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Smith RD, Shing JSY, Lin J, Bosanquet K, Fong DYT, Lok KYW. Meta-analysis of diagnostic properties of the Whooley questions to identify depression in perinatal women. J Affect Disord 2022; 315:148-155. [PMID: 35931230 DOI: 10.1016/j.jad.2022.07.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 06/16/2022] [Accepted: 07/17/2022] [Indexed: 10/16/2022]
Abstract
BACKGROUND This study's objective was to assess the diagnostic properties of the Whooley questions in identifying depression among perinatal women according to previously published studies. We conducted a systematic review and meta-analysis of studies investigating the diagnostic accuracy of the Whooley questions in perinatal women. METHODS Nine databases were searched in October 2021. All primary studies evaluated the diagnostic properties of the Whooley questions compared with a diagnostic gold standard in women during the perinatal period or, if not identified as being in the perinatal stage within the study, women between 20 weeks' gestation to 4 weeks post-delivery. A bivariate mixed-effects meta-analysis was performed to estimate pooled diagnostic properties and measure heterogeneity. Meta-regression was conducted to evaluate factors contributing to heterogeneity. RESULTS Six studies were included in the review; five were used in the meta-analysis. The pooled sensitivity (95 % confidence interval) was 0.95 (0.81-0.99), pooled specificity was 0.60 (0.44-0.74), pooled positive likelihood ratio was 2.4 (1.6-3.4), pooled negative likelihood ratio was 0.09 (0.02-0.32), and pooled diagnostic odds ratio was 27 (7-106); heterogeneity was substantial (I2 = 0.90, 0.81-1.00). Participant age and setting (community vs. hospital) significantly contributed to heterogeneity. CONCLUSIONS The Whooley questions have high sensitivity but moderate specificity for perinatal women. The Whooley questions are a short and acceptable tool for identifying depression in perinatal women. However, a potential risk exists of incorrectly identifying a high proportion of women as positive. Using the Whooley questions followed by a secondary case-finding tool could reduce the misdiagnosis risk.
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Affiliation(s)
- Robert D Smith
- School of Nursing, the University of Hong Kong, Hong Kong, China
| | | | - Jessie Lin
- Department of Rehabilitation Sciences, the Hong Kong Polytechnic University, Hong Kong, China
| | - Kate Bosanquet
- Department of Health Sciences, University of York, York YO10 5DD, UK
| | - Daniel Y T Fong
- School of Nursing, the University of Hong Kong, Hong Kong, China
| | - Kris Y W Lok
- School of Nursing, the University of Hong Kong, Hong Kong, China.
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Gilbody S, Brabyn S, Mitchell A, Ekers D, McMillan D, Bailey D, Hems D, Chew Graham CA, Keding A, Bosanquet K. Can We Prevent Depression in At-Risk Older Adults Using Self-Help? The UK SHARD Trial of Behavioral Activation. Am J Geriatr Psychiatry 2022; 30:197-207. [PMID: 34266750 DOI: 10.1016/j.jagp.2021.06.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 06/12/2021] [Accepted: 06/14/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Treatment of established depression is the dominant approach to care of older adults, but prevention holds much promise. Self-help interventions are a feasible preventive approach, since they are scalable and low cost. There are few trials in this area. Behavioral Activation (BA) is a credible candidate psychological approach, which has been shown to work in therapist led care but not been trialled in a self-help form. AIM To test the effectiveness of an unguided self-help intervention based on BA for older adults. METHODS We compared a self-help intervention based on BA for older people (n = 172) to usual care (n = 160) in a pragmatic randomized controlled trial. Outcomes were depression status and severity (PHQ9) and health related quality of life (SF12). The primary timepoint of the primary outcome was depression at 4 months, with longer term follow up at 12 months to test sustained impact of the primary outcome. RESULTS At 4 months adjusted PHQ-9 scores for BA self-help were 0.79 lower (95% CI: -1.70 to 0.13; p = 0.09) and the proportion of participants with case-level depression was significantly reduced (BA 31/137 (22.6%) versus usual care 41/141 (29.1%); Odds Ratio 0.48; 95% CI: 0.26-0.92; p = 0.03). There was no PHQ-9 difference at 12 months or for health related quality of life at any point (4 or 12 months). DISCUSSION Self-help using BA for older people at risk of depression is a feasible and scalable intervention with potential short-term benefits in preventing depression.
