Christian Schulz-Quach

Background: Workplace violence (WPV) remains a significant and escalating challenge across healthcare settings, threatening the safety, well-being, and retention of frontline healthcare professionals (HCPs). Verbal de-escalation is widely promoted as a first-line strategy to prevent or manage aggressive patient behavior. However, the scope, implementation, and effectiveness of these techniques have not been consistently synthesized. Methods: This systematic review was conducted in accordance with PRISMA guidelines. Studies were eligible if they examined verbal de-escalation as a primary strategy for preventing or managing WPV in healthcare settings, including hospitals, emergency departments, psychiatric units, long-term care, and outpatient clinics. All study designs were considered, including empirical research and structured descriptive guidance relevant to clinical practice. Searches were conducted in Ovid MEDLINE ALL, Embase, Emcare, PsycINFO, and CINAHL from database inception, with results downloaded on August 29, 2024, and updated on January 30, 2026. Of 15,987 records identified, 9,096 were screened following duplicate removal, 446 underwent full-text review, and 36 studies met inclusion criteria. Methodological quality was appraised using the Mixed Methods Appraisal Tool (MMAT). Results: Substantial heterogeneity was observed in how verbal de-escalation was defined, delivered, and evaluated. Intervention studies commonly assessed structured training programs delivered through didactic sessions, interactive workshops, simulation-based education, technology-enhanced learning, or clinical unit–based training. These studies frequently reported improvements in staff knowledge, confidence, and preparedness to manage aggression. Observational and descriptive studies emphasized communication behaviors used during escalated encounters and highlighted recurring strategies, such as empathetic listening, calm verbal tone, validation, and collaborative problem-solving. Outcome measures varied considerably across studies, limiting direct comparison. Conclusions: Verbal de-escalation represents a central component of WPV prevention in healthcare, yet implementation approaches and evaluation methods remain inconsistent. The evidence suggests associations with improved clinician confidence, reduced patient agitation, and enhanced perceptions of safety. Healthcare organizations can use these findings to strengthen training curricula, integrate de-escalation within broader safety frameworks, and support sustainable workforce protection strategies. Systematic review registration: OSF, identifier https://doi.org/10.17605/OSF.IO/S7QD9 .

Background: Sexually and gender diverse people affected by cancer (SGDc) experience significant disparities and minority stress across the cancer continuum, alongside high levels of unmet psychosocial needs and limited access to affirming support groups. Existing reviews and equity‑focused frameworks have called for SGDc interventions that centre queer and trans experiences, yet few evaluated models exist in psychosocial oncology. Methods: We conducted a pragmatic quality improvement project within the SGDc Program at Princess Margaret Cancer Centre to develop, implement, and evaluate QUEERMUNITY, a queer‑affirming psychotherapy support group for SGDc patients informed by a gender, sex, and relationship diversity (GSRD) framework. A pre‑implementation needs assessment survey of SGDc patients (n = 19) assessed supportive care priorities, including interest in queer‑specific groups. In response, we launched QUEERMUNITY and invited group participants (n = 31) to complete a one‑time cross‑sectional post‑implementation survey assessing perceived impact on safety, relevance, coping, community, and overall satisfaction, supplemented by qualitative feedback and facilitator observations. Results: In the needs assessment, 15 of 19 respondents (52.6-78.9%) rated "patient support groups specifically for 2SLGBTQIA+ patients and caregivers" as important or very important; adolescent/young adult and older‑adult 2SLGBTQIA+ groups were similarly prioritized. Dedicated SGDc‑specific professional supports (psychiatry, psychology, social work, and other healthcare providers) were endorsed as important or very important by 73.7-89.5% of respondents. One year post‑implementation, 25 of 31 QUEERMUNITY participants completed the survey (80.6% response rate). 91.3% reported feeling safe, comfortable, and inclined to continue engagement, with 95.7% recommending the group to others and rating strong satisfaction regarding community, support, queer joy, and pride.. Qualitative feedback highlighted the value of an explicitly queer‑centred space for discussing cancer, identity, and chosen family; relief at not navigating cis‑heteronormative assumptions; and perceived gains in coping, validation, and sense of community. Conclusions: Pre‑implementation data demonstrated strong demand for queer‑specific support groups and SGDc‑tailored professional supports, and post‑implementation findings suggest that QUEERMUNITY is a feasible, acceptable, and highly valued GSRD‑informed queer‑affirming group intervention in psychosocial oncology. This model offers a practical approach to operationalizing minority stress‑informed, intersectional, and GSRD‑theoretical frameworks in cancer care and may contribute to more equitable, affirming services for SGDc populations.

