'I just thought it was normal aches and pains': a qualitative study of decision-making processes in patients with early rheumatoid arthritis
'I just thought it was normal aches and pains': a qualitative study of decision-making processes in patients with early rheumatoid arthritis
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DOI：
10.1093/rheumatology/ken304
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发表时间：
2008-10-01
期刊：
影响因子：
5.5
通讯作者：
Raza, K.
中科院分区：
文献类型：
--
作者：
Sheppard, J.;Kumar, K.;Raza, K.
目标。只有在RA早期发现患者，才能给予有效的治疗。然而，许多患者在寻求医疗建议之前拖延了很长时间。本研究探讨影响RA患者就诊决定的因素。对24例患者进行了深入的半结构化访谈。有目的的抽样确保了在呈现时间、性别、年龄和种族背景方面的横截面。使用既定的方法分析访谈记录并确定主题。有四个主题影响着寻求医疗咨询的决定：(i)症状经历：症状的严重程度及其对功能的影响；（ii）症状评估：患者对其症状的解释和对其重要性的认识；（iii）了解类风湿性关节炎和现有治疗方法；（四）对保健提供者的经验和态度。疾病对功能能力的显著而迅速的影响是早期患者的特征。许多人对他们的症状做出了与之前的活动有关的解释。认识到这种解释不足以解释症状的进展，经常促使咨询。只有一名患者寻求建议，因为她认为她可能患有ra。症状评估是影响其他疾病患者就医速度的关键因素。与许多癌症的情况相反，症状和体征与最终诊断有广泛的联系，但类风湿性关节炎的情况并非如此。我们的研究结果应该为减少早期RA患者寻求帮助的延迟提供策略。
Objective. Effective treatment can only be given during the early stages of RA if patients are seen early. However, many patients delay for prolonged periods before seeking medical advice. This study explores factors influencing the decision to seek medical advice in RA patients.Methods. In-depth, semi-structured interviews were carried out with 24 patients. Purposive sampling ensured a cross-section in terms of time to presentation, gender, age and ethnic background. Interview transcripts were analysed and themes identified using established methods.Results. Four main themes influenced the decision to seek medical advice: (i) symptom experience: the severity of symptoms and their impact on functional ability; (ii) symptom evaluation: the patients explanation for their symptoms and recognition of their significance; (iii) knowledge of RA and available therapies; and (iv) experience of and attitudes towards health care providers. A significant and rapid impact of the disease on functional ability characterized those presenting early. Many developed an explanation for their symptoms that related to preceding activities. Recognition that this explanation was inadequate to explain symptom progression frequently prompted a consultation. Only one patient sought advice because she thought that she might have RA.Conclusions. Symptom evaluation is a key factor influencing how quickly medical advice is sought in other diseases. In contrast to the situation with many cancers where there is widespread association of symptoms and signs with the eventual diagnosis, this was not the case in RA. Our findings should inform strategies to reduce delays in help-seeking in people with early RA.