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Affiliation(s)
- Simon Gilbody
- Department of Health Sciences (SG, SB, AM, DE, DM, DB, DH, AK, KB), University of York, UK; Hull York Medical School (SG, DM), UK.
| | - Sally Brabyn
- Department of Health Sciences (SG, SB, AM, DE, DM, DB, DH, AK, KB), University of York, UK
| | - Alex Mitchell
- Department of Health Sciences (SG, SB, AM, DE, DM, DB, DH, AK, KB), University of York, UK; York Trials Unit (AM, AD), University of York, UK
| | - David Ekers
- Department of Health Sciences (SG, SB, AM, DE, DM, DB, DH, AK, KB), University of York, UK; Tees Esk and Wear Valleys NHS Foundation Trust (DE), North Yorkshire, UK
| | - Dean McMillan
- Department of Health Sciences (SG, SB, AM, DE, DM, DB, DH, AK, KB), University of York, UK; Hull York Medical School (SG, DM), UK
| | - Della Bailey
- Department of Health Sciences (SG, SB, AM, DE, DM, DB, DH, AK, KB), University of York, UK
| | - Deborah Hems
- Department of Health Sciences (SG, SB, AM, DE, DM, DB, DH, AK, KB), University of York, UK
| | | | - Ada Keding
- Department of Health Sciences (SG, SB, AM, DE, DM, DB, DH, AK, KB), University of York, UK; York Trials Unit (AM, AD), University of York, UK
| | - Kate Bosanquet
- Department of Health Sciences (SG, SB, AM, DE, DM, DB, DH, AK, KB), University of York, UK
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Harrison R, Birks Y, Bosanquet K, Iedema R. Enacting open disclosure in the UK National Health Service: A qualitative exploration. J Eval Clin Pract 2017; 23:713-718. [PMID: 28220984 DOI: 10.1111/jep.12702] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Revised: 12/08/2016] [Accepted: 12/09/2016] [Indexed: 12/01/2022]
Abstract
BACKGROUND Open and honest discussion between healthcare providers and patients and families affected by error is considered to be a central feature of high quality and safer patient care, evidenced by the implementation of open disclosure policies and guidance internationally. This paper discusses the perceived enablers that UK doctors and nurses report as facilitating the enactment of open disclosure. METHODS Semistructured interviews with 13 doctors and 22 nurses from a range of levels and specialities from 5 national health service hospitals and primary care trusts in the UK were conducted and analysed using a framework approach. RESULTS Five themes were identified which appear to capture the factors that are critical in supporting open disclosure: open disclosure as a moral and professional duty, positive past experiences, perceptions of reduced litigation, role models and guidance, and clarity. CONCLUSION Greater openness in relation to adverse events requires health professionals to recognise candour as a professional and moral duty, exemplified in the behaviour of senior clinicians and that seems more likely to occur in a nonpunitive, learning environment. Recognising incident disclosure as part of ongoing respectful and open communication with patients throughout their care is critical.
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Affiliation(s)
- Reema Harrison
- University of New South Wales, New South Wales, 2052, Australia
| | - Yvonne Birks
- Social Policy Research Unit, University of York, York, YO10 5DD, United Kingdom
| | - Kate Bosanquet
- Department of Health Sciences, University of York, York, YO10 5DD, United Kingdom
| | - Rick Iedema
- Centre for Health Research and Implementation, Monash University, Wellington Rd & Blackburn Rd, Clayton, Victoria, 3800, Australia
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Overend K, Lewis H, Bailey D, Bosanquet K, Chew-Graham C, Ekers D, Gascoyne S, Hems D, Holmes J, Keding A, McMillan D, Meer S, Meredith J, Mitchell N, Nutbrown S, Parrott S, Richards D, Traviss G, Trépel D, Woodhouse R, Gilbody S. Erratum to: CASPER plus (CollAborative care in screen-positive EldeRs with major depressive disorder): study protocol for a randomised controlled trial. Trials 2016; 17:217. [PMID: 27121377 PMCID: PMC4848845 DOI: 10.1186/s13063-016-1361-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 04/22/2016] [Indexed: 11/10/2022] Open
Affiliation(s)
- Karen Overend
- Department of Health Sciences, University of York, Seebohm Rowntree, Building Heslington, York, YO10 5DD, UK
| | - Helen Lewis
- Department of Health Sciences, University of York, Seebohm Rowntree, Building Heslington, York, YO10 5DD, UK
| | - Della Bailey
- Department of Health Sciences, University of York, Seebohm Rowntree, Building Heslington, York, YO10 5DD, UK
| | - Kate Bosanquet
