“Passing Out is a Serious Thing”: Patient Expectations for Syncope Evaluation and Management

Figures & data

Table 1 Study Activities to Assess Barriers and Facilitators Based on CFIR Constructs

Domain	Construct	Assessment within Project MISSION
Inner Setting	Readiness for Implementation	Surveys, focus groups and key informant interviews – clinicians and stakeholders^Citation18
	Structural characteristics (eg, availability of electronic information infrastructure)	Focus groups and key informant interviews – clinicians and stakeholders^Citation18
Individual Characteristics	Patient needs, values, and preferences^a	Individual and focus froup interviews – patients and family caregivers
	Provider attitudes to evidence-based practices	Survey of clinicians and stakeholders^Citation14,Citation18
Intervention Characteristics	Strength of evidence, relative advantage, adaptability, and complexity	Focus groups and key informant interviews – clinicians and stakeholders^Citation18

Note: ^aFocus of the present article.

Table 2 Interview Guide Outline

Contextual details surrounding patient’s syncopal episode Participant’s interaction with care team in the ED Participant’s reaction to being admitted (if applicable) Participant’s hypothetical reactions to scenarios regarding level of testing and treatment eg, length of observation, tests ordered, explanation from doctor Participant’s discharge process Family caregiver involvement

Table 3 Participant Demographics (N=31)

	N	SD/%
Age (Mean, SD)	44	17
Gender
Male	16	51
Female	15	48
Race
White	19	61
Black	9	29
Other	2	6
Missing	1	3
Hispanic/Latino Ethnicity
Yes	2	6
No	26	84
Missing	3	10
Education
≤ High school	10	32
Some college	7	23
Associate	1	3
≥ College	8	25
Missing	5	16
Marital Status
Single	12	39
Married	7	23
Widowed	4	13
Other	5	16
Missing	3	10
Employment Status
Full-time	11	35
Part-time	2	6
Not employed	7	23
Disabled	3	10
Other	4	13
Missing	4	13
Insurance type
Medicaid	9	29
Medicare	6	19
Employer-sponsored/Private	8	25
Uninsured	2	6
Other	2	6
Missing	4	13

Table 4 Themes of Patient Expectations and Desires

Theme	Sub-Theme	Quote
Clarity surrounding their care plan and diagnosis	Syncope as symptom of underlying problem	Passing out, you know, is a serious thing. So, you never know what’s going on.
	Emergency department means action, answers	Like, my thinking is why would they call it emergency department if they are going to sit down and watch? [Patient]
	Patients tended to prefer an aggressive approach to testing	If you leave here just thinking everything’s gonna be fine and it might be. But six months down the road, you might have some other issue that, you know, may not have been caught, but [if you had done aggressive testing] you’d at least have that better feeling of there’s nothing else they could’ve done. [Patient] – Interviewer: Are you hoping that they run a lot of tests? Is that kind of your expectation? Patient: Yeah, cause I would really like to know why I started feeling so bad, and especially why I pass out. Because that’s really concerning.
Context surrounding their care plan and approach to diagnostic testing	Patients and Caregivers often reported insufficient communication	I had 3 EKGs, which I never understood [why]. And I had an echocardiogram, and I never understood why ... They just randomly came up like “Hey, we’re going to give you an echocardiogram.” And I was like “Why?” “To check for something.” They did not even do it. [Patient]
	Patient preferences regarding testing were often discussed in the context of communication	I could see how that ... like, in a way, [an aggressive approach to testing] would make me happy, you know what I mean? Because I feel like they are really like, concerned with what’s going on and trying to figure it out... But then the other side of me feels like maybe that [aggressive testing] could make me nervous, because if there was like a bunch of doctors and stuff, like I might just feel like something really serious is going on, because that’s not usually how things, go, you know? [ED Patient]
	Patient awareness and knowledge of syncope varied	The doctor himself never told me I had syncope. I never found out before they moved me to the ICU on the floor. The nurse said something about it ... I asked her if I could go smoke and she said “No, you have syncope ... I can’t let you walk around and stuff.” And I said, “Well what’s that?” [Patient]
Being seen, heard, and cared about by their health care team	Patients and caregivers wanted to feel seen, heard, and cared about	It’s nice to know that somebody that you are seeing, a physician, or a care specialist, or anything, really does not see you as a number. They see you as a person. And want to take the time to find out what’s wrong, or brush you off so they can move on to their next patient. [Patient]
	Listening and attentive communication was viewed as an indication of provider concern	Patient: Actually, Hospital A is the only one that even gave us a remote feeling that maybe I will know what’s wrong now. Interviewer: Right. Okay. And, what did they do at Hospital A that made you feel that way? Caregiver: They come out and say that they would know what–that they would try their best to find out what the problem was. And they listened to what he was saying to them.
	Testing was viewed as an indication of providers’ concern	I could see how that ... like, in a way, [an aggressive approach to testing] would make me happy, you know I mean? Because I feel like they are really like, concerned with what’s going on and trying to figure it out.[Patient]

Li J, Gupta V, Smyth SS, et al. Value-based syncope evaluation and management: perspectives of health care professionals on readiness, barriers and enablers. Am J Emerg Med. 2020;38(9):1867–1874. doi:10.1016/j.ajem.2020.05.029

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Smyth S, Gupta V, Williams M, et al. Identifying guideline-practice gaps to optimize evaluation and management for patients with syncope. Can J Cardiol. 2020;37(3):500–503. doi:10.1016/j.cjca.2020.05.022

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