Key result
Symptom interpretation and reluctance to burden doctors complicate patient pathways to coronary heart disease diagnosis.
Why the study?
The pathway to diagnosis for suspected coronary heart disease symptoms in a rapid access chest pain clinic context is underexplored.
Complex issues, including symptom interpretation and reluctance, shape patients' decisions to seek help for suspected coronary heart disease, highlighting areas for targeted health promotion.
Answers are grounded in this paper and cite their sources.
Complex barriers may delay CHD diagnosis; hypothesis-generating for access interventions and requires prospective validation before practice change.
OBJECTIVE: A number of studies have explored delayed help-seeking practices for acute coronary syndrome (ACS) and have indentified multiple intersecting factors which may play a role, for example, attributing symptoms, age, gender, ethnicity and contextual influences. However, the pathway to diagnosis for suspected coronary heart disease (CHD) symptoms in a rapid access chest pain clinic (RACPC) context is underexplored. The objective of this study was to examine patients' help-seeking experiences of accessing RACPC services, from the point at which they notice and interpret symptoms, to their decision to seek help from their general practitioner. DESIGN: Qualitative study. SETTING: Interviews were conducted in the RACPC at Queen Mary's Roehampton Hospital, London, UK. PARTICIPANTS: Maximum variation sampling was used to recruit 30 participants (15 men and 15 women) referred to a RACPC, using sampling dimensions of age, ethnicity and occupation. METHODS: Semi-structured interviews focussed on the patient experience of their pathway to the RACPC. Thematic analysis was used to analyse the interview data. RESULTS: Participant interpretation of symptoms was shaped by multiple influences; reluctance to seek help contributed to delay; various factors acted as drivers as well as barriers to help-seeking; and GP referrals to RACPC were based on symptoms as well as patients' need for reassurance. CONCLUSION: We found complex issues shaped the patient's decision-making when accessing the RACPC, including making sense of symptoms and help-seeking practices. These findings can be used to develop health promotion literature to encourage early help-seeking and improve RACPC services.
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Stain et al. (2020) studied Suspected coronary heart disease (n=30). Experiencing suspected coronary heart disease symptoms and navigating the rapid access chest pain clinic pathway was evaluated on Help-seeking experiences and patient pathways to diagnosis, identified through qualitative thematic analysis. Patients with suspected coronary heart disease experience complex help-seeking pathways shaped by symptom interpretation, reluctance to burden doctors, and varying primary care accessibility.
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