Patient views on asthma diagnosis and how a clinical decision support system could help: A qualitative study

Abstract

IntroductionMaking a diagnosis of asthma can be challenging for clinicians and patients. A clinical decision support system (CDSS) for use in primary care including a patient-facing mode, could change how information is shared between patients and healthcare professionals, and improve the diagnostic process. MethodsParticipants diagnosed with asthma within the last five years were recruited from general practices across four UK regions. In-depth interviews were used to explore patient experiences relating to their asthma diagnosis, and to understand how a CDSS could be used to improve the diagnostic process for patients. Interviews were audio recorded, transcribed verbatim and analysed using a thematic approach. Results17 participants (12 female) undertook interviews, including 14 individuals and 3 parents of children with asthma. Being diagnosed with asthma was generally considered an uncertain process.Participants felt a lack of consultation time and poor communication affected their understanding of asthma and what to expect. Had the nature of asthma and steps required to make a diagnosis been explained more clearly, patients felt their understanding and engagement in asthma self-management could have been improved. Participants considered that a CDSS could provide resources to support the diagnostic process, prompt dialogue, aid understanding and support shared decision making. ConclusionUndergoing an asthma diagnosis was uncertain for patients if their ideas and concerns were not addressed by clinicians and was influenced by a lack of consultation time and limitations in communication. An asthma diagnosis CDSS could provide structure and an interface to prompt dialogue, provide visuals about asthma to aid understanding, and encourage patient involvement. Patient and public contributionPre-specified semi-structured interview topic guides (young person and adult versions) were developed by the research team and piloted with members of the Asthma UK Centre for Applied Research Patient and Public Involvement (PPI) group. Findings were regularly discussed within the research group and with PPI colleagues to aid interpretation of data.

The experience of shared decision‐making for people with asthma: A systematic review and metasynthesis of qualitative studies

“…In our review, a portion of patients expressed that they had longer interaction times with nurses. 15,22,39 Lenzen et al 54 suggest that nurses can serve as suitable decision coaches in facilitating SDM. They can bring a complementary set of skills to those of physicians.…”

“…the studies were conducted in America (n = 11), 18,[24][25][26][27][28][29][30][31]37,38 England (n = 3), 15,22,39 Australia (n = 1), 16 France (n = 1), 21 New Zealand (n = 1), 23 Canada (n = 1), 17 and Saudi Arabia(n = 1). 14 Quality assessment revealed that most of these studies met most Joanna Briggs Institute criteria (Table 1).…”

“…Unfortunately, many patients expressed a lack of agency in decision-making, as health care professionals did not proactively offer different choices for patients to choose and initiate thought-provoking discussions. 15,21,25,38,39 You sometimes feel that people are just giving you a And that was it. (PC02) 15 Furthermore, the involvement of people living with asthma in SDM or the healthcare process is significantly constrained by their social environment, encompassing aspects such as time availability and accessibility to medical services.…”

“…If she can't go, I can't go. 28 3.4.2 | Institutional problems in the medical system Some medical systems may lack sufficient support for SDM, 16,[25][26][27][28]37,39 potentially due to constraints in terms of medical insurance and medical resources patient needed. These constraints can limit the diversity of making choices.…”

Implementation of digital home monitoring and management of respiratory disease

“…Table 1 summarizes some existing digital home monitoring interventions in a number of respiratory conditions that have benefit in supporting patients to manage their conditions, reducing hospitalization, and facilitating remote consultation [10 ▪ ,13,18,27–59]. These interventions have proved to be feasible and effective in research contexts and potentially could be developed for implementation in routine practice.…”