Doherty Carole, Stavropoulou Charitini
Department of Health Care Management and Policy, Faculty of Business, Economics and Law, University of Surrey, Stagg Hill Campus, Guilford, Surrey GU2 7XH, United Kingdom.
Soc Sci Med. 2012 Jul;75(2):257-63. doi: 10.1016/j.socscimed.2012.02.056. Epub 2012 Apr 13.
This systematic review identifies the factors that both support and deter patients from being willing and able to participate actively in reducing clinical errors. Specifically, we add to our understanding of the safety culture in healthcare by engaging with the call for more focus on the relational and subjective factors which enable patients' participation (Iedema, Jorm, & Lum, 2009; Ovretveit, 2009). A systematic search of six databases, ten journals and seven healthcare organisations' web sites resulted in the identification of 2714 studies of which 68 were included in the review. These studies investigated initiatives involving patients in safety or studies of patients' perspectives of being actively involved in the safety of their care. The factors explored varied considerably depending on the scope, setting and context of the study. Using thematic analysis we synthesized the data to build an explanation of why, when and how patients are likely to engage actively in helping to reduce clinical errors. The findings show that the main factors for engaging patients in their own safety can be summarised in four categories: illness; individual cognitive characteristics; the clinician-patient relationship; and organisational factors. We conclude that illness and patients' perceptions of their role and status as subordinate to that of clinicians are the most important barriers to their involvement in error reduction. In sum, patients' fear of being labelled "difficult" and a consequent desire for clinicians' approbation may cause them to assume a passive role as a means of actively protecting their personal safety.
本系统评价确定了支持和阻碍患者愿意并能够积极参与减少临床错误的因素。具体而言，我们通过响应更多关注促进患者参与的关系性和主观性因素的呼吁（伊德马、乔姆和卢姆，2009年；奥夫雷特维特，2009年），加深了对医疗保健安全文化的理解。对六个数据库、十种期刊和七个医疗保健组织的网站进行系统检索后，共识别出2714项研究，其中68项被纳入本评价。这些研究调查了让患者参与安全事务的举措，或关于患者对积极参与自身护理安全的看法的研究。根据研究的范围、背景和环境，所探讨的因素差异很大。我们采用主题分析法对数据进行综合，以解释患者何时、为何以及如何可能积极参与帮助减少临床错误。研究结果表明，促使患者参与自身安全事务的主要因素可归纳为四类：疾病；个体认知特征；医患关系；以及组织因素。我们得出结论，疾病以及患者认为自己的角色和地位从属于临床医生的观念，是他们参与减少错误的最重要障碍。总之，患者担心被贴上“难相处”的标签，以及由此产生的对临床医生认可的渴望，可能导致他们采取被动角色，作为积极保护自身安全的一种方式。