- Department of Health Sciences, University of York, Seebohm Rowntree, Building Heslington, York, YO10 5DD, UK
| | - Carolyn Chew-Graham
- Research Institute, Primary Care and Health Sciences, Keele University, Keele, ST5 5BG, UK
| | - David Ekers
- Centre for Mental Health Research, University of Durham, Durham, TS17 6BH, UK
| | - Samantha Gascoyne
- Department of Health Sciences, University of York, Seebohm Rowntree, Building Heslington, York, YO10 5DD, UK
| | - Deborah Hems
- Department of Health Sciences, University of York, Seebohm Rowntree, Building Heslington, York, YO10 5DD, UK
| | - John Holmes
- Leeds Institute of Health Sciences, University of Leeds, Charles Thackrah, Building, 101 Clarendon Road, Leeds, LS2 9LJ, UK
| | - Ada Keding
- Department of Health Sciences, University of York, Seebohm Rowntree, Building Heslington, York, YO10 5DD, UK
| | - Dean McMillan
- Department of Health Sciences, University of York, Seebohm Rowntree, Building Heslington, York, YO10 5DD, UK
| | - Shaista Meer
- Leeds Institute of Health Sciences, University of Leeds, Charles Thackrah, Building, 101 Clarendon Road, Leeds, LS2 9LJ, UK
| | - Jodi Meredith
- Department of Health Sciences, University of York, Seebohm Rowntree, Building Heslington, York, YO10 5DD, UK
| | - Natasha Mitchell
- Department of Health Sciences, University of York, Seebohm Rowntree, Building Heslington, York, YO10 5DD, UK
| | - Sarah Nutbrown
- Department of Health Sciences, University of York, Seebohm Rowntree, Building Heslington, York, YO10 5DD, UK
| | - Steve Parrott
- Department of Health Sciences, University of York, Seebohm Rowntree, Building Heslington, York, YO10 5DD, UK
| | - David Richards
- Washington Singer Laboratories, School of Psychology, University of Exeter, Perry Road, Exeter, EX4 4QG, UK
| | - Gemma Traviss
- Leeds Institute of Health Sciences, University of Leeds, Charles Thackrah, Building, 101 Clarendon Road, Leeds, LS2 9LJ, UK
| | - Dominic Trépel
- Department of Health Sciences, University of York, Seebohm Rowntree, Building Heslington, York, YO10 5DD, UK
| | - Rebecca Woodhouse
- Department of Health Sciences, University of York, Seebohm Rowntree, Building Heslington, York, YO10 5DD, UK
| | - Simon Gilbody
- Department of Health Sciences, University of York, Seebohm Rowntree, Building Heslington, York, YO10 5DD, UK.
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Keding A, Lewis H, Bosanquet K, Gilbody S, Buckley H, Tilbrook H, Torgerson D. Post-it notes to improve questionnaire response rates in RCTs - findings from a randomised sub-study. Trials 2015. [PMCID: PMC4660291 DOI: 10.1186/1745-6215-16-s2-p102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Birks Y, Entwistle V, Harrison R, Bosanquet K, Watt I, Iedema R. Being open about unanticipated problems in health care: the challenges of uncertainties. J Health Serv Res Policy 2014; 20:54-60. [DOI: 10.1177/1355819614558100] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Discussion of unanticipated problems in care with patients and their families (‘open disclosure’) is now widely advocated. Despite international efforts and the introduction of a range of policies and guidance to promote such discussions, the expectations of policy makers and patients are often not matched in practice. We consider some reasons for the persistence of shortfalls in the occurrence and quality of open disclosure. We draw on research conducted to investigate the implementation of a ‘ Being open’ policy in England, reflecting particularly on insights derived from interviews with health care professionals. Health care professionals were broadly supportive of the idea of open disclosure. Some expressed well-recognized concern about punishment and being blamed, but this did not appear to be the main driver of their communication practices. Their accounts of what happened around particular problems in health care indicated that they brought a complex range of considerations to bear on questions of whether and how these were discussed with patients and relatives. Guidance about open disclosure based on assessments of levels of harm to patients can complicate and perhaps distort health care professionals’ approaches, particularly when the extent and/or cause of harm was uncertain. Health care professionals who engage in open disclosure must be able to negotiate appropriate ways through complex and sensitive discussions. The responses of patients and relatives are not always predictable and even the best open disclosure practice may not resolve problems and concerns. Guidance, training and support for staff need to reflect these challenges.
