Creating safer cancer care with ethnic minority patients: A qualitative analysis of the experiences of cancer service staff

Perceptions and Experiences of Consumer Representatives on Patient Safety Investigation Teams: A Qualitative Analysis

INTRODUCTION

There is growing recognition of the importance of consumer representatives (CRs), consumers with lived experience, and advisors and volunteers in health systems to foster consumer-oriented care. As part of this changing perception, some health services are inviting CRs to be on patient safety investigation teams. However, little is known from empirical studies about these representatives' experiences and perceptions of their roles. This paper aims to contribute to understanding CR's involvement on investigation teams by examining the benefits, challenges, and other aspects of their participation.

METHODS

The study takes a qualitative approach and draws on data from interviews with 11 CRs and 10 focus groups comprising health service staff from Victoria, Australia, and a data interpretation workshop with an advisory panel of six consumers across four Australian states. Thematic analysis was used for data analysis.

RESULTS

We found that CRs have positive experiences in patient safety investigation teams, and their involvement often leads to more patient-focused reviews and outcomes, and use of plain language. However, they also experienced some challenges, such as not being fully respected as equal members of the team, feeling uncomfortable speaking up, and practical issues such as payments and access to documents. The chair/facilitator plays a significant role in engaging with CRs meaningfully, and directly shapes the behaviours of the entire investigation team. Both CRs and chairs/facilitators require considerable institutional and systematic training and support within health services.

CONCLUSION

The benefit of CRs on investigation teams outweighs the challenges across the individual, team/organisational and health systems levels. More resources and policies are needed to support CRs' sustainable inclusion, diversity and involvement in our current and future health services.

PATIENT OR PUBLIC CONTRIBUTION

Eleven individuals with experience as CRs in patient safety investigation teams were interviewed. As indicated by the co-authors of this paper, six consumers from four states who are members of a research consumer advisory committee have been involved in co-designing the study methodology, interpreting the data, and writing this paper with the research team.

Patient Safety Events Among People from Ethnic Minority Backgrounds: A Retrospective Medical Record Review of Australian Cancer Services

OBJECTIVES

People from ethnic minority backgrounds are exposed to greater risk of patient safety events (such as healthcare-acquired infections and medication errors) occurring in their healthcare. However, evidence of the type and frequency of patient safety events occurring in cancer care among patients from ethnic minority background is lacking. This study sought to address this evidence gap.

DESIGN

A two-stage retrospective medical record review was conducted at four cancer services in two Australian states. Eligible medical records at each service that were identified as belonging to ethnic minority patients were reviewed by two clinician researchers in stage one, followed by authentication of extracted data by a site-specific cancer clinician in stage two. Descriptive statistics were used to report the frequency and type of safety events. Chi-square and independent sample T-tests were used to examine the association between safety events and patient socio-cultural indicators.

RESULTS

A total of 628 patient records were included. Of the 628 patient records, 212 (33.75%) documented at least one safety event. A total of 410 safety events were documented in the 212 patient records. Medication-related safety events were most commonly documented (121/410, 29.5%), followed by clinical process/procedure-related safety events (76/410, 18.5%) and patient accidents (60/410, 14.6%). The occurrence of a safety event was associated with patient records that documented 'no interpreter was required'.

CONCLUSION

Patient safety events in cancer care occur frequently among patients from ethnic minority backgrounds. Unsafe cancer care for this population is associated with inadequate use of interpreters, lack of shared understanding and expectations of care processes linked to cultural and linguistic barriers. Approaches to enhance engagement are required.