Coping strategies among second victims of adverse events: A systematic review and meta-analysis

Aims: Adverse events do not only affect patients but may also have a relevant psychological impact on the involved healthcare providers, who are considered as second victims. The aim of this study was to critically summarize and meta-analyze the type and frequency of coping strategies applied by second victims in the aftermath of an adverse event Methods: A systematic search of nine electronic databases without restrictions to publication date and language was conducted. Additional sources like grey databases were also examined. Two reviewers independently screened titles and abstracts of all the records and evaluated the full texts of the eligible articles. Data extraction from the selected studies was performed by the two reviewers and a metaanalysis was conducted using random-effects modeling. Results: The search of all databases and additional sources provided an overall amount of 7209 records. After the screening of titles and abstracts, 104 potentially relevant studies were identified. The full-text evaluation led to a final selection of 21 studies. Among the numerous coping strategies, planful problem solving, for instance, was applied very often (77.4%, 95%CI[59.3 to 88.9]). Disclosing the error and apologizing to the patient and the family was used by less than half of the investigated healthcare providers (38.8%, 95%C1[19.5 to 62.3]). Escape-avoidance and considering to leave the profession were applied, respectively, by 18%(95%CI|10.2 to 29.8)) and 12.5% of the second victims (95%CI[8.0 to 19.1]). Conclusion: The results of our study, the first one of its kind about second victims, showed that a large number of second victims applies various coping strategies in the aftermath of an adverse event in order to deal with its profound impact. Our findings are expected to serve as a robust basis for developing and implementing support programs for second victims.