53 results found
Archer S, Donoso FS, Carver T, et al., 2023, Exploring the barriers to and facilitators of implementing CanRisk in primary care: a qualitative thematic framework analysis., Br J Gen Pract, Vol: 73, Pages: e586-e596
BACKGROUND: The CanRisk tool enables the collection of risk factor information and calculation of estimated future breast cancer risks based on the multifactorial Breast and Ovarian Analysis of Disease Incidence and Carrier Estimation Algorithm (BOADICEA) model. Despite BOADICEA being recommended in National Institute for Health and Care Excellence (NICE) guidelines and CanRisk being freely available for use, the CanRisk tool has not yet been widely implemented in primary care. AIM: To explore the barriers to and facilitators of the implementation of the CanRisk tool in primary care. DESIGN AND SETTING: A multi-methods study was conducted with primary care practitioners (PCPs) in the East of England. METHOD: Participants used the CanRisk tool to complete two vignette-based case studies; semi-structured interviews gained feedback about the tool; and questionnaires collected demographic details and information about the structural characteristics of the practices. RESULTS: Sixteen PCPs (eight GPs and eight nurses) completed the study. The main barriers to implementation included: time needed to complete the tool; competing priorities; IT infrastructure; and PCPs' lack of confidence and knowledge to use the tool. Main facilitators included: easy navigation of the tool; its potential clinical impact; and the increasing availability of and expectation to use risk prediction tools. CONCLUSION: There is now a greater understanding of the barriers and facilitators that exist when using CanRisk in primary care. The study has highlighted that future implementation activities should focus on reducing the time needed to complete a CanRisk calculation, integrating the CanRisk tool into existing IT infrastructure, and identifying appropriate contexts in which to conduct a CanRisk calculation. PCPs may also benefit from information about cancer risk assessment and CanRisk-specific training.
Snudden CM, Calanzani N, Archer S, et al., 2023, Can we do better? A qualitative study in the East of England investigating patient experience and acceptability of using the faecal immunochemical test in primary care., BMJ Open, Vol: 13
OBJECTIVES: The faecal immunochemical test (FIT) is increasingly used in UK primary care to triage patients presenting with symptoms and at different levels of colorectal cancer risk. Evidence is scarce on patients' views of using FIT in this context. We aimed to explore patients' care experience and acceptability of using FIT in primary care. DESIGN: A qualitative semi-structured interview study. Interviews were conducted via Zoom between April and October 2020. Transcribed recordings were analysed using framework analysis. SETTING: East of England general practices. PARTICIPANTS: Consenting patients (aged ≥40 years) who presented in primary care with possible symptoms of colorectal cancer, and for whom a FIT was requested, were recruited to the FIT-East study. Participants were purposively sampled for this qualitative substudy based on age, gender and FIT result. RESULTS: 44 participants were interviewed with a mean age 61 years, and 25 (57%) being men: 8 (18%) received a positive FIT result. Three themes and seven subthemes were identified. Participants' familiarity with similar tests and perceived risk of cancer influenced test experience and acceptability. All participants were happy to do the FIT themselves and to recommend it to others. Most participants reported that the test was straightforward, although some considered it may be a challenge to others. However, test explanation by healthcare professionals was often limited. Furthermore, while some participants received their results quickly, many did not receive them at all with the common assumption that 'no news is good news'. For those with a negative result and persisting symptoms, there was uncertainty about any next steps. CONCLUSIONS: While FIT is acceptable to patients, elements of communication with patients by the healthcare system show potential for improvement. We suggest possible ways to improve the FIT experience, particularly regarding communication about the test and its results.
