reported harm related to physical health (13%), pain (11%), and mental health (19%) and harm that increased limitations in social activities (14%). Physical harm was associated with incidents affecting diagnosis (β = 0.43; delayed and wrong), and treatment (0.12; delayed, wrong treatment, or dose), which were in turn associated with incidents with patient-provider communication, coordination between providers, appointments, and laboratory tests. Pain was associated with laboratory tests (0.21; caused when collecting blood or tissue samples) and with problems booking an appointment when needed (0.13; delaying treatment for pain). Harm to mental health was associated with incidents related to the following: diagnosis (0.28), patient-provider communication (0.18), appointments (0.17), coordination between different providers (0.14), and laboratory tests (0.12). Harm increasing limitations in social activities was associated with incidents related to diagnosis (0.42) and diagnostic and monitoring procedures (0.20).

CONCLUSIONS

Our findings suggest the need for patient-centered strategies to reduce harm in primary care focusing on the improvement of the quality of diagnosis and patient-provider communication.

What constitutes feeling safe at home? A qualitative interview study with frail older people receiving home care

Aim

To highlight experiences of what constitutes feeling safe at home among frail older people receiving home care.

Design

Qualitative descriptive study.

Methods

The sample consists of 12 individual recorded interviews with frail older people in their homes. Interviews were transcribed verbatim and analysed using qualitative content analysis. The data collection was performed in spring 2018.

Results

The analysis resulted in three categories: "Having a feeling of 'at-homeness'" describes the older people's surrounding environment and their efforts to maintain independence; "being able to influence" describes the importance for older people to shape their care by being in control and having an opportunity for self-determination in the context of home care; and "being able to trust staff" relates to expecting staff's knowledge and skills and to appreciating the staff's ability to create positive relations.

Chronic medicine users' self-managing medication with information - A typology of patients with self-determined, security-seeking and dependent behaviors

BACKGROUND

Information on medicines is key for safety and quality of care in long-term treatment courses with medicines. Little is known on how patients self-manage medication with information, and how interactions with health professionals influence such self-managing.

OBJECTIVE

The objective of this study was to investigate how patients manage long-term medication with information, and how interactions with health professionals influence this managing, with the aim of developing a typology of patients' practices for managing with information. A secondary objective was to generate theoretical reflections on patients' roles in establishing resilience in health care systems.

METHODS

Qualitative interviews with 15 chronic medicine users. A Safety-II-approach was used to obtain knowledge of what worked for medicine users, at the same time as acknowledging hindrances. Data were analyzed using thematic analysis and Halkiers' method for ideal-typologizing.

RESULTS

Four types of practices for managing medication with information were identified, distinguished by patients' ways of self-managing on their own and through relations with health professionals: Ideal-type I: Self-determined and highly self-managing; Ideal-type II: Security-seeking and self-managing; Ideal-type III: Dependent with limited self-managing; Ideal-type IV: Co-managing with close family. The findings suggest that patients with a high degree of self-managing medication with information have good chances for facilitating quality of medical treatment. For patients who are more dependent on oral information from health professionals, the character of dialogue facilitated or hindered their self-managing. All patients had the best options for managing medication when being recognized by health professionals through dialogues.

CONCLUSION

A typology of 4 types of managing practices was developed, characterized by patients' different abilities to self-manage medication with information and their relations to health professionals. Recognizing patients' different behaviors for managing medication with information is important for maximizing treatment quality of long-term medical treatment in a modern and resilient healthcare system.