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

Jyrki Korkeila,Grigori Joffe,Maritta Välimäki,Päivi Soininen,Hanna Putkonen

doi:10.1186/1471-244x-14-162

Abstract

BackgroundDespite 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.MethodsSystematic 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.ResultsOut 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).ConclusionsThe 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.

Highlights

Despite improvements in psychiatric inpatient care, patient restrictions in psychiatric hospitals are still in use
Major efforts have been made to reduce the use of coercion in psychiatric care at national and international level [1]
The use of seclusion or restraint may be perceived to increase feelings of safety and attention paid to inpatients [12,11]

Summary

Introduction

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. Investigating patients’ perceptions of being secluded or restrained [10,14,11], outcome studies [15], or evaluating the effectiveness of S/R includes a number of methodological and ethical challenges [16]. The question raised is how a valid informed consent process can be guaranteed [22]. It is almost impossible to ask patients’ consent before the coercive intervention, which is not predictable [16]

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Results

Discussion

Conclusion