Hardy V, Usher-Smith J, Archer S, et al., 2023, Agreement between patient's description of abdominal symptoms of possible upper gastrointestinal cancer and general practitioner consultation notes: a qualitative analysis of video-recorded UK primary care consultation data., BMJ Open, Vol: 13
INTRODUCTION: Abdominal symptoms are common in primary care but infrequently might be due to an upper gastrointestinal (UGI) cancer. Patients' descriptions may differ from medical terminology used by general practitioners (GPs). This may affect how information about abdominal symptoms possibly due to an UGI cancer are documented, creating potential missed opportunities for timely investigation. OBJECTIVES: To explore how abdominal symptoms are communicated during primary care consultations, and identify characteristics of patients' descriptions that underpin variation in the accuracy and completeness with which they are documented in medical records. METHODS AND ANALYSIS: Primary care consultation video recordings, transcripts and medical records from an existing dataset were screened for adults reporting abdominal symptoms. We conducted a qualitative content analysis to capture alignments (medical record entries matching patient verbal and non-verbal descriptions) and misalignments (symptom information omitted or differing from patient descriptions). Categories were informed by the Calgary-Cambridge guide's 'gathering information' domains and patterns in descriptions explored. RESULTS: Our sample included 28 consultations (28 patients with 18 GPs): 10 categories of different clinical features of abdominal symptoms were discussed. The information GPs documented about these features commonly did not match what patients described, with misalignments more common than alignments (67 vs 43 instances, respectively). Misalignments often featured patients using vague descriptors, figurative speech, lengthy explanations and broad hand gestures. Alignments were characterised by patients using well-defined terms, succinct descriptions and precise gestures for symptoms with an exact location. Abdominal sensations reported as 'pain' were almost always documented compared with expressions of 'discomfort'. CONCLUSIONS: Abdominal symptoms that are well defined or communicated as 'p
Ravindran S, Cavilla R, Ashrafian H, et al., 2022, Development of the "Teamwork in Endoscopy Assessment Module for Endoscopic Non-Technical Skills" (TEAM-ENTS) behavioral marker system, ENDOSCOPY, ISSN: 0013-726X
Barrow E, Lear RA, Morbi A, et al., 2022, How do hospital inpatients conceptualise patient safety? A qualitative interview study using constructivist grounded theory, BMJ QUALITY & SAFETY, ISSN: 2044-5415
Bielinska A-M, Soosaipillai G, Riley J, et al., 2022, Views of advance care planning in older hospitalized patients following an emergency admission: A qualitative study, PLOS ONE, Vol: 17, ISSN: 1932-6203
Merriel S, Archer S, Forster A, et al., 2022, Experiences of ‘traditional’ and ‘one-stop’ MRI-based prostate cancer diagnostic pathways in England: a qualitative study with patients and GPs, BMJ Open, ISSN: 2044-6055
Archer S, Fennell N, Colvin E, et al., 2022, Personalised Risk Prediction in Hereditary Breast and Ovarian Cancer: A Protocol for a Multi-Centre Randomised Controlled Trial, CANCERS, Vol: 14
Bielinska A, Archer S, Darzi A, et al., 2022, Co-designing an intervention to increase uptake of Advance Care Planning in later life following emergency hospitalisation: a research protocol using Accelerated Experience-Based Co-design (AEBCD) and The Behaviour Change Wheel (BCW)., BMJ Open, Vol: 12, Pages: 1-7, ISSN: 2044-6055
Introduction: Despite the potential benefits of advance care planning, uptake in older adults is low. In general, there is a lack of guidance as to how to initiate advance care planning conversations and encourage individuals to take action in planning their future care, including after emergency hospitalisation. Participatory action research methods are harnessed in health services research to design interventions that are relevant to end-users and stakeholders. This study aims to involve older persons, carers and healthcare professionals in co-designing an intervention to increase uptake of advance care planning in later life, which can be used by social contacts and healthcare professionals, particularly in the context of a recent emergency hospitalisation.Methods and analysis: The theory-driven participatory design research method integrates and adapts Accelerated Experience-Based Co-Design with the Behaviour Change Wheel, in the form of a collaborative multi-stakeholder co-design workshop. In total, 12 participants, comprising 4 lay persons aged 70+, 4 carers and 4 healthcare professionals with experience in elder care, will be recruited to participate