Patient Safety Events Among People from Ethnic Minority Backgrounds: A Retrospective Medical Record Review of Australian Cancer Services

Journal of Racial and Ethnic Health Disparities https://doi.org/10.1007/s40615-025-02318-8 Patient Safety Events Among People from Ethnic Minority Backgrounds: A Retrospective Medical Record Review of Australian Cancer Services Ashfaq Chauhan1 · Kathryn Joseph1 · Melvin Chin2 · Meron Pitcher3 · Carlene Wilson4,5,13 · Elizabeth Manias6 · Guncag Ozavci7 · Hui Gan4,8,9,10 · Bronwyn Newman1 · Ramesh Lahiru Walpola11 · Holly Seale12 · Ramya Walsan1 · Reema Harrison1 Received: 19 June 2024 / Revised: 16 August 2024 / Accepted: 16 February 2025 © The Author(s) 2025 Abstract Objectives People from ethnic minority backgrounds are exposed to greater risk of patient safety events (such as healthcareacquired infections and medication errors) occurring in their healthcare. However, evidence of the type and frequency of patient safety events occurring in cancer care among patients from ethnic minority background is lacking. This study sought to address this evidence gap. Design A two-stage retrospective medical record review was conducted at four cancer services in two Australian states. Eligible medical records at each service that were identified as belonging to ethnic minority patients were reviewed by two clinician researchers in stage one, followed by authentication of extracted data by a site-specific cancer clinician in stage two. Descriptive statistics were used to report the frequency and type of safety events. Chi-square and independent sample T-tests were used to examine the association between safety events and patient socio-cultural indicators. Results A total of 628 patient records were included. Of the 628 patient records, 212 (33.75%) documented at least one safety event. A total of 410 safety events were documented in the 212 patient records. Medication-related safety events were most commonly documented (121/410, 29.5%), followed by clinical process/procedure-related safety events (76/410, 18.5%) and patient accidents (60/410, 14.6%). The occurrence of a safety event was associated with patient records that documented ‘no interpreter was required’. Conclusion Patient safety events in cancer care occur frequently among patients from ethnic minority backgrounds. Unsafe cancer care for this population is associated with inadequate use of interpreters, lack of shared understanding and expectations of care processes linked to cultural and linguistic barriers. Approaches to enhance engagement are required. Keywords Ethnic minorities · Patient safety · Medication safety · Health services research · Cancer Introduction A patient safety event describes a healthcare event that could have or did result in patient harm due to the care provided or omitted rather than the disease [1]. Common patient safety events include healthcare-acquired infections, medication errors and the lack of adherence to policy and procedures when delivering care [1]. Studies examining the rate of patient safety events among the general population have consistently indicated that at least one in ten patients accessing hospital care is exposed to a patient safety event [2–9]. People from ethnic minority backgrounds include those being born overseas, who have one or more parents born overseas, who speak a non-mainstream language, practice a religion, culture or hold a faith beyond the national, mainstream religion, culture or faiths [10, 11]. Systematic review evidence demonstrates that people from ethnic minority backgrounds worldwide experience higher rates of patient safety events, coupled with poorer clinical outcomes, across a range of health settings when compared with those from a non-ethnic minority background [12, 13]. Minimising differences in exposure to unsafe care is central to achieving equitable healthcare quality, which is a priority in contemporary health system and service frameworks [14–17]. Extended author information available on the last page of the article Vol.:(0123456789) Journal of Racial and Ethnic Health Disparities Evidence of the association between safety events and ethnic diversity has largely originated from the United States (US). Many service and population-based studies demonstrate that people from ethnic minority groups are at higher risk of safety events such as healthcare-acquired infections and medication errors [12, 18, 19]. Ethnicity has been predominantly defined by race in these studies, with comparisons made between Black, Caucasian, Asia/Pacific Islanders and Hispanic populations. Increased incidence of patient safety events is noted among patients with low-English or national language proficiency [20] with studies indicating safer health outcomes when trained professional interpreters are used [12]. Retrospective review studies that have explored language barriers alone show increased incidence of patient harm among low-English proficiency patients [20] and longer hospital stays, accompanied with increased odds of a serious or sentinel event among Spanish speaking children [21]. Beyond the US, studies that report disparate patient safety outcomes among ethnic minority populations have done so with regard to a single patient safety issue, e.g. medication safety [13, 22] or health setting, e.g. obstetrics and neonatal care, and often are single-site studies [23, 24]. Exploratory qualitative research has also been conducted providing critical insight into key factors influencing safe care among this population, which suggests that national language proficiency, health literacy, differences in perception of illness and understanding of care expectations between patients from ethnic minority backgrounds and their clinicians and the extent of family involvement may impact patient safety outcomes for patients from ethnic minority backgrounds [25–27]. The potential patient safety events are particularly high in cancer care [28]. A retrospective record review of 6720 medical records of general population patients identified that 24.2% (197/812) of the hospital admissions for cancer patients had a safety event compared to 17.4% (1027/5908) of admissions of other patients at one hospital in Norway [29]. Another study that included adverse drug reactions and drug toxicities in their definition of patient safety events documented that approximately 34% (136/400) of patients accessing a cancer service in the United States experienced a safety event over a 12-month follow-up period (30). Despite the established evidence that the patients from ethnic minority backgrounds are exposed to greater risk of patient safety event and that there is a high risk of safety events occurring in cancer care, there is a lack of evidence of the nature and rate of patient safety events among patients from ethnic minority backgrounds in cancer care [12, 31]. This study aimed to fill in this gap by providing evidence on the frequency and nature of patient safety events among patients from ethnic minority backgrounds accessing caner care. The study also aimed to examine any associatio (...truncated)