Does greater patient involvement in healthcare decision-making affect malpractice complaints? A large case vignette survey

Understanding Risk Factors for Complaints Against Pharmacists: A Content Analysis

OBJECTIVES

Pharmacists constitute a crucial component of the healthcare system, significantly influencing the provision of medication services and ensuring patient safety. This study aims to understand the characteristics and risk factors for complaints against pharmacists through Health and Disability Commissioner (HDC) published decisions.

METHODS

This study adopts a retrospective, qualitative approach. An inductive content analysis technique was used to analyze 37 complaints against pharmacists published decisions from the New Zealand Health and Disability Commissioner website to investigate a range of underlying risk factors contributing to the occurrence of complaints against pharmacists.

RESULTS

A set of 20 categories of risk factors emerged through the content analysis and were subsequently grouped into five overarching themes: pharmacist individual factors, organizational factors, system factors, medication-specific factors, and external environmental factors.

CONCLUSIONS

The findings of this study provide valuable insights that expand the understanding of risk management in pharmacist practice, serving as a valuable resource for regulatory bodies, policymakers, educators, and practitioners. It is recommended not only to focus solely on individual pharmacists but also to consider integrating their environment and individual behaviors to proactively address situations prone to errors and subsequent complaints.

Associations between knowledge of health issues and health care satisfaction and propensity to complain: a cross-sectional survey of adult men in Denmark

OBJECTIVES

The objective of this study was to investigate associations between knowledge of health issues and healthcare satisfaction and propensity to complain including the association between knowledge and greater patient involvement.

DESIGN

The present study is a secondary analysis of a larger cross-sectional case vignette survey.

SETTING

Survey conducted in adult Danish men.

PARTICIPANTS

Participants included 6755 men aged 45-70 years.

INTERVENTIONS

Participants responded to a survey with scenarios illustrating prostate-specific antigen (PSA) testing and different information provision.

PRIMARY AND SECONDARY OUTCOME MEASURES

Using Likert scales (scored 1-5), participants rated their satisfaction with the care described and their inclination to complain and responded to a short quiz (scored 0-3) assessing their knowledge about the PSA test.

RESULTS

Satisfaction with healthcare increased with better quiz performance (Likert difference 0.13 (95% CI .07 to 0.20), p <0.001, totally correct vs totally incorrect responders) and correspondingly, the desire to complain significantly decreased (Likert difference -0.34 (95% CI 0.40 to -0.27), p <0.001). Respondents with higher education performed better (mean quiz score difference 0.59 (95% CI 0.50 to 0.67), p <0.001, most educated vs least educated). Responders who received information about the PSA test generally performed better (quiz score difference 0.41 (95% CI 0.35 to 0.47), p<0.001, neutral vs no information). Overestimation of PSA merits was more common than underestimation (7.9% vs 3.8%).

CONCLUSIONS

Mens' knowledge of the benefits of screening varies with education, predicts satisfaction with care and the desire to complain, and may be improved through greater involvement in decision-making.

Shared decision making with breast cancer patients - does it work? Results of the cluster-randomized, multicenter DBCG RT SDM trial

BACKGROUND AND PURPOSE

Shared decision making (SDM) is a patient engaging process advocated especially for preference-sensitive decisions, such as adjuvant treatment after breast cancer. An increasing call for patient engagement in decision making highlights the need for a systematic SDM approach. The objective of this trial was to investigate whether the Decision Helper (DH), an in-consultation patient decision aid, increases patient engagement in decisions regarding adjuvant whole breast irradiation.

MATERIAL AND METHODS

Oncologists at four radiotherapy units were randomized to practice SDM using the DH versus usual practice. Patient candidates for adjuvant whole breast irradiation after breast conserving surgery for node-negative breast cancer were eligible. The primary endpoint was patient-reported engagement in the decision process assessed with the Shared Decision Making Questionnaire (SDM-Q-9) (range 0-100, 4 points difference considered clinical relevant). Other endpoints included oncologist-reported patient engagement, decisional conflict, fear of cancer recurrence, and decision regret after 6 months.

