Identifying hazards for psychological harm in cancer care using incident reports: searching for the invisible

Keeping patients safe means not only preventing physical harm events, but also psychological harm. However, little is known about psychological harm in health care. The aim of this study was to investigate whether and what types of hazards for preventable psychological harm (PPH) were present in incidents reported by cancer care healthcare workers.

Incidents reported by staff working in the wards and ambulatory infusion centres providing cancer care in three Swiss hospitals during the years 2022 and 2023 were qualitatively analysed in order to identify hazards for psychological harm. In an iterative process N = 623 reports were explored and a coding scheme developed.

The generated coding scheme distinguished events solely involving primary PPH from events in which primary PPH co-occurred with physical harm. Two and a half percent (2.5%) of the reports pointed to hazards for primary PPH, and 15% (15.4%) of the incidents reported PPH co-occurring with physical harm. The most frequently identified PPH hazard was 'not providing appropriate information to patients and their close others'. Events that were potentially psychologically harmful included 'communication issues', 'privacy or autonomy violations', and 'poor transitions of care'. In the group of incidents in which the potential for physical and psychological harm were concurrently prevalent, we identified errors potentially affecting the effectiveness of cancer care, and instances in which patients or their close others detected or prevented an error. Relatives or close others were mentioned in 17 (18%) of the PPH-related reports.

This study suggests that while incident databases do contain reported hazards for primary PPH, it is likely that they are largely under represented. In line with existing research, we found hazards for PPH such as privacy or autonomy violations. Well-known safety hotspots, such as patient transfers, may pose hazards for psychological harm, suggesting that designing strong organizational practices may help prevent psychological harm. Future research needs to use other data sources and shed light on various perspectives to learn more about the variety of PPH, its causes, and potential consequences and preventive measures.