Dan Le, Charles H Lim, Rouhi Fazelzad, Lyndon Morley, Jean-Pierre Bissonnette, Melanie Powis, Monika K Krzyzanowska
{"title":"Interventions to Promote Safety Culture in Cancer Care: A Systematic Review.","authors":"Dan Le, Charles H Lim, Rouhi Fazelzad, Lyndon Morley, Jean-Pierre Bissonnette, Melanie Powis, Monika K Krzyzanowska","doi":"10.1097/PTS.0000000000001181","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>There is limited guidance on how to effectively promote safety culture in health care settings. We performed a systematic review to identify interventions to promote safety culture, specifically in oncology settings.</p><p><strong>Methods: </strong>Medical Subject Headings and text words for \"safety culture\" and \"cancer care\" were combined to conduct structured searches of MEDLINE, EMBASE, CDSR, CINAHL, Cochrane CENTRAL, PsycINFO, Scopus, and Web of Science for peer-reviewed articles published from 1999 to 2021. To be included, articles had to evaluate a safety culture intervention in an oncology setting using a randomized or nonrandomized, pre-post (controlled or uncontrolled), interrupted time series, or repeated-measures study design. The review followed PRISMA guidelines; quality of included citations was assessed using the ROBINS-I risk of bias tool.</p><p><strong>Results: </strong>Eighteen articles meeting the inclusion criteria were retained, reporting on interventions in radiation (14 of 18), medical (3 of 18), or general oncology (1 of 18) settings. Articles most commonly addressed incident learning systems (7 of 18), lean initiatives (4 of 18), or quality improvement programs (3 of 18). Although 72% of studies reported improvement in safety culture, there was substantial heterogeneity in the evaluation approach; rates of reporting of adverse events (9 of 18) or Agency for Healthcare Research and Quality Safety Culture survey results (9 of 18) were the most commonly used metrics. Most of the studies had moderate (28%) or severe (67%) risk of bias.</p><p><strong>Conclusions: </strong>Despite a growing evidence base describing interventions to promote safety culture in cancer care, definitive recommendations were difficult to make because of heterogeneity in study designs and outcomes. Implementation of incident learning systems seems to hold most promise.</p>","PeriodicalId":48901,"journal":{"name":"Journal of Patient Safety","volume":null,"pages":null},"PeriodicalIF":1.7000,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Patient Safety","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/PTS.0000000000001181","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2023/12/1 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"HEALTH CARE SCIENCES & SERVICES","Score":null,"Total":0}
引用次数: 0
Abstract
Objectives: There is limited guidance on how to effectively promote safety culture in health care settings. We performed a systematic review to identify interventions to promote safety culture, specifically in oncology settings.
Methods: Medical Subject Headings and text words for "safety culture" and "cancer care" were combined to conduct structured searches of MEDLINE, EMBASE, CDSR, CINAHL, Cochrane CENTRAL, PsycINFO, Scopus, and Web of Science for peer-reviewed articles published from 1999 to 2021. To be included, articles had to evaluate a safety culture intervention in an oncology setting using a randomized or nonrandomized, pre-post (controlled or uncontrolled), interrupted time series, or repeated-measures study design. The review followed PRISMA guidelines; quality of included citations was assessed using the ROBINS-I risk of bias tool.
Results: Eighteen articles meeting the inclusion criteria were retained, reporting on interventions in radiation (14 of 18), medical (3 of 18), or general oncology (1 of 18) settings. Articles most commonly addressed incident learning systems (7 of 18), lean initiatives (4 of 18), or quality improvement programs (3 of 18). Although 72% of studies reported improvement in safety culture, there was substantial heterogeneity in the evaluation approach; rates of reporting of adverse events (9 of 18) or Agency for Healthcare Research and Quality Safety Culture survey results (9 of 18) were the most commonly used metrics. Most of the studies had moderate (28%) or severe (67%) risk of bias.
Conclusions: Despite a growing evidence base describing interventions to promote safety culture in cancer care, definitive recommendations were difficult to make because of heterogeneity in study designs and outcomes. Implementation of incident learning systems seems to hold most promise.
目的:关于如何在卫生保健环境中有效促进安全文化的指导有限。我们进行了系统回顾,以确定促进安全文化的干预措施,特别是在肿瘤学环境中。方法:结合医学主题标题和“安全文化”和“癌症护理”的文本词,在MEDLINE、EMBASE、CDSR、CINAHL、Cochrane CENTRAL、PsycINFO、Scopus和Web of Science中进行结构化检索,检索1999年至2021年发表的同行评议文章。纳入的文章必须采用随机或非随机、前后(对照或非对照)、中断时间序列或重复测量研究设计来评估肿瘤学环境中的安全培养干预。审查遵循PRISMA准则;使用ROBINS-I偏倚风险工具评估纳入引文的质量。结果:18篇符合纳入标准的文章被保留下来,报道了放疗(18篇中的14篇)、医学(18篇中的3篇)或普通肿瘤学(18篇中的1篇)方面的干预措施。文章最常见的是讨论事件学习系统(18篇中的7篇),精益计划(18篇中的4篇),或者质量改进计划(18篇中的3篇)。尽管72%的研究报告了安全培养的改善,但评估方法存在很大的异质性;不良事件报告率(18个中的9个)或卫生保健研究和质量安全文化机构调查结果(18个中的9个)是最常用的指标。大多数研究有中度(28%)或重度(67%)偏倚风险。结论:尽管越来越多的证据基础描述了在癌症治疗中促进安全文化的干预措施,但由于研究设计和结果的异质性,很难提出明确的建议。事件学习系统的实施似乎最有希望。
期刊介绍:
Journal of Patient Safety (ISSN 1549-8417; online ISSN 1549-8425) is dedicated to presenting research advances and field applications in every area of patient safety. While Journal of Patient Safety has a research emphasis, it also publishes articles describing near-miss opportunities, system modifications that are barriers to error, and the impact of regulatory changes on healthcare delivery. This mix of research and real-world findings makes Journal of Patient Safety a valuable resource across the breadth of health professions and from bench to bedside.