https://orcid.org/0000-0003-4064-8277
Abstract
Purpose
Syncope is a complex symptom requiring thoughtful evaluation. The ACC/AHA/HRS published syncope management guidelines in 2017. Effective guideline implementation hinges on overcoming multilevel barriers, including providers’ perceptions that patients prefer aggressive diagnostic testing when presenting to the emergency department (ED) with syncope, which conflicts with the 2017 Guideline on Syncope. To better understand this perceived barrier, we explored patient and family caregiver expectations and preferences when presenting to the ED with syncope.
Patients and Methods
We conducted semi-structured focus groups (N=12) and in-depth interviews (N=19) with patients presenting to the ED with syncope as well as with their family caregivers. Interviews were recorded, transcribed verbatim, and analyzed by a team of researchers following a directed content analysis. Results were reviewed and shared iteratively with all team members to confirm mutual understanding and agreement.
Results
Syncope patients and caregivers discussed three main desires when presenting to the ED with syncope: 1) clarity regarding their diagnosis,; 2) context surrounding their care plan and diagnostic approach; and 3) to feel seen, heard and cared about by their health care team.
Conclusion
Clinicians have cited patient preferences for aggressive diagnostic testing as a barrier to adhering to the 2017 Guideline on Syncope, which recommends against routine administration of imaging testing (eg, echocardiograms). Our results suggest that while participants preferred diagnostic testing as a means to achieve clarity and even a feeling of being cared for, other strategies, such as a patient-engaged approach to communication and shared decision-making, may address the spectrum of patient expectations when presenting to the ED with syncope while adhering to guideline recommendations.
Acknowledgments
The authors wish to thank Hilary L. Surratt, PhD, for assistance with conducting interviews.
Disclosure
Dr Mark V Williams reports grants from National Heart, Lung and Blood Institute and the Center for Medicare and Medicaid Services (CMS) during the conduct of the study; received Salary from University of Kentucky, personal fees from OptumHealth Care Solutions, personal fees from Society of Hospital Medicine, from Northwestern University, outside the submitted work.
Dr Jing Li reports grants from NHLBI during the conduct of the study; served as NIH study section reviewer outside the submitted work. The authors declare no conflicts of interest.