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Affiliation(s)
- Yvonne Birks
- Professor of Health and Social Care, Social Policy Research Unit, University of York, UK
| | - Vikki Entwistle
- Professor of Health Services Research and Ethics, Health Services Research Unit, University of Aberdeen, UK
| | - Reema Harrison
- Lecturer and Research Fellow, School of Public Health, Sydney Medical School, The University of Sydney, Australia
| | - Kate Bosanquet
- Research Fellow, Department of Health Sciences, University of York, UK
| | - Ian Watt
- Professor of Primary and Community Care, Department of Health Sciences, University of York, UK
| | - Rick Iedema
- Professor of Healthcare Innovation, School of Health Sciences, University of Tasmania and Research Manager, Agency for Clinical Innovation, New South Wales, Ministry of Health, Australia
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Overend K, Lewis H, Bailey D, Bosanquet K, Chew-Graham C, Ekers D, Gascoyne S, Hems D, Holmes J, Keding A, McMillan D, Meer S, Meredith J, Mitchell N, Nutbrown S, Parrott S, Richards D, Traviss G, Trépel D, Woodhouse R, Gilbody S. CASPER plus (CollAborative care in Screen-Positive EldeRs with major depressive disorder): study protocol for a randomised controlled trial. Trials 2014; 15:451. [PMID: 25409776 PMCID: PMC4247639 DOI: 10.1186/1745-6215-15-451] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 10/14/2014] [Indexed: 11/25/2022] Open
Abstract
Background Depression accounts for the greatest disease burden of all mental health disorders, contributes heavily to healthcare costs, and by 2020 is set to become the second largest cause of global disability. Although 10% to 16% of people aged 65 years and over are likely to experience depressive symptoms, the condition is under-diagnosed and often inadequately treated in primary care. Later-life depression is associated with chronic illness and disability, cognitive impairment and social isolation. With a progressively ageing population it becomes increasingly important to refine strategies to identity and manage depression in older people. Currently, management may be limited to the prescription of antidepressants where there may be poor concordance; older people may lack awareness of psychosocial interventions and general practitioners may neglect to offer this treatment option. Methods/design CASPER Plus is a multi-centre, randomised controlled trial of a collaborative care intervention for individuals aged 65 years and over experiencing moderate to severe depression. Selected practices in the North of England identify potentially eligible patients and invite them to participate in the study. A diagnostic interview is carried out and participants with major depressive disorder are randomised to either collaborative care or usual care. The recruitment target is 450 participants. The intervention, behavioural activation and medication management in a collaborative care framework, has been adapted to meet the complex needs of older people. It is delivered over eight to 10 weekly sessions by a case manager liaising with general practitioners. The trial aims to evaluate the clinical and cost effectiveness of collaborative care in addition to usual GP care versus usual GP care alone. The primary clinical outcome, depression severity, will be measured with the Patient Health Questionnaire-9 (PHQ-9) at baseline, 4, 12 and 18 months. Cost effectiveness analysis will assess health-related quality of life using the SF-12 and EQ-5D and will examine cost-consequences of collaborative care. A qualitative process evaluation will be undertaken to explore acceptability, gauge the extent to which the intervention is implemented and to explore sustainability beyond the clinical trial. Discussion Results will add to existing evidence and a positive outcome may lead to the commissioning of this model of service in primary care. Trial registration ISRCTN45842879 (24 July 2012).
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Simon Gilbody
- Department of Health Sciences, University of York, Seebohm Rowntree, Building, Heslington, York YO10 5DD, UK.
