Patients' silence towards the healthcare system after ethical transgressions by staff: associations with patient characteristics in a cross-sectional study among Swedish female patients

Objectives: To identify which patient characteristics are associated with silence towards the healthcare system after experiences of abusive or ethically wrongful transgressive behaviour by healthcare staff. Design: Cross-sectional questionnaire study using the Transgressions of Ethical Principles in Health Care Questionnaire. Setting: A women's clinic in the south of Sweden. Participants: Selection criteria were: consecutive female patients coming for an outpatient appointment, >= 18-year-old, with the ability to speak and understand the Swedish language, and a known address. Questionnaires were answered by 534 women (60%) who had visited the clinic, of which 293 were included in the present study sample. Primary outcome measure: How many times the respondent remained silent towards the healthcare system relative to the number of times the respondent spoke up. Results: Associations were found between patients' silence towards the healthcare system and young age as well as lower self-rated knowledge of patient rights. Both variables showed independent effects on patients' silence in a multivariate model. No associations were found with social status, country of birth, health or other abuse. Conclusions: The results offer opportunities for designing interventions to stimulate patients to speak up and open up the clinical climate, for which the responsibility lies in the hands of staff; but more research is needed.