Marie Curie Palliative Care Research Department, University College London, London, UK.
Central and North West London NHS Foundation Trust, London, UK.
BMJ Open. 2021 Sep 13;11(9):e048696. doi: 10.1136/bmjopen-2021-048696.
Approximately 20% of serious safety incidents involving palliative patients relate to medication. These are disproportionately reported when patients are in their usual residence when compared with hospital or hospice. While patient safety incident reporting systems can support professional learning, it is unclear whether these reports encompass patient and carer concerns with palliative medications or interpersonal safety.
To explore and compare perceptions of (un)safe palliative medication management from patient, carer and professional perspectives in community, hospital and hospice settings.
We will use an innovative mixed-methods study design combining systematic review searching techniques with cross-sectional quantitative descriptive analysis and interpretative qualitative metasynthesis to integrate three elements: (1) Scoping review: multiple database searches for empirical studies and first-hand experiences in English (no other restrictions) to establish how patients and informal carers conceptualise safety in palliative medication management. (2)Medication incidents from the England and Wales National Reporting and Learning System: identifying and characterising reports to understand professional perspectives on suboptimal palliative medication management. (3) Comparison of 1 and 2: contextualising with stakeholder perspectives.
Our team includes a funded patient and public involvement (PPI) collaborator, with experience of promoting patient-centred approaches in patient safety research. Funded discussion and dissemination events with PPI and healthcare (clinical and policy) professionals are planned.
Prospective ethical approval granted: Cardiff University School of Medicine Research Ethics Committee (Ref 19/28). Our study will synthesise multivoiced constructions of patient safety in palliative care to identify implications for professional learning and actions that are relevant across health and social care. It will also identify changing or escalating patterns in palliative medication incidents due to the COVID-19 pandemic. Peer-reviewed publications, academic presentations, plain English summaries, press releases and social media will be used to disseminate to the public, researchers, clinicians and policy-makers.
约 20%的涉及姑息治疗患者的严重安全事件与药物有关。与医院或临终关怀机构相比，当患者在其常住地时，这些事件的报告比例不成比例。虽然患者安全事件报告系统可以支持专业学习，但尚不清楚这些报告是否包含患者和护理人员对姑息治疗药物或人际安全的担忧。
探讨并比较社区、医院和临终关怀环境中患者、护理人员和专业人员对（不安全）姑息治疗药物管理的看法。
我们将采用一种创新的混合方法研究设计，结合系统综述搜索技术与横断面定量描述性分析和解释性定性荟萃综合，整合三个要素：（1）范围综述：多数据库搜索英文实证研究和第一手经验（无其他限制），以确定患者和非正规护理人员如何理解姑息治疗药物管理中的安全性。（2）英格兰和威尔士国家报告和学习系统中的药物事件：识别和描述报告，以了解专业人员对姑息治疗药物管理不理想的看法。（3）1 和 2 的比较：从利益相关者的角度进行背景化。
我们的团队包括一位有资金支持的患者和公众参与（PPI）合作者，他在促进以患者为中心的患者安全研究方法方面具有丰富的经验。计划与 PPI 和医疗保健（临床和政策）专业人员进行有资金支持的讨论和传播活动。
已获得前瞻性伦理批准：卡迪夫大学医学院研究伦理委员会（Ref 19/28）。我们的研究将综合姑息治疗中患者安全的多方面构建，以确定对专业学习和行动的影响，这些影响与卫生和社会保健相关。它还将确定由于 COVID-19 大流行导致姑息治疗药物事件的变化或升级模式。同行评议的出版物、学术演讲、通俗易懂的摘要、新闻稿和社交媒体将用于向公众、研究人员、临床医生和政策制定者传播。