RESULTS

Of the 674 included patients, 635 (94.2%) completed the SDM-Q-9. Patients in the intervention group reported higher level of engagement (median 80; IQR 68.9 to 94.4) than the control group (71.1; IQR 55.6 to 82.2; p < 0.0001). Oncologist-reported patient engagement was higher in the invention group (93.3; IQR 82.2 to 100) compared to control group (73.3; IQR 60.0 to 84.4) (p < 0.0001).

CONCLUSION

Patient engagement in medical decision making was significantly improved with the use of an in-consultation patient decision aid compared to standard. The DH on adjuvant whole breast irradiation is now recommended as standard of care in the Danish guideline.

Complaint management system and patient satisfaction in grassroots hospitals

Primary healthcare institutions face limitations in medical resources, leading to concerns from patients and their families regarding the quality of medical services, resulting in complaints against these institutions. This study aims to analyze the causes of complaints and implement improvement measures to enhance the service quality of primary healthcare institutions, increase satisfaction among patients and their families, and reduce the number of complaints. Relevant data were collected, and verified complaints were categorized based on departments, administrative office, and category. Pearson Chi-square test, Spearman correlation analysis, as well as univariate logistic regression were employed to analyze factors influencing patient satisfaction. A complaint-handling process was established, and regulations pertaining to complaints were formulated. Pearson Chi-square test results indicated a significant correlation between satisfaction and departments (P = .016) and administrative office (P = .022). Spearman correlation analysis revealed a significant correlation between satisfaction and departments (ρ = 0.157, P = .017) and administrative office (ρ = 0.151, P = .021). Univariate logistic regression analysis demonstrated a significant correlation between satisfaction and other related complaints in administrative office (OR = 3.321, 95% CI = 1.196-9.218, P = .021). Complaints related to departments and administrative offices are significantly correlated with satisfaction. After the implementation of a complaint management system in primary healthcare institutions, there is a notable improvement in service quality, enhanced patient experience, increased satisfaction, and a reduction in hospital complaints.

Complaint behaviour among healthcare users: self-reported complaint experience and complaint proneness in adult men

AIMS

When patients are harmed by, or dissatisfied with, healthcare, only a minority will lodge a complaint or file a claim for compensation. This survey aimed to investigate complaint behaviour and inequalities in complaints using self-reports and hypothetical case vignettes.

METHODS

Cross-sectional, web-based survey among 6755 Danish men aged 45-70 years (response rate=30%). Participants reported their lifetime complaint experience and the likelihood that they would complain in response to hypothetical case vignettes.

RESULTS

Overall, 4.8% of participants had complained about healthcare. Predictors were younger age (OR 2.08, 95% CI 1.32 to 3.27, p=0.002 45-50 years compared with 65-70 years), chronic illness (OR 1.49, 95% CI 1.12 to 1.98, p=0.006), rural residence (OR 2.11, 95% CI 1.20 to 3.73, p=0.010 comparing least and most populated areas), high healthcare utilisation (OR 1.55, 95% CI 1.18 to 2.03, p=0.002 primary care, and OR 1.97, 95% CI 1.52 to 2.55, p=0.000 hospital care) and decreased agreeableness on the 10-item Big Five personality inventory (OR 0.91, 95% CI 0.83 to 0.99, p=0.034). Complaint experience was associated with increased wish to complain about the treatment in the hypothetical vignettes (p=0.006).

CONCLUSIONS

Roughly 1 in 20 men reported having complained about healthcare. Complaints were more common among men who were younger, living in rural areas, diagnosed with chronic illness and high users of healthcare services. Prior complaint experience may be associated with a higher proclivity for complaining about future healthcare. Findings suggest differences in the way healthcare users respond to care experiences, pointing to the importance of aligning expectations and providing clear information about treatment options.

