For example, time pressure and social relationships have been reported to be important barriers to speaking up. Participants in our study could make deliberate decisions after considering the potential risks and benefits of speaking up, something that is often not possible in clinical care. Research into affective forecasting shows that subjects often fail to predict their emotional response to future events and typically overestimate the intensity and duration of their emotional response due to ��impact bias��. In effect, we cannot rule out that responders in our study over or underestimated their own willingness to voice and we do not know whether participants�� hypothetical behaviors correlate with their actual behaviors. A Glycitin second limitation is that nurses are overrepresented in the sample due to the sampling strategy. While systematic differences in outcome variables between nurses and physicians exist, there were no differences between nurses approached via hospitals and those included in the professional membership file. As we have no data about nonresponders or about the distribution of characteristics in the entire oncology staff population we cannot estimate how representative our sample is. The strengths of this study are the relatively large sample size and the high response rate to the survey. In addition, we approached staff from a heterogeneous group of hospitals. The low correlations between the vignette ratings of each individual also provide some evidence that situation-specific context is important and that responders adjusted their ratings in response to the information provided. Finally, the use of a full-factorial experimental design allowed us to estimate all possible combinations of contextual factors without contamination by other factors. In conclusion, clinicians�� willingness to speak up about errors and rule violations was generally high but differed strongly according to type of error and rule violation. Physicians and nurses in oncology, in particular those without managerial Ginsenoside-Ro function, reported substantial discomfort with speaking up.