Communication about the end-of-life (EOL) is often avoided, despite its association with positive outcomes for those affected and their caregivers. Negative expectations seem to be a mechanism through which avoidance is maintained. This study examined existing expectations in talking about death to a significant other and validated a caregiver’s version of the End-of-Life Conversation – Expectation Scale (EOLC-E-c) with a German community sample of N = 250. Participants most frequently expected EOL conversations to cause sadness in themselves and the other person. Confirmatory factor analysis supported the original three-factor structure: Expected own emotional burden (α = .92), expected emotional burden of the other person (α = .94), and communication self-efficacy (=.90). Internal consistency of the scale was excellent, and its validity was supported. Using the scale could be valuable for clinicians and researchers in understanding individuals’ expectations concerning EOL conversations and in developing targeted interventions focusing on expectation violation.

Introduction: The COVID-19 pandemic created an urgent need for an innovative method of care delivery for psychosocial oncology. The psychosocial oncology services at the University Health Network in Toronto, Canada transitioned expeditiously to digital technologies that were readily available and accessible for patients and clinicians, facilitating care provision while reducing the transmission of COVID-19. This study aims to provide a validated framework for transitioning to digital delivery methods of care. Methods: A quality improvement team was established and tasked with successfully transitioning services from primarily in-person to digital delivery methods of care quickly and seamlessly. This included analyzing the psychosocial oncology workflow, planning and implementing a digital transition, and collecting data and feedback on the impact of this digital workflow through the use of surveys. Results: The average response rate of the surveys was 68.0%. Feedback and data collection demonstrated that more than 90% of psychosocial oncology processes were completed with digital tools following the transition with limited impact on clinical delivery. The clinicians reported feeling confident and satisfied providing care using digital workflow tools. Conclusion: The psychosocial oncology quality improvement team at the University Health Network provides a validated framework for transitioning to new methods of delivering care. As technology continues to develop, guidance on transitioning clinics and departments to new digital tools will be crucial for healthcare institutions. The framework provided in this study can be utilized to ensure the successful implementation of new technologies.

Despite advances in cancer care, disparities persist. The collection of the social determinants of health (SDOH) is fundamental to addressing disparities. However, SDOH are inconsistently collected in many regions of the world. This two-phase multiple methods study examined patient and community perspectives regarding SDOH data collection in Canada. In phase 1, a survey was administered to patients at a cancer centre (n = 549) to assess perspectives on an SDOH data collection tool. In phase 2, broader perspectives were sought through a community consultation with patient partners experiencing structural inequality (n = 15). Most participants were comfortable with SDOH data collection. Of survey respondents, 95% were comfortable with the collection of language, birthplace, sex, gender, education, and disability, and 82% to 94% were comfortable with SES, sexual orientation, social support, and race/ethnicity. Discomfort levels did not differ across subgroups, except women were more uncomfortable disclosing SES (OR: 2.00; 95%CI: 1.26, 3.19). Most (71%) preferred face-to-face data collection with a healthcare professional and only half were comfortable with storage of SDOH in electronic health records. Open-ended survey responses (n = 1533) and the community consultation revealed concerns about privacy, discrimination, relevance to care, and data accuracy. SDOH data collection efforts should include a clear rationale for patients, training for providers, strong data privacy and security measures, and actionable strategies to address needs.