Risk identification and prediction of complaints and misconduct against health practitioners: a scoping review

Identifying the risk and predicting complaints and misconduct against health practitioners are essential for healthcare regulators to implement early interventions and develop long-term prevention strategies to improve professional practice and enhance patient safety. This scoping review aims to map out existing literature on the risk identification and prediction of complaints and misconduct against health practitioners. This scoping review followed Arksey and O'Malley's five-stage methodological framework. A comprehensive literature search was conducted on MEDLINE, EMBASE, and CINAHL databases and finished on the same day (6 September 2021). Articles meeting the eligibility criteria were charted and descriptively analysed through a narrative analysis method. The initial search generated 5473 articles. After the identification, screening, and inclusion process, 81 eligible studies were included for data charting. Three key themes were reported: methods used for identifying risk factors and predictors of the complaints and misconduct, synthesis of identified risk factors and predictors in eligible studies, and predictive tools developed for complaints and misconduct against health practitioners. The findings reveal that risk identification and prediction of complaints and misconduct are complex issues influenced by multiple factors, exhibiting non-linear patterns and being context specific. Further efforts are needed to understand the characteristics and interactions of risk factors, develop systematic risk prediction tools, and facilitate the application in the regulatory environment.

[In the final analysis, who is "problematic"? An integrative review of patients, physicians and problematic relationships]

The scope of this study was to assess the literature on the characteristics of patients, physicians, and physician-patient relationships considered 'problematic.' An integrative review of primary studies published between January 1, 2016, and September 30, 2021, in Portuguese, English and Spanish was conducted, Of the 3,414 papers identified in the PubMed, Embase, Scopus and Lilacs databases, 19 were selected for qualitative analysis. Seven studies were carried out in Europe, eight in North America, two in South America and two in China, totaling 1,694 patients, 1,903 assistant physicians, 101 residents and 160 medical academics. Physicians and academics considered the following to be problematic: patients with clinical conditions such as psychosomatic and chronic illnesses; symptoms and complaints such as pain; powerful emotions; problems in obtaining and sharing information, in decision-making, in the adherence to the therapeutic plan and in their self-care; and some sociodemographic and vulnerability characteristics. Among other aspects, patients, or their relatives, considered physicians to be problematic when they did not listen to them or appear to care about their children, Teaching medical communication and systemic interventions are recommended to improve physician-patient relationships.

Personality characteristics associated with satisfaction with healthcare and the wish to complain

BACKGROUND

There is increasing evidence that satisfaction with healthcare and complaint rates vary with patients' socio-demographic characteristics. Likewise, patient personality might influence the perception of health care; however, empirical research has been scarce. The aim of this study was to investigate associations between health care user personality and satisfaction with care and urge to complain.

METHODS

This study is a randomized survey among Danish men aged 45 to 70 years (N = 6,756; 30% response rate) with hypothetical vignettes illustrating different courses of healthcare. Assuming they received the care described in vignettes, participants rated their satisfaction and wish to complain on a five-point Likert scale. Information on personality characteristics was obtained through self-reports using the standardized Big Five Inventory-10 (BFI-10).

RESULTS

In multivariate analyses, we found respondents with higher scores on the agreeableness dimension expressing greater satisfaction with care (Likert difference 0.06, 95% CI 0.04 to 0.07; p < 0.001) and decreased wish to complain (-0.07, 95% CI -0.08 to -0.05; p < 0.001) while high neuroticism scores were associated with less satisfaction (-0.02, 95% CI -0.03 to -0.00, p = 0.012) and an increased wish to complain about healthcare (0.04, 95% CI 0.03 to 0.06, p < 0.001). Interaction analyses could demonstrate no statistically significant interaction between the level of patient involvement in decision making in the scenarios and the effect of personality on respondents' satisfaction and wish to complain. Generally, however, when adjusting for personality, respondents' satisfaction increased (P < 0.001) with greater patient involvement illustrated in case scenarios while the wish to complain decreased (P < 0.001).

