Background: Workplace violence (WPV) against healthcare workers is a prevalent global issue, with over half experiencing such incidents. Oncology settings, characterized by high-stakes care and patient distress, are recognized as particularly high-risk environments for WPV.
Objectives: To determine the nationwide prevalence of WPV against medical staff in China's tertiary public cancer hospitals, identify key risk factors, and explore staff perceptions on the causes of and solutions for patient-physician tension, aiming to inform targeted prevention strategies.
Methods: This nationwide cross-sectional study was conducted in 2021 across 33 national or provincial tertiary cancer centers, covering all 31 administrative regions of mainland China. Using a multistage sampling method, 11,250 medical professionals (5,755 nurses and 5,495 physicians) were enrolled. Self-reported exposure to verbal and physical violence in the preceding year was collected. Predictors of WPV were examined using multivariable logistic regression. Staff perceptions on causes of poor patient-physician relationships and suggestions for improvement were thematically analyzed.
Results: The overall prevalence was 24.50% for verbal violence and 2.86% for physical violence. Physicians reported a higher prevalence of verbal violence (26.21% vs. 22.87%), while nurses reported a slightly higher prevalence of physical violence (2.94% vs. 2.78%). Regarding organizational factors, compared to internal medicine departments, staff in surgery (OR, 0.82; 95% CI, 0.69–0.96) and anesthesiology (OR, 0.24; 95% CI, 0.16–0.35) had lower odds of verbal violence, whereas emergency medicine had significantly higher odds of physical violence (OR, 2.93; 95% CI, 1.59–5.39). Regarding personal factors, compared to staff aged below 35 years, those aged 35-45 years had higher odds of physical violence (OR, 1.52; 95% CI, 1.02-2.26). Compared to those with a master’s degree or higher, staff with an associate degree also had significantly higher odds of physical violence (OR, 2.65; 95% CI, 1.70–4.12). Regarding workload, working more than four night shifts per month was associated with increased odds of both verbal (OR, 1.17; 95% CI, 1.12–1.35) and physical (OR, 1.37; 95% CI, 1.06–1.76) violence. Critically, a strong dose-response relationship was observed between weekly working hours and both types of violence. Working >60 hours per week was associated with markedly increased odds of verbal (OR, 3.30; 95% CI, 2.48–4.41) and physical (OR, 8.90; 95% CI, 6.56–12.08) violence. From thematic analysis, the five most cited causes of poor patient-physician relationships were: insufficient communication, lack of patient trust, unrealistic patient expectations, inadequate legal frameworks for dispute resolution, and biased media coverage. Correspondingly, the top five suggestions for improvement included: enhancing communication, improving quality of care, optimizing clinical environments, increasing medical insurance coverage, and expanding government financial support.
Conclusions: In this large national study of Chinese cancer hospital staff, WPV was prevalent, with notable variations by specialty, workload, and training. The findings highlight modifiable risk factors, most notably excessive working hours, and align staff-identified solutions with needed systemic and interpersonal interventions. Ensuring a safe practice environment and strengthening trust in patient-provider relationships are essential to support oncology care quality and outcomes.