Methodological and ethical challenges in studying patients’ perceptions of coercion: a systematic mixed studies review

BMC Psychiatry

Maritta Välimäki¹  Jyrki Korkeila⁵  Grigori Joffe³  Hanna Putkonen²  Päivi Soininen⁴ 

[1]Turku University Hospital, Turku, Finland

[2]Vanha Vaasa Hospital, Vaasa, Finland

[3]Department of Psychiatry, Hospital District of Helsinki and Uusimaa, Helsinki University Central Hospital, Helsinki, Finland

[4]Hospital District of Helsinki and Uusimaa, Hyvinkää Hospital Area, Kellokoski Hospital, Tuusula, Finland

[5]Hospital District of Satakunta, Pori, Finland

关键词: Perception;    Inpatient;    Coercion;    Ethics;    Methodology;   

Others  :  1123538
DOI  :  10.1186/1471-244X-14-162

 received in 2013-02-25, accepted in 2014-05-16,  发布年份 2014

【 摘 要 】

Background

Despite improvements in psychiatric inpatient care, patient restrictions in psychiatric hospitals are still in use. Studying perceptions among patients who have been secluded or physically restrained during their hospital stay is challenging. We sought to review the methodological and ethical challenges in qualitative and quantitative studies aiming to describe patients’ perceptions of coercive measures, especially seclusion and physical restraints during their hospital stay.

Methods

Systematic mixed studies review was the study method. Studies reporting patients’ perceptions of coercive measures, especially seclusion and physical restraints during hospital stay were included. Methodological issues such as study design, data collection and recruitment process, participants, sampling, patient refusal or non-participation, and ethical issues such as informed consent process, and approval were synthesized systematically. Electronic searches of CINALH, MEDLINE, PsychINFO and The Cochrane Library (1976-2012) were carried out.

Results

Out of 846 initial citations, 32 studies were included, 14 qualitative and 18 quantitative studies. A variety of methodological approaches were used, although descriptive and explorative designs were used in most cases. Data were mainly collected in qualitative studies by interviews (n = 13) or in quantitative studies by self-report questionnaires (n = 12). The recruitment process was explained in 59% (n = 19) of the studies. In most cases convenience sampling was used, yet five studies used randomization. Patient’s refusal or non-participation was reported in 37% (n = 11) of studies. Of all studies, 56% (n = 18) had reported undergone an ethical review process in an official board or committee. Respondents were informed and consent was requested in 69% studies (n = 22).

Conclusions

The use of different study designs made comparison methodologically challenging. The timing of data collection (considering bias and confounding factors) and the reasons for non-participation of eligible participants are likewise methodological challenges, e.g. recommended flow charts could aid the information. Other challenges identified were the recruitment of large and representative samples. Ethical challenges included requesting participants’ informed consent and respecting ethical procedures.

【 授权许可】

   
2014 Soininen et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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