CONCLUSION

Our findings suggest low agreeableness and high neuroticism scores are associated with lower patient satisfaction with healthcare and increased wish to complain. Irrespective of personality, however, the wish to complain seems responsive to changes in patient involvement, underscoring the importance of inclusive healthcare communication.

Patients' Preference for Participation in Medical Decision-Making: Secondary Analysis of the BEDSIDE-OUTSIDE Trial

BACKGROUND

Patients may prefer different levels of involvement in decision-making regarding their medical care which may influence their medical knowledge.

OBJECTIVE

We investigated associations of patients' decisional control preference (DCP) with their medical knowledge, ward round performance measures (e.g., duration, occurrence of sensitive topics), and perceived quality of care measures (e.g., trust in the healthcare team, satisfaction with hospital stay).

DESIGN

This is a secondary analysis of a randomized controlled multicenter trial conducted between 2017 and 2019 at 3 Swiss teaching hospitals.

PARTICIPANTS

Adult patients that were hospitalized for inpatient care.

MAIN MEASURES

The primary outcome was patients' subjective average knowledge of their medical care (rated on a visual analog scale from 0 to 100). We classified patients as active, collaborative, and passive according to the Control Preference Scale. Data collection was performed before, during, and after the ward round.

KEY RESULTS

Among the 761 included patients, those with a passive DCP had a similar subjective average (mean ± SD) knowledge (81.3 ± 19.4 points) compared to patients with a collaborative DCP (78.7 ± 20.3 points) and active DCP (81.3 ± 21.5 points), p = 0.25. Regarding patients' trust in physicians and nurses, we found that patients with an active vs. passive DCP reported significantly less trust in physicians (adjusted difference, - 5.08 [95% CI, - 8.69 to - 1.48 points], p = 0.006) and in nurses (adjusted difference, - 3.41 [95% CI, - 6.51 to - 0.31 points], p = 0.031). Also, patients with an active vs. passive DCP were significantly less satisfied with their hospital stay (adjusted difference, - 7.17 [95% CI, - 11.01 to - 3.34 points], p < 0.001).

CONCLUSION

Patients with active DCP have lower trust in the healthcare team and lower overall satisfaction despite similar perceived medical knowledge. The knowledge of a patient's DCP may help to individualize patient-centered care. A personalized approach may improve the patient-physician relationship and increase patients' satisfaction with medical care.

TRIAL REGISTRATION

ClinicalTrials.gov (NCT03210987).

Sociodemographic characteristics associated with a higher wish to complain about health care

OBJECTIVES

Previous research has shown that patients who are older, less educated, or have lower income are less likely to lodge complaints about health care. This variation may reflect less wish to complain or inequitable access to complaint channels or remedies. We aimed to investigate associations between sociodemographic characteristics and health users' wish to complain.

STUDY DESIGN

This was a randomized case vignette survey among 6756 Danish men aged 45-70 years (30% response rate).

METHODS

Assuming they received the care in vignettes about prostate cancer (prostate-specific antigen) testing, participants rated their wish to complain on a 5-point Likert scale. Information on sociodemographic characteristics was obtained through self-reports and municipality-level information from national registries.

RESULTS

Lower education was associated with an increased wish to complain (mean Likert difference 0.44 [95% CI 0.36-0.51]; P < .001). The wish to complain was higher among unemployed men (difference 0.16 [95% CI 0.04-0.28]; P < .011) and those with a chronic illness (difference 0.06 [95% CI 0.02-0.10]; P < .004). Given the same healthcare scenarios, there was no difference in wish to complain among health users who were retired, living rurally, or from lower income groups.

CONCLUSIONS

Health users who are less educated, lower income, elderly, or from rural or minority communities appear to be as likely, or more likely, to wish to complain about health care as others. Yet, younger, well-educated, and higher income citizens are overrepresented in actual complaint statistics. The finding suggests persisting inequalities in the suitability or accessibility of complaint processes for some groups of patients.