in two online half-day sessions, together comprising one online workshop. There will be a maximum of 2 workshops. Firstly, in the discovery phase, participants will reflect on findings from earlier qualitative research on views and experiences of advance care planning from three workstreams: patients, carers, and healthcare professionals. Secondly, in the co-design phase, participants will explore practical mechanisms in which older persons aged 70+ can be encouraged to adopt advance care planning behaviours based on the Behaviour Change Wheel, in order to co-design a behavioural intervention to increase uptake of advance care planning in older adults after an emergency hospitalisation.Ethics and dissemination: Ethical approval has been obtained from the Science Engineering Technology Research Ethics Committee at
Joshi M, Archer S, Morbi A, et al., 2022, Perceptions on the use of wearable sensors and continuous monitoring in surgical patients: interview study among surgical staff, JMIR Formative Research, Vol: 6, Pages: 1-9, ISSN: 2561-326X
BACKGROUND: Continuous vital sign monitoring by using wearable sensors may result in the earlier detection of patient deterioration and sepsis. Few studies have explored the perspectives of surgical team members on the use of such sensors in surgical patients. OBJECTIVE: This study aims to understand the views of surgical team members regarding novel wearable sensors for surgical patients. METHODS: Wearable sensors that monitor vital signs (heart rate, respiratory rate, and temperature) continuously were used by acute surgical patients. The opinions of surgical staff who were treating patients with these sensors were collated through in-depth semistructured interviews to thematic saturation. Interviews were audio recorded, transcribed, and analyzed via thematic analysis. RESULTS: A total of 48 interviews were performed with senior and junior surgeons and senior and junior nurses. The main themes of interest that emerged from the interviews were (1) problems with current monitoring, (2) the anticipated impact of wearables on patient safety, (3) the impact on staff, (4) the impact on patients overall, (5) potential new changes, and (6) the future and views on technology. CONCLUSIONS: Overall, the feedback from staff who were continuously monitoring surgical patients via wearable sensors was positive, and relatively few concerns were raised. Surgical staff members identify problems with current monitoring and anticipate that sensors will both improve patient safety and be the future of monitoring.
King L, Matthews S, Foster C, et al., 2022, 'A fascinating time to be involved with research' exploring the impact of COVID-19 on postgraduate psycho-oncology researchers, PSYCHO-ONCOLOGY, Vol: 31, Pages: 671-675, ISSN: 1057-9249
LeBoutillier C, Urch C, King A, et al., 2022, ‘Still living with it even though it’s gone’: Using Interpretive Phenomenological Analysis to explore shared experiences of living with and beyond breast, prostate, and colorectal cancer, European Journal of Oncology Nursing (EJON), Vol: 56, ISSN: 1462-3889
Purpose:Living with and beyond cancer is an increasingly common experience. While research is uncovering valuable individual experiences of those living with and beyond cancer, it has been argued that this idiographic approach is limited in outlook, reach and impact. This study contributes to the understanding of what it means to live with and beyond cancer by complementing idiographic knowledge with multiple perspectives from a group of participants who are living with and beyond cancer, to explore how individual experiences may be relevant to others.Method:Semi-structured interviews were conducted with people who had received treatment for breast (n = 6), prostate (n = 6) or colorectal cancer (n = 6). Data were analysed using interpretive phenomenological analysis. The early findings were then shared with a wider group of people who had received treatment for breast, prostate or colorectal cancer (n = 26) in six focus groups, to explore whether they had similar experiences.Results:While individual accounts of living with and beyond cancer detail unique features specific to each person's experience, focus group discussions illustrated how participant life worlds interact and overlap. The findings identified thematic similarities within and between individual and group levels and across cancer types. Three super-ordinate themes describe the shared experience of living with and beyond cancer: i) the cancer shock, ii) managing cancer and getting through and iii) getting over cancer.Conclusions:A multiple perspective approach informs our understanding of shared experiences of living with and beyond cancer. This knowledge can be used to direct, design, and deliver relevant supportive cancer care.