Background: Workplace violence (WPV) in healthcare, particularly in emergency departments (EDs), is a growing and complex issue that significantly impacts healthcare providers (HCPs). Following the COVID-19 pandemic, the rates of WPV have increased globally, contributing to increased burnout, reduced morale, and heightened challenges in staff retention within EDs. Objective: This study aimed to explore HCPs’ perspectives on WPV in EDs. The insights gathered were intended to inform targeted interventions in a quality improvement initiative focused on addressing WPV in our healthcare institutions. Methods: A qualitative study involving semi-structured interviews was conducted with 52 HCPs across two urban EDs at a multi-site academic health center. Participants from various roles and shifts shared experiences related to safety, leadership, training, and security. Interviews were recorded, transcribed, anonymized, and thematically analyzed to identify key themes surrounding WPV in EDs. Results: The thematic analysis identified four main themes, including (1) Violence is Part of the Job, (2) Leadership Dynamics regarding WPV, (3) Disconnect Among ED Staff During WPV Response, and (4) Enhancing Systems and Culture for Effective WPV Management. These themes provide a comprehensive view of HCPs’ experiences and offer actionable recommendations for healthcare organizations seeking to address WPV. Conclusions: The study provides valuable qualitative insights into WPV in EDs, emphasizing the importance of addressing cultural, structural, and procedural gaps. These findings can guide the development of more supportive and effective strategies to create a safer environment for ED staff. Further rounds of interviews are planned post-intervention to assess changes in HCPs’ perceptions and experiences.

Background Workplace violence (WPV) in healthcare, particularly in emergency departments (EDs), is a growing and complex issue that significantly impacts healthcare providers (HCPs). Following the COVID-19 pandemic, rates of WPV have increased globally, contributing to increased burnout, reduced morale, and heightened challenges in staff retention within EDs. Objective This study aimed to explore HCPs’ perspectives on WPV in EDs. The insights gathered were intended to inform targeted interventions in a quality improvement initiative focused on addressing WPV in our healthcare institution. Methods A qualitative study involving semi-structured interviews was conducted with 52 HCPs across two urban EDs at a multi-site academic health center. Participants from various roles and shifts shared experiences related to safety, leadership, training, and security. Interviews were recorded, transcribed, anonymized, and thematically analyzed to identify key themes surrounding WPV in EDs. Results The thematic analysis identified 4 main themes including (1) Violence is Part of the Job, (2) Leadership Dynamics regarding WPV, (3) Disconnect Among ED Staff During WPV Response, and (4) Enhancing Systems and Culture for Effective WPV Management. These themes provide a comprehensive view of HCPs’ experiences and offer actionable recommendations for healthcare organizations seeking to address WPV. Conclusion The study provides valuable qualitative insights into WPV in EDs, emphasizing the importance of addressing cultural, structural, and procedural gaps. These findings can guide the development of more supportive and effective strategies to create a safer environment for ED staff. Further rounds of interviews are planned post-intervention to assess changes in HCPs’ perceptions and experiences.

Background: Globally, healthcare institutions have seen a marked rise in workplace violence (WPV), especially since the Covid-19 pandemic began, affecting primarily acute care and emergency departments (EDs). At the University Health Network (UHN) in Toronto, Canada, WPV incidents in EDs jumped 169% from 0.43 to 1.15 events per 1000 visits (p < 0.0001). In response, UHN launched a comprehensive, systems-based quality improvement (QI) project to ameliorate WPV. This study details the development of the project’s design and key takeaways, with a focus on presenting trauma-informed strategies for addressing WPV in healthcare through the lens of health systems innovation. Methods: Our multi-intervention QI initiative was guided by the Systems Engineering Initiative for Patient Safety (SEIPS) 3.0 framework. We utilized the SEIPS 101 tools to aid in crafting each QI intervention. Results: Using the SEIPS 3.0 framework and SEIPS 101 tools, we gained a comprehensive understanding of organizational processes, patient experiences, and the needs of HCPs and patient-facing staff at UHN. This information allowed us to identify areas for improvement and develop a large-scale QI initiative comprising 12 distinct subprojects to address WPV at UHN. Conclusions: Our QI team successfully developed a comprehensive QI project tailored to our organization’s needs. To support healthcare institutions in addressing WPV, we created a 12-step framework designed to assist in developing a systemic QI approach tailored to their unique requirements. This framework offers actionable strategies for addressing WPV in healthcare settings, derived from the successes and challenges encountered during our QI project. By applying a systems-based approach that incorporates trauma-informed strategies and fosters a culture of mutual respect, institutions can develop strategies to minimize WPV and promote a safer work environment for patients, families, staff, and HCPs.