Taylor C J, Hobbs F D R, Marshall T, Leyva-Leon F, Gale N
Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
BMJ Open. 2017 Mar 10;7(3):e013648. doi: 10.1136/bmjopen-2016-013648.
To explore 2 key points in the heart failure diagnostic pathway-symptom onset and diagnostic meaning-from the patient perspective.
Qualitative interview study.
Participants were recruited from a secondary care clinic in central England following referral from primary care.
Over age 55 years with a recent (<1 year) diagnosis of heart failure confirmed by a cardiologist following initial presentation to primary care.
Semistructured interviews were carried out with 16 participants (11 men and 5 women, median age 78.5 years) in their own homes. Data were audio-recorded and transcribed. Participants were asked to describe their diagnostic journey from when they first noticed something wrong up to and including the point of diagnosis. Data were analysed using the framework method.
Participants initially normalised symptoms and only sought medical help when daily activities were affected. Failure to realise that anything was wrong led to a delay in help-seeking. Participants' understanding of the term 'heart failure' was variable and 1 participant did not know he had the condition. The term itself caused great anxiety initially but participants learnt to cope with and accept their diagnosis over time.
Greater public awareness of symptoms and adequate explanation of 'heart failure' as a diagnostic label, or reconsideration of its use, are potential areas of service improvement.
从患者角度探讨心力衰竭诊断流程中的两个关键点——症状出现及诊断意义。
定性访谈研究。
参与者从英格兰中部一家二级护理诊所招募，由初级护理机构转诊而来。
年龄超过55岁，近期（<1年）经心脏病专家确诊为心力衰竭，最初由初级护理机构接诊。
对16名参与者（11名男性和5名女性，中位年龄78.5岁）在其家中进行半结构式访谈。数据进行录音和转录。要求参与者描述从最初发现身体不适到确诊这一过程的诊断经历。采用框架法对数据进行分析。
参与者最初将症状视为正常情况，只有在日常活动受到影响时才寻求医疗帮助。未能意识到身体有问题导致寻求帮助的延迟。参与者对“心力衰竭”一词的理解各不相同，有1名参与者不知道自己患有此病。这个词最初引起了极大的焦虑，但随着时间的推移，参与者学会了应对并接受自己的诊断。
提高公众对症状的认识，对“心力衰竭”这一诊断标签进行充分解释或重新考虑其使用，是服务改进的潜在领域。