Bielinska A, Archer S, Soosaipillai G, et al., 2022, Views of advance care planning in caregivers of older hospitalised patients following an emergency admission: a qualitative study, Journal of Health Psychology, Vol: 27, Pages: 432-444, ISSN: 1359-1053
This study explores the views of advance care planning in caregivers of older hospitalised patients following an emergency admission. Semi-structured interviews were conducted with eight carers, mostly with a personal relationship to the older patient. Thematic analysis generated three themes: (1) working with uncertainty – it all sounds very fine. . . what is the reality?, (2) supporting the older person – you have to look at it on an individual basis and (3) enabling the process – when you do it properly. The belief that advance care planning can support older individuals and scepticism whether advance care planning can be enabled among social and healthcare challenges are discussed.
Hardy V, Yue A, Archer S, et al., 2022, The role of Primary Care Physician factors on diagnostic testing and referral decisions for symptoms of possible cancer: a systematic review, BMJ Open, ISSN: 2044-6055
Chen B, Galus T, Archer S, et al., 2021, Capturing the experiences of patients with inherited optic neuropathies: A systematic review of Patient-Reported Outcome Measures (PROMs) and qualitative studies, Graefe's Archive for Clinical and Experimental Ophthalmology, ISSN: 0721-832X
Archer S, Cheung NHY, Williams I, et al., 2021, The impact of digital health interventions on the psychological outcomes of patients and families receiving paediatric palliative care: a systematic review and narrative synthesis, Palliative Medicine, Vol: 35, Pages: 2017-2023, ISSN: 0269-2163
Background:Digital health interventions are becoming increasingly important and may be particularly relevant for paediatric palliative care. In line with the aims of palliative care, digital health interventions should aim to maintain, if not improve, psychological wellbeing. However, the extent to which the psychological outcomes of digital health interventions are assessed is currently unknown.Aim:To identify and synthesise the literature exploring the impact of all digital health interventions on the psychological outcomes of patients and families receiving paediatric palliative care.Design:Systematic review and narrative synthesis.Data sources:MEDLINE, EMBASE, Health Management Information Consortium, PsycINFO, Cumulative Index to Nursing and Allied Health Literature and the Midwives Information & Resource Service were searched on the 27th July 2020, in addition to the first five pages of Google Scholar. To be included in the review, papers must have contained: quantitative or qualitative data on psychosocial outcomes, data from patients aged 0–18 receiving palliative care or their families, a digital health intervention, and been written in English.Results:Three studies were included in the review. All looked at the psychological impact of telehealth interventions. Papers demonstrated fair or good quality reporting but had small sample sizes and varied designs.Conclusions:Despite the design and development of digital health interventions that span the technological landscape, little research has assessed their psychosocial impact in the paediatric palliative care community. Whilst the evidence base around the role of these interventions continues to grow, their impact on children and their families must not be overlooked.
Arora S, Tsang F, Kekecs Z, et al., 2021, Patient Safety Education 20 years after the Institute of Medicine Report: results from a cross-sectional National Survey, Journal of Patient Safety, Vol: 17, Pages: 1884-1888, ISSN: 1549-8417
Objectives Educating healthcare professionals in patient safety is essential to achieving sustainable improvements in care. This study aimed to identify the key constituents of patient safety education alongside its facilitators and barriers from a frontline perspective.Methods An electronic survey was sent to 592 healthcare professionals and educators in patient safety education in the United Kingdom. Two independent reviewers conducted a thematic analysis of the free-text data. Themes focused on effective content, learning practices and facilitators and barriers to patient safety education.Results Of 592 individuals completing the survey, 545 (92%) submitted analyzable responses. Interrater reliability of coding was high with Cohen k value of 0.86. Participants endorsed experiential and interactive learning as ideal modalities for delivery and expressed a need for content to be based on real clinical cases and tailored to the needs of the learners. The most commonly mentioned facilitators were standardization of methods and assessment (49%), dedicated funding (21%), and culture of openness (20%). Staffing problems and high workload (41%) and lack of accessibility of training (23%) were identified as primary barriers of efficacy and uptake.Conclusions This study identified key factors to the success of patient safety education in terms of content and delivery alongside facilitators and barriers. Future curricula developers and interventions should improve standardization, funding, culture, and access so as to optimize education programs to enhance patient safety.
