Frequency of and predictors for withholding patient safety concerns among oncology staff: a survey study

Eur J Cancer Care (Engl). 2015 May;24(3):395-403. doi: 10.1111/ecc.12255. Epub 2014 Oct 7.


Speaking up about patient safety is vital to avoid errors reaching the patient and to improve a culture of safety. This study investigated the prevalence of non-speaking up despite concerns for safety and aimed to identify predictors for withholding voice among healthcare professionals (HCPs) in oncology. A self-administered questionnaire assessed safety concerns, speaking up beliefs and behaviours among nurses and doctors from nine oncology departments. Multiple regression analysis was used to identify predictors for withholding safety concerns. A total of 1013 HCPs returned the completed survey (response rate 65%). Safety concerns were common among responders. Fifty-four per cent reported to recognise their colleagues making potentially harmful errors at least sometimes. A majority of responders reported at least some episodes of withholding concerns about patient safety. Thirty-seven per cent said they remained silent at least once when they had information that might have helped prevent an incident. Respondents believed that a high level of interpersonal, communication and coping skills are necessary to speak up about patient safety issues at their workplace. Higher levels of perceived advocacy for patient safety and psychological safety significantly decreased the frequency of withholding voice. Remaining silent about safety concerns is a common phenomenon in oncology. Improved strategies are needed to support staff in effective communication and make cancer care safer.

Keywords: communication; medical errors; oncology; patient safety; safety culture; survey.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Attitude of Health Personnel*
  • Communication
  • Female
  • Humans
  • Male
  • Medical Errors / prevention & control*
  • Middle Aged
  • Oncology Service, Hospital / standards*
  • Organizational Culture
  • Patient Safety*
  • Surveys and Questionnaires
  • Switzerland
  • Whistleblowing / psychology*
  • Young Adult