• Aileen Collier, Ros Sorensen, and Rick Iedema.
• Discipline Palliative and Supportive Services, School of Health Sciences, Flinders University, Adelaide, SA, Australia.
• Int J Qual Health Care. 2016 Feb 1; 28 (1): 66-73.

ObjectiveThe aim of this study was to investigate patients' and families' perspectives of safety and quality in the setting of a life-limiting illness.DesignData reported here were generated from a qualitative study using video-reflexive ethnographic methodology. Data were collected over 18 months and generated through participant observation, shadowing of clinicians, field-interviews and semi-structured interviews with patients and families.SettingThe study was conducted at two hospital sites in Sydney, Australia and in patients' homes.ParticipantsPatients with an advanced life-limiting illness (n = 29) ranging in age between 27 and 89 years and family members (n = 5) participated in the study.ResultsPatient safety remains important to dying patients and families. For dying people, iatrogenic harm is not regarded as 'one off' incidents. Rather, harm is experienced as a result of an unfolding series of negative events. Critically, iatrogenic harm is emotional, social and spiritual and not solely technical-clinical misadventure and is inextricably linked with feeling unsafe. Thus, patient safety extends beyond narrowly defined technical-clinical parameters to include interpersonal safety.ConclusionsCurrent approaches to patient safety do not address fully the needs of dying patients and their families. Patients and their families regard poor communication with and by health professionals to be harmful in and of itself.© The Author 2015. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.

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