Predictors of chemotherapy patients' intentions to engage in medical error prevention

Abstract

Background: Patients can make contributions to the safety of chemotherapy administration but little is known about their motivations to participate in safety-enhancing strategies. The theory of planned behavior was applied to analyze attitudes, norms, behavioral control, and chemotherapy patients' intentions to participate in medical error prevention.

Methods: A quantitative, cross-sectional survey study among chemotherapy patients treated at the oncology/hematology department of a large regional hospital was conducted. Confirmatory factor analysis and structural equation modeling were used to investigate the relationship between patients' responses to measures of attitudes, norms, and behavioral control and their intentions.

Results: Four hundred seventy-nine patients completed the survey (52% response rate). Attitudes, perceived behavioral control, and subjective norms explained 62% of the variance in intentions to engage in error monitoring and reporting. Perceived behavioral control (beta = 0.476), norms relating to patients' relatives (beta = 0.343), and instrumental attitudes (beta = 0.281) were the strongest (direct) predictors of patients' intentions. Experiential attitudes had the smallest effect on intentions (beta = 0.178). Subjective norms relating to expectations attributed to oncology staff had strong direct and indirect effects on patients' intentions (total effect, 0.382).

Conclusions: Patients acknowledge the benefit of error monitoring and reporting and anticipate positive outcomes of involvement, but their valuations of the process of engaging in error prevention are less positive. Behavioral control and perceptions of staff approval are central for patients. Involvement of cancer patients in safety requires oncologists to address their patients' normative and control beliefs through education and proactive approval of patient engagement.

Figure 1.

Schematic model of the theory of planned behavior.

Figure 2.

Fraction of patients who disagreed with theory of planned behavior items. The two bottom adjacent response categories are merged. See methods for detailed item descriptions. Abbreviations: ATT, attitude; INT, intention; N, norm; PBC, perceived behavioral control.

Figure 3.

Results of structural equation modeling. Effects of norms, attitudes, and perceived behavioral control on patients' intentions to notify staff of errors. Observed manifest variables (survey items) are presented as rectangles. Latent variables are presented as ellipses. Error and residual terms are omitted from display. Standardized estimates are presented. p-values for all paths' coefficients were <.001. Abbreviations: ATT, attitude; INT, intention; PBC, perceived behavioral control.