Tools to engage patients and family members in diagnostic safety: we see the trees, but what about the forest?

In 2015, the National Academy of Science, Engineering and Medicine report ‘Improving Diagnosis’ sounded a call to action, urging patient and family engagement (PFE) in diagnostic safety.1 While many clinicians agree in principle with PFE, tangible ways to engage patients and families in diagnostic safety were underexplored.2 Fast forward to 2026 and this issue of BMJ Quality and Safety, where Hill et al 3 describe a changed landscape with the results of their scoping review of PFE interventions in diagnosis. In both grey and peer-reviewed literature, the authors identified 260 unique PFE interventions relating to diagnosis, including 213 in the grey literature, originating from healthcare delivery systems, research funders and patient organisations. Patients were the intended primary users for 63% of the interventions, but only 24% were designed with patients. The authors categorised the interventions into 16 different types that could be used across various stages of the diagnostic process. In their summary, the authors appropriately highlight the need for increased patient involvement in tool development, the creation of tools to address inequities, tools to improve the referral process and more rigorous evaluation of tools.