Background:
Evidence suggests that including the patient in the decision-making process leads to better health outcomes. The objective of this qualitative study is to explore barriers and facilitators to self-advocacy among patients during the diagnostic process in the emergency department (ED).
Methods:
ED patients (n=16) completed 15-30 minute semi-structured phone interviews 2 weeks to 3 months following an ED visit. Patients were eligible who had at least one chief complaint linked to common, dangerous cardiovascular conditions that are often misdiagnosed (chest pain, dizziness, headache, abdominal pain, and/or cough). Interviews were transcribed verbatim and coded by two independent reviewers using an inductive thematic analysis approach.
Findings:
The participants’ average age was 51 years-old (range 26-73 years-old). 62.5% of participants identified their race as White, 37.5% Black or African American, and 6.2% Asian. Interviews centered on the patients’ experience with the diagnostic process in the ED, including expectations, communication with clinical care team, and satisfaction and understanding of follow-up plans. The analysis revealed three common themes: (1) Doctors perceived as having total authority. Patients voiced that they must do as prescribed and not question the explanation given for their health problems by the doctors, who were the experts. (2) Satisfaction without a thorough assessment. Patients reported an acceptance of being “rushed” from the ED without thorough diagnosis or explanation because they expect doctors to be busy. Patients are satisfied with being told their diagnosis is unknown but not life-threatening. (3) Patients reported a high-level of self-awareness of their baseline health status, and used their intuition to seek medical care. Three of the sixteen patients reported developing a dangerous cardiovascular condition, including a stroke and a venous thromboembolism, after discharge that potentially could have been identified in the ED. They each reported a self-awareness that a dangerous health situation may be developing, but a trust in providers’ decision-making to discharge them.
Conclusions:
The interviews shared common themes of reduced self-advocacy in the setting of the ED and trust in providers’ opinions over patients’ own intuition. In three cases, patients reported developing a dangerous cardiovascular condition shortly after discharge that may have been identified earlier with increased self-advocacy.Implications for Practice: The fast-paced ED system may exacerbate patient vulnerability and impede their willingness to assert themselves. Empowering patients to provide input in the diagnostic process may contribute valuable information that leads to more accurate diagnoses.
Challenges of recruiting emergency department patients to a qualitative study: a thematic analysis of researchers’ experiences