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Birks Y, Harrison R, Bosanquet K, Hall J, Harden M, Entwistle V, Watt I, Walsh P, Ronaldson S, Roberts D, Adamson J, Wright J, Iedema R. An exploration of the implementation of open disclosure of adverse events in the UK: a scoping review and qualitative exploration. Health Services and Delivery Research 2014. [DOI: 10.3310/hsdr02200] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundIn 2009 the UK National Patient Safety Agency relaunched its Being Open framework to facilitate the open disclosure of adverse events to patients in the NHS. The implementation of the framework has been, and remains, challenging in practice.AimThe aim of this work was to both critically evaluate and extend the current evidence base relating to open disclosure, with a view to supporting the implementation of a policy of open disclosure of adverse events in the NHS.MethodsThis work was conducted in three phases. The first phase comprised two focused systematic literature reviews, one summarising empirical research on the effectiveness of interventions to enhance open disclosure, and a second, broader scoping review, looking at reports of current opinion and practice and wider knowledge. The second phase involved primary qualitative research with the objective of generating new knowledge about UK-based stakeholders’ views on their role in and experiences of open disclosure. Stakeholder interviews were analysed using the framework approach. The third phase synthesised the findings from the first two phases to inform and develop a set of short pragmatic suggestions for NHS trust management, to facilitate the implementation and evaluation of open disclosure.ResultsA total of 610 papers met the inclusion criteria for the broad review. A large body of literature discussed open disclosure from a number of related, but sometimes conflicted, perspectives. Evidential gaps persist and current practice is based largely on expert consensus rather than evidence. There appears to be a tension between the existing pragmatic guidance and the more in-depth critiques of what being consistent and transparent in health care really means. Eleven papers met the inclusion criteria for the more focused review. There was little evidence for the effectiveness of disclosure alone on organisational or individual outcomes or of interventions to promote and support open disclosure. Interviews with stakeholders identified strong support for the basic principle of being honest with patients or relatives when someone was seriously harmed by health care. In practice however, the issues are complex and there is confusion about a number of issues relating to disclosure policies in the UK. The interviews generated insights into the difficulties perceived within health care at individual and institutional levels, in relation to fully implementing the Being Open guidance.ConclusionsThere are several clear strategies that the NHS could learn from to implement and sustain a policy of openness. Literature reviews and stakeholder accounts both identified the potential benefits of a culture that was generally more open (not just retrospectively open about serious harm). Future work could usefully evaluate the impact of disclosure on legal challenges within the NHS, best practice in models of support and training for open disclosure, embedding disclosure conversations in critical incident analysis and disclosure of less serious events.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Yvonne Birks
- Social Policy Research Unit, University of York, York, UK
| | - Reema Harrison
- Department of Health Sciences, University of York, York, UK
| | - Kate Bosanquet
- Department of Health Sciences, University of York, York, UK
| | - Jill Hall
- Department of Health Sciences, University of York, York, UK
| | - Melissa Harden
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Vikki Entwistle
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Ian Watt
- Department of Health Sciences, University of York, York, UK
| | - Peter Walsh
- Action against Medical Accidents, Croydon, UK
| | | | | | - Joy Adamson
- Department of Health Sciences, University of York, York, UK
| | - John Wright
- Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK
| | - Rick Iedema
- Centre for Health Communication, Faculty of Arts and Social Sciences, University of Technology, Sydney, Australia
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Harrison R, Birks Y, Hall J, Bosanquet K, Harden M, Iedema R. The contribution of nurses to incident disclosure: a narrative review. Int J Nurs Stud 2013; 51:334-45. [PMID: 23910400 DOI: 10.1016/j.ijnurstu.2013.07.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Revised: 07/02/2013] [Accepted: 07/03/2013] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To explore (a) how nurses feel about disclosing patient safety incidents to patients, (b) the current contribution that nurses make to the process of disclosing patient safety incidents to patients and (c) the barriers that nurses report as inhibiting their involvement in disclosure. DESIGN A systematic search process was used to identify and select all relevant material. Heterogeneity in study design of the included articles prohibited a meta-analysis and findings were therefore synthesised in a narrative review. DATA SOURCES A range of text words, synonyms and subject headings were developed in conjunction with the York Centre for Reviews and Dissemination and used to undertake a systematic search of electronic databases (MEDLINE; EMBASE; CENTRAL; PsycINFO; Health Management and Information Consortium; CINAHL; ASSIA; Science Citation Index; Social Science Citation Index; Cochrane Database of Systematic Reviews; Database of Abstracts of Reviews of Effects; Health Technology Assessment Database; Health Systems Evidence; PASCAL; LILACS). Retrieval of studies was restricted to those published after 1980. Further data sources were: websites, grey literature, research in progress databases, hand-searching of relevant journals and author contact. REVIEW METHODS The title and abstract of each citation was independently screened by two reviewers and disagreements resolved by consensus or consultation with a third person. Full text articles retrieved were further screened against the inclusion and exclusion criteria then checked by a second reviewer (YB). Relevant data were extracted and findings were synthesised in a narrative empirical synthesis. RESULTS The systematic search and selection process identified 15 publications which included 11 unique studies that emerged from a range of locations. Findings suggest that nurses currently support both physicians and patients through incident disclosure, but may be ill-prepared to disclose incidents independently. Barriers to nurse involvement included a lack of opportunities for education and training, and the multiple and sometimes conflicting roles within nursing. CONCLUSIONS Numerous potential benefits were identified that may result from nurses having a greater contribution to the disclosure process, but the provision of support and training is essential to overcome the reported barriers faced by nurses internationally.
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Affiliation(s)
- Reema Harrison
- Institute of Psychological Sciences, University of Leeds, Leeds LS2 9JT, England, United Kingdom.
| | - Yvonne Birks
- University of York, York, England, United Kingdom
| | - Jill Hall
- University of York, York, England, United Kingdom
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