Archer S, Calanzani N, Honey S, et al., 2021, Impact of the COVID-19 pandemic on cancer assessment in primary care: a qualitative study of GP views, British Journal of General Practice Open, ISSN: 2398-3795
Wedderburn S, Archer S, Tischkowitz M, et al., 2021, Update: Variable implementation of the 2018 UKCGG/UKGTN guidelines for breast cancer gene panel tests offered by UK genetics services, Journal of Medical Genetics, Vol: 58, Pages: 579-580, ISSN: 0022-2593
Lee A, Yang X, Tyrer J, et al., 2021, A Comprehensive Epithelial Tubo-Ovarian Cancer Risk Prediction Model Incorporating Genetic and Epidemiological Risk Factors, Journal of Medical Genetics, ISSN: 0022-2593
Joshi M, Archer S, Morbi A, et al., 2021, Short-term wearable sensors for in-hospital medical and surgical patients: mixed methods analysis of patient perspectives, JMIR Perioperative Medicine, Vol: 4, ISSN: 2561-9128
Background: Continuous vital sign monitoring using wearable sensors may enable early detection of patient deterioration and sepsis.Objective: This study aimed to explore patient experiences with wearable sensor technology and carry out continuous monitoring through questionnaire and interview studies in an acute hospital setting.Methods: Patients were recruited for a wearable sensor study and were asked to complete a 9-item questionnaire. Patients responses were evaluated using a Likert scale and with continuous variables. A subgroup of surgical patients wearing a Sensium Vital Sign Sensor was invited to participate in semistructured interviews. The Sensium wearable sensor measures the vital signs: heart rate, respiratory rate, and temperature. All interview data were subjected to thematic analysis.Results: Out of a total of 500 patients, 453 (90.6%) completed the questionnaire. Furthermore, 427 (85.4%) patients agreed that the wearable sensor was comfortable, 429 (85.8%) patients agreed to wear the patch again when in hospital, and 398 (79.6%) patients agreed to wear the patch at home. Overall, 12 surgical patients consented to the interviews. Five main themes of interest to patients emerged from the interviews: (1) centralized monitoring, (2) enhanced feelings of patient safety, (3) impact on nursing staff, (4) comfort and usability, and (5) future use and views on technology.Conclusions: Overall, the feedback from patients using wearable monitoring sensors was strongly positive with relatively few concerns raised. Patients felt that the wearable sensors would improve their sense of safety, relieve pressure on health care staff, and serve as a favorable aspect of future health care technology.
Bielinska A, Archer S, Obanobi A, et al., 2021, Advance care planning in older hospitalised patients following an emergency admission: a mixed methods study, PLoS One, Vol: 16, Pages: 1-14, ISSN: 1932-6203
Introduction: Although advance care planning may be beneficial for older adults in the last year of life, its relevance following an emergency hospitalisation requires further investigation. This study quantifies the one-year mortality outcomes of all emergency admissions for patients aged 70+ years and explores patient views on the value of advance care planning following acute hospitalisation.Method: This mixed methods study used a two-stage approach: firstly, a quantitative longitudinal cohort study exploring the one-year mortality of patients aged 70+ admitted as an emergency to a large multi-centre hospital cohort; secondly, a qualitative semi-structured interview study gathering information on patient views of advance care planning.Results: There were 14,260 emergency admissions for 70+-year olds over a 12-month period. One-year mortality for admissions across all conditions was 22.6%. The majority of these deaths (59.3%) were within 3 months of admission. Binary logistic regression analysis indicated higher one-year mortality with increasing age and male sex. Interviews with 20 patients resulted in one superordinate theme, “Planning