"Passing Out is a Serious Thing": Patient Expectations for Syncope Evaluation and Management.
"Passing Out is a Serious Thing": Patient Expectations for Syncope Evaluation and Management.
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DOI：
10.2147/ppa.s307186
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发表时间：
2021
影响因子：
2.2
通讯作者：
Li J
中科院分区：
文献类型：
--
作者：
Clouser JM;Sirrine M;McMullen CA;Cowley AM;Smyth SS;Gupta V;Williams MV;Li J
晕厥是一种复杂的症状，需要仔细评估。ACC/AHA/HRS于2017年发布了晕厥管理指南。有效的指南实施取决于克服多层次的障碍，包括提供者认为患者在因晕厥到急诊室（艾德）就诊时更喜欢积极的诊断测试，这与2017年晕厥指南相冲突。为了更好地理解这种感知障碍，我们探讨了患者和家庭照顾者在因晕厥就诊于艾德时的期望和偏好。我们进行了半结构化的焦点小组（N=12）和深入访谈（N=19）与患者提出的艾德晕厥以及与他们的家庭照顾者。访谈记录，逐字转录，并由一组研究人员进行分析后，有针对性的内容分析。审查结果并与所有团队成员反复分享，以确认相互理解和一致。晕厥患者和护理人员在向艾德就诊时讨论了三个主要愿望：1）明确诊断; 2）围绕其护理计划和诊断方法的背景; 3）感觉被其医疗保健团队看到、听到和关心。临床医生将患者对积极诊断测试的偏好列为遵守2017年晕厥指南的障碍，该指南建议不要常规进行成像测试（例如，超声心动图）。我们的研究结果表明，虽然参与者更喜欢诊断测试作为一种手段，以实现清晰，甚至被照顾的感觉，其他策略，如患者参与的沟通和共同决策的方法，可能会解决患者的期望范围时，向艾德晕厥，同时坚持指南建议。
Syncope is a complex symptom requiring thoughtful evaluation. The ACC/AHA/HRS published syncope management guidelines in 2017. Effective guideline implementation hinges on overcoming multilevel barriers, including providers’ perceptions that patients prefer aggressive diagnostic testing when presenting to the emergency department (ED) with syncope, which conflicts with the 2017 Guideline on Syncope. To better understand this perceived barrier, we explored patient and family caregiver expectations and preferences when presenting to the ED with syncope. We conducted semi-structured focus groups (N=12) and in-depth interviews (N=19) with patients presenting to the ED with syncope as well as with their family caregivers. Interviews were recorded, transcribed verbatim, and analyzed by a team of researchers following a directed content analysis. Results were reviewed and shared iteratively with all team members to confirm mutual understanding and agreement. Syncope patients and caregivers discussed three main desires when presenting to the ED with syncope: 1) clarity regarding their diagnosis,; 2) context surrounding their care plan and diagnostic approach; and 3) to feel seen, heard and cared about by their health care team. Clinicians have cited patient preferences for aggressive diagnostic testing as a barrier to adhering to the 2017 Guideline on Syncope, which recommends against routine administration of imaging testing (eg, echocardiograms). Our results suggest that while participants preferred diagnostic testing as a means to achieve clarity and even a feeling of being cared for, other strategies, such as a patient-engaged approach to communication and shared decision-making, may address the spectrum of patient expectations when presenting to the ED with syncope while adhering to guideline recommendations.