Dreismann Lara, Zambrano Sofia, Pfeiffer Yvonne, Schwappach David
Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
BMJ Open Qual. 2025 Aug 26;14(3):e003466. doi: 10.1136/bmjoq-2025-003466.
While patient safety is receiving increasing attention in healthcare services research and policies, it is mainly centred around prevention of physical harm. Preventable psychological harm (PPH) remains invisible in reports and quality measurements. As patients with cancer are particularly vulnerable due to the severity of their condition and therapies, they are exposed to risks such as non-physical adverse events. Recently, incidents of psychological harm have gained more attention in patient safety research, but a common and accepted definition and classification are missing.
We aimed to develop a common definition of PPH and a corresponding framework to classify events, settled within patient safety concepts and terminology.
Through a literature review, expert interviews from various healthcare backgrounds and workshops with patient representatives, we gathered information on PPH, which was reviewed and structured by an interdisciplinary research team (patient safety, psycho-oncology, palliative care research, nursing, organisational psychology). The final definition and framework were iteratively developed taking into account existing patient safety concepts.
The definition broadens the classification of PPH to include a wide range of commissions and omissions by individuals or organizational practices within the health care system. These actions and inactions result in consequences of varying severity for patients and their close ones. The framework complements the definition of PPH, including those impacted by PPH, types of PPH, potential causes and contributing factors, vulnerabilities influencing severity and occurrence, moderating factors for mitigation and negative consequences of PPH.
Defining and classifying PPH is the first step to make it accessible for measurement, analysis and prevention. Its integration within patient safety terminology is important to ensure uptake and integration in research and practice.
虽然患者安全在医疗服务研究和政策中受到越来越多的关注，但主要集中在预防身体伤害方面。可预防的心理伤害（PPH）在报告和质量衡量中仍然未被重视。由于癌症患者病情严重且接受多种治疗，他们特别容易受到非身体不良事件等风险的影响。最近，心理伤害事件在患者安全研究中受到了更多关注，但缺少一个通用且被认可的定义和分类。
我们旨在制定PPH的通用定义以及相应的事件分类框架，该框架基于患者安全概念和术语。
通过文献综述、来自不同医疗背景的专家访谈以及与患者代表的研讨会，我们收集了有关PPH的信息，由一个跨学科研究团队（患者安全、心理肿瘤学、姑息治疗研究、护理、组织心理学）进行审查和梳理。最终的定义和框架在考虑现有患者安全概念的基础上经过反复完善。
该定义拓宽了PPH的分类范围，涵盖了医疗系统内个人或组织行为的各种作为和不作为。这些行为和不作为会给患者及其亲人带来不同严重程度的后果。该框架对PPH的定义进行了补充，包括受PPH影响的人群、PPH的类型、潜在原因和促成因素、影响严重程度和发生情况的脆弱性、减轻影响的调节因素以及PPH的负面后果。
定义和分类PPH是使其能够进行衡量、分析和预防的第一步。将其纳入患者安全术语对于确保在研究和实践中得到应用和整合非常重要。