for health and wellbeing in the spectrum of illness”. Sub-themes entitled (1) Advance care planning benefitting healthcare for physical and psycho-social health, (2) Contemplation of physical deterioration death and dying and 3) Collaborating with healthcare professionals to undertake advance care planning, suggest that views of advance care planning are shaped by experiences of acute hospitalisation.Conclusion: Since approximately 1 in 5 patients aged 70+ admitted to hospital as an emergency are in the last year of life, acute hospitalisation can act as a trigger for tailored ACP. Older hospitalised patients believe that advance care planning can benefit physical and psychosocial health and that discussions should consider a spectrum of possibilities, from future health to the potential of chronic illness, disability
Carver T, Hartley S, Lee A, et al., 2020, CanRisk Tool - A web interface for the prediction of breast and ovarian cancer risk and the likelihood of carrying genetic pathogenic variants., Cancer Epidemiology, Biomarkers and Prevention, ISSN: 1055-9965
Archer S, Holch T, Armes J, et al., 2020, ‘No turning back’ Psycho-oncology in the time of COVID-19 - insights from a survey of UK professionals, Psycho-Oncology: journal of the psychological, social and behavioral dimensions of cancer, Vol: 29, Pages: 1430-1435, ISSN: 1057-9249
Soosaipillai G, Archer S, Ashrafian H, et al., 2020, Breaking bad news training in the COVID-19 era and beyond, Journal of Medical Education and Curricular Development, Vol: 7, Pages: 1-4, ISSN: 2382-1205
COVID-19 has disrupted the status quo for healthcare education. As a result, redeployed doctors and nurses are caring for patients at the end of their lives and breaking bad news with little experience or training. This article aims to understand why redeployed doctors and nurses feel unprepared to break bad news through a content analysis of their training curricula. As digital learning has come to the forefront in health care education during this time, relevant digital resources for breaking bad news training are suggested.
Montague J, Phillips E, Holland F, et al., 2020, Expanding Hermeneutic Horizons: Working as Multiple Researchers and with Multiple Participants, Research Methods in Medicine & Health Sciences
Archer S, Thibaut B, Dewa L, et al., 2020, Barriers and facilitators to incident reporting in mental healthcare settings: a qualitative study, Journal of Psychiatric and Mental Health Nursing, Vol: 27, Pages: 211-223, ISSN: 1351-0126
IntroductionBarriers and facilitators to incident reporting have been widely researched in general healthcare. However, it is unclear if the findings are applicable to mental healthcare where care is increasingly complex.AimTo investigate if barriers and facilitators affecting incident reporting in mental healthcare are consistent with factors identified in other healthcare settings.MethodData were collected from focus groups (n=8) with 52 members of staff from across [a large Mental Health] Trust and analysed with thematic analysis.ResultsFive themes were identified during the analysis. Three themes (i)learning and improvement, (ii)time, and (iii)fear were consistent with the existing wider literature on barriers and facilitators to incident reporting. Two further themes (iv)interaction between patient diagnosis and incidents and (v)aftermath of an incident – prosecution specifically linked to the provision of mental healthcare.ConclusionsWhilst some barriers and facilitators to incident reporting identified in other settings are also prevalent in the mental healthcare setting, the increased incidence of violent and aggressive behaviour within mental healthcare presents a unique challenge for incident reporting.Clinical ImplicationsAlthough Interventions to improve incident reporting may be adapted/adopted from other settings, there is a need to develop specific interventions to improve reporting of violent and aggressive incidents.
