Risk factors for patient-reported errors during cancer follow-up: Results from a national survey in Denmark.

Due to an increased cancer survival, more cancer patients are referred to follow-up after primary treatment. Knowledge of patient safety during follow-up is sparse. OBJECTIVE: To examine patient-reported errors during cancer follow-up and identify factors associated with errors. DESIGN: A national survey on cancer patients' experiences of treatment and aftercare was conducted in 2012, about two years following cancer diagnosis (N=6914). Associations between patient-reported errors during follow-up and covariates were examined using multiple logistic regression. Qualitative responses were analysed using text analysis. RESULTS: This study included 3731 patients, representing a response rate of 64%. Overall, 27.6% of patients reported at least one error during cancer follow-up. 11.7% reported that important information was missing at follow-up consultations; 9.8% were not called in for a follow-up as expected; 16.7% reported that the doctor/nurse handling the follow-up consultation were ill-prepared on their course of disease. Other errors were reported by 4.7%. Patients who reported errors in follow-up were more likely to report an error or complication during primary cancer treatment, not having one health professional with oversight and responsibility for their overall follow-up pathway, be younger, have a diagnosis of rare cancer, poorer self-rated health and high usage of healthcare services. CONCLUSION: Workflows related to handling of test results, referrals, bookings and medical records have to be improved. Introduction of one particular healthcare professional responsible for the patients' follow-up may result in fewer patient-reported errors however interventions are needed to examine this. Patients prone to errors should be subject to particular attention.

Attention to cancer patients' safety after primary treatment is needed.

INTRODUCTION: Knowledge about patient safety issues after primary treatment of cancer is sparse. METHODS: The present article is a retrospective analysis of adverse events (AEs) after primary cancer treatment to characterise the types of AEs and their consequences. A total of 724 AEs reported from 2010 to 2013 were identified via the Danish Patient Safety Database. The International Classification for Patient Safety was used to characterise event types. Consequences were characterised as either psychical harm or delay. We focused on AEs in care transitions. RESULTS: Common event types were administrative processes (58%), communication and documentation (56%), clinical processes (42%) and medication (27%). 46% of AEs led to physical harm. 4% resulted in severe physical harm or death. 18% resulted in delay in diagnosis of relapse or new cancer, treatment or referral. 50% of all AEs were related to care transitions. The AEs in care transitions carry great potential for prevention as they often relate to inadequate administrative practices, poor communication and documentation, or to unclear transferal of responsibility for the patient. CONCLUSION: Attention to patient safety after primary cancer treatment is required. The identification of a substantial number of AEs in care transitions stresses a need for increased continuity and clear transfer of responsibility in cancer care after primary treatment. To support learning from AEs, the AE reports should provide more details on the contextual factors.

Preoperative smoking status and postoperative complications: a systematic review and meta-analysis.

OBJECTIVE: To systematically review and summarize the evidence of an association between preoperative smoking status and postoperative complications elaborated on complication type. BACKGROUND: The conclusions of studies examining the association between preoperative smoking and postoperative complications are inconsistent, thus there is a need for a review and meta-analysis to summarize the existing evidence. METHODS: A systematic review and meta-analysis based on a search in MEDLINE, EMBASE, CINAHL, and PsycINFO. Included were original studies of the association between smoking status and postoperative complications occurring within 30 days of operation. In total, 9354 studies were identified and reviewed for eligibility and data were extracted. Forest plots and summarized relative risks (RR) including 95% confidence intervals (CIs) were estimated for various complication types. RESULTS: Of the 9354 identified studies, 107 studies were included in the meta-analyses and based on these, 157 data sets were extracted. Preoperative smoking was associated with an increased risk of various postoperative complications including general morbidity (RR=1.52, 95% CI: 1.33-1.74), wound complications (RR=2.15, 95% CI: 1.87-2.49), general infections (RR=1.54, 95% CI: 1.32-1.79), pulmonary complications (RR=1.73, 95% CI: 1.35-2.23), neurological complications (RR=1.38, 95% CI: 1.01-1.88), and admission to intensive care unit (RR=1.60, 95% CI: 1.14-2.25). Preoperative smoking status was not observed to be associated with postoperative mortality, cardiovascular complications, bleedings, anastomotic leakage, or allograft rejection. CONCLUSIONS: Preoperative smoking was found to be associated with an increased risk of the following postoperative complications: general morbidity, wound complications, general infections, pulmonary complications, neurological complications, and admission to the intensive care unit.

Faced with a dilemma: Danish midwives' experiences with and attitudes towards late termination of pregnancy.

BACKGROUND: The introduction of prenatal screening for all pregnant women in Denmark in 2004 has lead to an increase in the number of late terminations of pregnancy after the 12th week of pregnancy. Midwives' experiences with late termination of pregnancy (TOP) are still poorly described in the scientific literature. AIM: To explore Danish midwives' experiences with and attitudes towards late TOP. Focus was on how midwives perceive their own role in late TOP, and how their professional identity is influenced by working with late TOP in a time where prenatal screening is rapidly developing. METHOD: A qualitative study consisting of ten individual interviews with Danish midwives, all of whom had taken part in late TOP. RESULTS: Current practice of late TOP resembles the practice of normal deliveries and is influenced by a growing personalisation of the aborted foetus. The midwives strongly supported women's legal right to choose TOP and considerations about the foetus' right to live were suppressed. Midwives experienced a dilemma when faced with aborted foetuses that looked like newborns and when aborted foetuses showed signs of life after a termination. Furthermore, they were critical of how physicians counsel women/couples after prenatal diagnosis. CONCLUSIONS: The midwives' practice in relation to late TOP was characterised by an acknowledgement of the growing ethical status of the foetus and the emotional reactions of the women/couples going through late TOP. Other professions as well as structural factors at the hospital highly influenced the midwives' ability to organize their work with late terminations. There is a need for more thorough investigation of how to secure the best possible working conditions for midwives, and how to optimise the care for women/couples going through late TOP.