Dangme West District Health Directorate, Ghana Health Service, PO Box DD1, Dodowa, Ghana.
Malar J. 2013 Jul 22;12:258. doi: 10.1186/1475-2875-12-258.
The debate on rapid diagnostic tests (RDTs) for malaria has begun to shift from whether RDTs should be used, to how and under what circumstances their use can be optimized. This has increased the need for a better understanding of the complexities surrounding the role of RDTs in appropriate treatment of fever. Studies have focused on clinician practices, but few have sought to understand patient perspectives, beyond notions of acceptability.
This qualitative study aimed to explore patient and caregiver perceptions and experiences of RDTs following a trial to assess the introduction of the tests into routine clinical care at four health facilities in one district in Ghana. Six focus group discussions and one in-depth interview were carried out with those who had received an RDT with a negative test result.
Patients had high expectations of RDTs. They welcomed the tests as aiding clinical diagnoses and as tools that could communicate their problem better than they could, verbally. However, respondents also believed the tests could identify any cause of illness, beyond malaria. Experiences of patients suggested that RDTs were adopted into an existing system where patients are both physically and intellectually removed from diagnostic processes and where clinicians retain authority that supersedes tests and their results. In this situation, patients did not feel able to articulate a demand for test-driven diagnosis.
Improvements in communication between the health worker and patient, particularly to explain the capabilities of the test and management of RDT negative cases, may both manage patient expectations and promote patient demand for test-driven diagnoses.
针对疟疾快速诊断检测（RDT）的争论已开始从 RDT 是否应该使用，转移到如何以及在什么情况下优化其使用的问题上。这增加了对 RDT 在适当治疗发热方面作用的复杂性的更好理解的需求。研究集中在临床医生的实践上，但很少有研究试图理解患者的观点，而不仅仅是接受性的概念。
这项定性研究旨在探讨患者和护理人员在一项试验后对 RDT 的看法和经验，该试验旨在评估在加纳一个地区的四个卫生机构中常规临床护理中引入这些检测。对那些接受了阴性 RDT 检测结果的人进行了六次焦点小组讨论和一次深入访谈。
患者对 RDT 抱有很高的期望。他们欢迎这些测试，因为它们有助于临床诊断，并且可以比他们更有效地口头传达他们的问题。然而，受访者还认为，这些测试可以识别出除疟疾以外的任何疾病的病因。患者的经历表明，RDT 被纳入了一个现有的系统中，在这个系统中，患者在身体上和智力上都被排除在诊断过程之外，而临床医生保留着超越测试及其结果的权威。在这种情况下，患者觉得自己无法表达对以测试为基础的诊断的需求。
改善卫生工作者与患者之间的沟通，特别是解释测试的能力和管理 RDT 阴性病例，可以管理患者的期望并促进患者对以测试为基础的诊断的需求。