Archer S, Babb de Villiers C, Scheibl F, et al., 2020, Evaluating clinician acceptability of the prototype CanRisk tool for predicting risk of breast and ovarian cancer: a multi-methods study, PLoS One, Vol: 15, ISSN: 1932-6203
BackgroundThere is a growing focus on the development of multi-factorial cancer risk prediction algorithms alongside tools that operationalise them for clinical use. BOADICEA is a breast and ovarian cancer risk prediction model incorporating genetic and other risk factors. A new user-friendly Web-based tool (CanRisk.org) has been developed to apply BOADICEA. This study aimed to explore the acceptability of the prototype CanRisk tool among two healthcare professional groups to inform further development, evaluation and implementation.MethodA multi-methods approach was used. Clinicians from primary care and specialist genetics clinics in England, France and Germany were invited to use the CanRisk prototype with two test cases (either face-to-face with a simulated patient or via a written vignette). Their views about the tool were examined via a semi-structured interview or equivalent open-ended questionnaire. Qualitative data were subjected to thematic analysis and organised around Sekhon’s Theoretical Framework of Acceptability.ResultsSeventy-five clinicians participated, 21 from primary care and 54 from specialist genetics clinics. Participants were from England (n = 37), France (n = 23) and Germany (n = 15). The prototype CanRisk tool was generally acceptable to most participants due to its intuitive design. Primary care clinicians were concerned about the amount of time needed to complete, interpret and communicate risk information. Clinicians from both settings were apprehensive about the impact of the CanRisk tool on their consultations and lack of opportunities to interpret risk scores before sharing them with their patients.ConclusionsThe findings highlight the challenges associated with developing a complex tool for use in different clinical settings; they also helped refine the tool. This prototype may not have been versatile enough for clinical use in both primary care and specialist genetics clinics where the needs of clinicians are different, emphas
Thibaut B, Dewa L, Ramtale S, et al., 2019, Patient safety in inpatient mental health settings: a systematic review, BMJ Open, Vol: 9, Pages: 1-19, ISSN: 2044-6055
Objectives: Patients in inpatient mental health settings face similar risks to those in other areas of health care (e.g. medication errors). In addition, some unsafe behaviours associated with serious mental health problems (e.g. self-harm), and the measures taken to address these (e.g. restraint), may result in further risks to patient safety. The objective of this review is to identify and synthesise the literature on patient safety within inpatient mental health settings using robust systematic methodology. Design: Systematic review and meta-synthesis. Embase, CINAHL, HMIC, MEDLINE, PsycINFO and Web of Science were systematically searched from 1999 to 2019. Search terms were related to “mental health”, “patient safety”, “inpatient setting” and “research”. Study quality was assessed using the Hawker checklist. Data was extracted and grouped based on study focus and outcome. Safety incidents were meta-analysed where possible using a random effects model.Results: Of the 57,637 article titles and abstracts, 364 met inclusion criteria. Included publications came from 31 countries and included data from over 150,000 participants. Study quality varied and statistical heterogeneity was high. Ten research categories were identified: interpersonal violence, coercive interventions, safety culture, harm to self, safety of the physical environment, medication safety, unauthorised leave, clinical decision making, falls and infection prevention and control. Conclusions: Patient safety in inpatient mental health settings is under researched in comparison to other non-mental health inpatient settings. Findings demonstrate that inpatient mental health settings pose unique challenges for patient safety which require investment in research, policy development, and translation into clinical practice.
Reynolds J, Archer S, Pilling M, et al., 2019, Public acceptability of nudging and taxing to reduce consumption of alcohol, tobacco, and food: A population-based survey experiment, Social Science and Medicine, Vol: 236, Pages: 1-10, ISSN: 0277-9536
There is growing evidence for the effectiveness of choice architecture or ‘nudge’ interventions to change a range of behaviours including the consumption of alcohol, tobacco and food. Public acceptability is key to implementing these and other interventions. However, few studies have assessed public acceptability of these interventions, including the extent to which acceptability varies with the type of intervention, the target behaviour and with evidence of intervention effectiveness. These were assessed in an online study using a between-participants full factorial design with three factors: Policy (availability vs size vs labelling vs tax) x Behaviour (alcohol consumption vs tobacco use vs high-calorie snack food consumption) x Evidence communication (no message vs assertion of policy effectiveness vs assertion and quantification of policy effectiveness [e.g., a 10% change in behaviour]). Participants (N = 7058) were randomly allocated to one of the 36 groups. The primary outcome was acceptability of the policy. Acceptability differed across policy, behaviour and evidence communication (all ps < .001). Labelling was the most acceptable policy (supported by 78%) and Availability the least (47%). Tobacco use was the most acceptable behaviour to be targeted by policies (73%) compared with policies targeting Alcohol (55%) and Food (54%). Relative to the control group (60%), asserting evidence of effectiveness increased acceptability (63%); adding a quantification to this assertion did not significantly increase this further (65%). Public acceptability for nudges and taxes to improve population health varies with the behaviour targeted and the type of intervention but is generally favourable. Communicating that these policies are effective can increase support by a small but significant amount, suggesting that highlighting effectiveness could contribute to mobilising public demand for policies. While uncertainty remains about the strength of public supp
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