Speaking up is important for patient safety, but often, health care professionals hesitate to voice concerns. Understanding the influencing factors can help to improve speaking-up behaviour and team communication. This review focused on health care professionals’ speaking-up behaviour for patient safety and aimed at (1) assessing the effectiveness of speaking up, (2) evaluating the effectiveness of speaking-up training, (3) identifying the factors influencing speaking-up behaviour, and (4) developing a model for speaking-up behaviour.

Background Patient safety training of healthcare professionals is a new area of education. Assessment of the pertinent competencies should be a part of this education. This review aims to identify the available assessment tools for different patient safety domains and evaluate them according to Miller's four competency levels. Methods The authors searched PubMed, MEDLINE, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, psycINFO and the Education Resource Information Center (ERIC) from the start of each database to December 2010 for English-language articles that evaluated or described tools for the assessment of the safety competencies of individual medical and/or nursing professionals. Reports on the assessment of technical, clinical, medication and disclosure skills were excluded. Results Thirty-four assessment tools in 48 studies were identified: 20 tools for medical professionals, nine tools for nursing professionals, and five tools for both medical and nursing professionals. Twenty of these tools assessed the two highest Miller levels (‘shows how’ and ‘does’) and four tools were directed at multiple levels. Most of the tools that aimed at the higher levels assessed the skills of working in teams (17 tools), risk management (15 tools), and communication (11 tools). Internal structure (reliability, 22 tools) and content validity (14 tools) when described were found to be moderate. Only a small number of tools addressed the relationship between the tool itself and (1) other assessments (concurrent, predictive validity, eight tools), and (2) educational outcomes (seven tools). Conclusions There are many tools designed to assess the safety competencies of healthcare professionals. However, a reliable and valid toolbox for summative testing that covers all patient safety domains at Miller's four competency levels cannot yet be constructed. Many tools, however, are useful for formative feedback.

Background: There is significant concern that cancer care is adversely impacted due to the coronavirus disease pandemic. Using the national database, we document the impact of the pandemic on cancer diagnosis in Japan. Methods: Data from 735 hospital-based cancer registries, covering >70% of newly diagnosed cases, were analysed. We compared trends during 2016–2019 and those in 2020 by the type of cancer, diagnostic process, stage and 13 prefectures as requiring special precautions to prevent the spread of infection. Results: Overall, the number of patients who began treatment decreased by 1.9% in 2020 as compared with the average number during 2016–2019. A sharp decline of 13.8% was observed for stomach cases. The decline in cases (22.0% decrease for all cancers) was more pronounced in May. Cancer screening and resulting detection decreased significantly in 2020 (8.1–24.3%). Case registrations of stage I and II gastric cancer, stage II intrahepatic cholangiocarcinoma, stage II oesophageal cancer, stage 0 and I laryngeal cancer and stage II gallbladder cancer decreased by >10% compared with those in 2018 and 2019. The trends in cancer cases by area of residence indicated a decline in 13 prefectures in May 2020 compared with other areas. Conclusions: The number of cancer diagnoses decreased during the year 2020 under coronavirus pandemic, especially right after the Japanese government declared the first state of emergency in April. We need to carefully observe the consequences of these decrease in diagnosis, or perhaps the delay in care, on patient survival or population mortality.

Background: Hospital-based cancer registries were developed to describe and improve clinical care for cancer patients. We described the hospital-based cancer registry coverage as a reference for the users, including researchers, policymakers and clinicians. Methods: The hospital-based cancer registry coverage was defined as the proportion of new cases registered in the hospital-based cancer registry to the National Cancer Registry as the denominator. To examine the coverage of respective cancer types, age groups and prefecture in the hospital-based cancer registry, cases were grouped based on the 10th International Statistical Classification of Diseases and Related Health Problems and were compared with the published report of the National Cancer Registry in 2017. Results: The overall hospital-based cancer registries coverage was 71.7%, and 52.5% of patients were treated at designated cancer care hospitals. The hospital-based cancer registries coverage and treatment rates at designated cancer care hospitals varied per cancer type, age group, and prefecture. The hospital-based cancer registries covered over 80% of the patients with cancers of the larynx, uterus, oesophagus, lip, oral cavity, pharynx and skin, whereas patients’ coverage with thyroid cancer was relatively low. The hospital-based cancer registry coverage of young patients (80%, whereas that for elderly patients (≥85 years) was <55%. The range of coverage in each prefecture was from 43.0 to 89.7%. Over 70% of the patients with cancers of the larynx, lip, oral cavity and pharynx were treated at designated cancer care hospitals. Conclusions: The hospital-based cancer registry coverage is ~70% of all cancers. Because the coverage differed across cancers and age groups, the respective target groups’ analysis should consider this factor.

Because of the physiological decline and the diversity of preferences, treating older patients with cancer is challenging. Given the insufficient evidence applicable to treating cancer in older patients, some clinical guidance is necessary. This study provides a description of current treatment practices in Japan, which may shed light on possible treatment options. Using data from the national database of hospital-based cancer registries, we described the first-course treatment of nine common cancers in patients who received care in Designated Cancer Care Hospitals between 2012 and 2015. We compared the patterns of first-course cancer treatment between younger and older patients. In total, 1 383 066 cases were analysed. The proportion of patients aged >75 years receiving first-course treatment has gradually increased since 2012 (range: 0.9% point increase for colorectal cancer to 2.7% point increase for stomach cancer). A higher proportion of patients aged ≥85 years, compared with younger patients, did not receive any treatment. Based on this cancer registry-based analysis, older patients—in particular those ≥85 years old at diagnosis and with advanced stage cancer—are less likely to receive anti-cancer treatment than younger patents are. Further research is warranted to identify patient characteristics that predict which older patients are most likely to benefit from active treatment.

Objectives The accuracy of the ascertainment of vital status impacts the validity of cancer survival. This study assesses the potential impact of loss-to-follow-up on survival in Japan, both nationally and in the samples seen at individual hospitals. Design Simulation study Setting and participants Data of patients diagnosed in 2007, provided by the Hospital-Based Cancer Registries of 177 hospitals throughout Japan. Primary and secondary outcome measures We performed simulations for each cancer site, for sample sizes of 100, 1000 and 8000 patients, and for loss-to-follow-up ranging from 1% to 5%. We estimated the average bias and the variation in bias in survival due to loss-to-follow-up. Results The expected bias was not associated with the sample size (with 5% loss-to-follow-up, about 2.1% for the cohort including all cancers), but a smaller sample size led to more variable bias. Sample sizes of around 100 patients, as may be seen at individual hospitals, had very variable bias: with 5% loss-to-follow-up for all cancers, 25% of samples had a bias of 3.06%. Conclusion Survival should be interpreted with caution when loss-to-follow-up is a concern, especially for poor-prognosis cancers and for small-area estimates.