Department of Psychology, University of Calgary, 2500 University Drive, NW, Calgary, AB, T2N 1N4, Canada.
Dhillon School of Business, University of Lethbridge, 4401 University Dr W, Lethbridge, AB, T1K 3M4, Canada.
CJEM. 2021 Mar;23(2):195-205. doi: 10.1007/s43678-020-00045-z. Epub 2021 Jan 7.
Protocols that support paramedics to assess, treat and refer low-risk syncope (fainting) may allow for ED transport of only high-risk patients. The development and uptake of such protocols is limited by a dearth of information about factors patients consider when deciding to seek EMS care following syncope.
We explored decision-making processes of individuals with syncope regarding whether (or not) to call EMS after fainting as a starting point in the development of prehospital risk-stratification protocols for syncope.
Twenty-five Canadian adults (aged 18-65 years) with a history of ≥ 1 syncopal episode were recruited. Individual semi-structured interviews were conducted, recorded, and transcribed. Straussian grounded theory methods were used to identify common themes and a core (overarching) category.
Four themes were identified: (a) previous experiences with the healthcare system (e.g., feeling dismissed), (b) individual patient factors (e.g., age, medical history), (c) attitudes and beliefs (e.g., burdening the health care system, syncope is "not serious"), and (d) contextual factors (e.g., influence of important others, symptom severity). Perceived judgement, including judgement from EMS and negative self-evaluations, was identified as the core category that influenced patients' decisions to seek care.
We theorize that, while patients consider many factors in deciding to contact EMS for syncope, previous experiences of feeling judged and unfavorable beliefs about syncope may interfere with patients' receptiveness to traditional EMS protocols for syncope. The findings highlight potential patient needs that program developers may wish to consider in the development of prehospital protocols to improve care and satisfaction among patients with syncope.
支持护理人员评估、治疗和转介低风险晕厥（晕厥）的方案可能允许仅将高风险患者送往急诊部。由于缺乏有关患者在晕厥后决定是否寻求紧急医疗服务（EMS）护理时考虑的因素的信息，这些方案的制定和采用受到限制。
我们探讨了晕厥后是否呼叫 EMS 的决策过程，作为制定晕厥院前风险分层协议的起点。
招募了 25 名加拿大成年人（年龄 18-65 岁），他们有≥1 次晕厥发作史。进行了个体半结构化访谈，记录并转录。使用 Straussian 扎根理论方法确定常见主题和核心（总体）类别。
确定了四个主题：（a）以前的医疗保健系统体验（例如，感到被忽视），（b）个体患者因素（例如，年龄、病史），（c）态度和信念（例如，给医疗保健系统带来负担，晕厥“不严重”），和（d）背景因素（例如，重要他人的影响，症状严重程度）。感知判断，包括来自 EMS 的判断和对晕厥的负面自我评价，被确定为影响患者寻求护理决策的核心类别。
我们推断，尽管患者在决定因晕厥而联系 EMS 时会考虑许多因素，但以前感到被评判和对晕厥的不利信念可能会干扰患者对传统 EMS 晕厥协议的接受程度。研究结果强调了患者的潜在需求，方案开发者可能希望在制定院前协议时考虑这些需求，以改善晕厥患者的护理和满意度。
