Relation between illness representation and self-reported degree-of-worry in patients calling out-of-hours services: a mixed-methods study in Copenhagen, Denmark

Abstract

ObjectivesTo examine the relation between patients’ illness representations, presented in telephone consultation to out-of-hours (OOH) services, and self-reported degree-of-worry (DOW), as a measure of self-evaluated urgency. If a clear relation is found, incorporating DOW during telephone triage could aid the triage process, potentially increasing patient safety.DesignA convergent parallel mixed methods design with quantitative data; DOW and qualitative data from recorded telephone consultations. Thematic analysis of the qualitative data was used to explore the content of the quantitatively scaled DOW, using the Common-Sense Model of Self-Regulation (CSM).SettingA convenience sampling of calls to the OOH services in Copenhagen, Denmark, during 3 days was included in the study.ParticipantsCalls from adults (≥15 years of age) concerning somatic illness during the data collection period were eligible for inclusion. Calls made on behalf of another person, calls concerning perceived life-threatening illness or calls regarding logistical/practical problems were excluded, resulting in analysis of 180 calls.ResultsAll five components of the CSM framework, regardless of DOW, were present in the data. All callers referred to identity and timeline and were least likely to refer to consequence (37%). Through qualitative analysis, themes were defined. Callers with a strong identity, illness duration of less than 24 hours, clear cause and solution for cure/control seemed to present a lower DOW. Callers with a medium identity, illness duration of more than 24 hours and a high consequence seemed to present a higher DOW.ConclusionThis study suggests a relation between a patient’s illness representation and self-evaluation of urgency. Incorporating a patient’s DOW during telephone triage could aid the triage process in determining urgency and type of healthcare needed, potentially increasing patient safety. Research on patient outcome after DOW-assisted triage is needed before implementation of the DOW scale is recommended.

Self-rated worry is associated with hospital admission in out-of-hours telephone triage – a prospective cohort study

“…There is a relation between the conceptual theory behind the common-sense model and DOW. Secondary analysis of data from a feasibility study on DOW found that the caller with a strong illness identity, short illness duration, a clear cause and solution for cure and control were more likely to present a low DOW [38]. In the current study, we present a strong association between DOW and hospital admission and thus established the connection between illness representation, DOW and outcome.…”

Possible associations between callers’ degree-of-worry and their socioeconomic status when contacting out-of-hours services: a prospective cohort study

“…Callers’ DOW could thereby, act as a mental forcing strategy, potentially debiasing the call handler’s perception of the caller. According to the Common-Sense Model of Self-Regulation (CSM) by Leventhal [ 45 ], a widely recognized theoretical framework, patients’ perceptions of their illness, is based on prior experience, personal beliefs, discussions with others and cultural understandings [ 46 ] and a relation between a patient’s illness representation and self-evaluation of urgency or DOW has previously been shown [ 12 ]. If the callers’ DOW, therefore, does not correspond to the call handler’s sense of urgency, the call handler may ask more in-depth questions, leading to a better understanding of the patient’s illness perception, especially in relation to DOW, possibly influencing and correcting the call handlers sense of urgency.…”

“…The goal is to increase patient-centred communication by encouraging patients' participation and thereby aiding call handlers in determining urgency and type of health care needed, potentially increasing patient safety. DOW has previously been shown to be feasible and associated with callers' illness representation [12]. It has also been shown that high DOW is strongly associated with hospitalisation [13], but that call handlers' awareness of callers' DOW had no effect on triage response [14].…”

Possible associations between callers’ degree-of-worry and their socioeconomic status when contacting out-of-hours services: a prospective cohort study

“…According to the Common-Sense Model of Self-Regulation (CSM) by Leventhal, a widely recognized theoretical framework, patients' perceptions of their illness, is based on prior experience, personal beliefs, discussions with others and cultural understandings and a relation between a patient's illness representation and self-evaluation of urgency or DOW has previously been shown. 12 If the callers' DOW, therefore, does not correspond to the call handler's sense of urgency, the call handler may ask more indepth questions, leading to a better understanding of the patient's illness perception, especially in relation to DOW, possibly in uencing and correcting the call handlers sense of urgency. Acknowledging the patient's DOW as valuable triage information will enable elicitation, attention to, and understanding of the individual meaning and signi cance of patient's symptoms.…”