The psychological impact of pulmonary embolism: A mixed‐methods study

Abstract

Background Patients diagnosed with pulmonary embolism (PE) are reported to experience symptoms of posttraumatic stress disorder (PTSD) and existential anxiety following their diagnosis. They may also experience negative changes in perspective and hypervigilance of PE symptoms. Objective The aim of this study was to document the mental and emotional experience associated with PE diagnosis through the lens of PTSD, to better understand the factors involved in psychological distress following receipt of a PE diagnosis. Patients/Methods This was a mixed‐methods study in two parts: (i) measurement of self‐reported PTSD symptoms among patients attending thrombosis clinic and (ii) semistructured interviews with patients about their experience of receiving a diagnosis of PE and its psychological aftermath. Results Of 72 patients who participated in the survey, two met the criteria for a tentative diagnosis of PTSD. The semistructured interviews with 37 patients suggested that around half of respondents experienced some degree of ongoing psychological distress. Those with psychological distress often recalled painful symptoms, recalled diagnosis delivery as stressful, worried about PE recurrence, and had anxieties about stopping their anticoagulant medication. Few patients reported inclination to seek support from professional mental health services. Conclusions We found ongoing and untreated psychological distress among people who were previously diagnosed with PE.

Communication at diagnosis of venous thromboembolism: Lasting impact of verbal and nonverbal provider communication on patients

“…Other studies have shown that lack of adequate understanding may drive patients to seek information from potentially dubious sources. 27 , 28 …”

Do physicians contribute to psychological distress after venous thrombosis?

“…Complications such as chronic thromboembolic pulmonary hypertension, postthrombotic syndrome, and bleeding are well characterized in the thrombosis literature, and much research has focused on optimizing therapy to mitigate these adverse outcomes. However, patients who have experienced pulmonary embolism or deep vein thrombosis consistently report other mental health complications such as anxiety, depression, and posttraumatic stress disorder 1‐3 . In fact, when patients with VTE are interviewed about their lived experience, they are seldom preoccupied by their physical recovery and instead focus on psychological distress, worry, and well‐being.…”

“…However, patients who have experienced pulmonary embolism or deep vein thrombosis consistently report other mental health complications such as anxiety, depression, and posttraumatic stress disorder. 1 , 2 , 3 In fact, when patients with VTE are interviewed about their lived experience, they are seldom preoccupied by their physical recovery and instead focus on psychological distress, worry, and well‐being.…”

“…Patients who report lasting psychological distress after pulmonary embolism are more likely to recall their diagnosis delivery as a traumatic event. 1 In this issue of Research and Practice in Thrombosis and Hemostasis , Hernandez‐Nino et al explore how health care practitioners can both cause and exacerbate the psychological distress arising from VTE diagnosis. The impact of physician word choice is striking and paints a picture of physicians so immersed in disease management that they cannot step back to see a patient who does not understand what is happening and who is being excluded from participating in the conversation.…”

“… 2 The resultant perceived lack of control can lead to further mistrust in health care providers, and it is not unusual for patients to seek out new physicians. 2 , 5 Patients describe lack of information at every level: from the pathophysiology of VTE, such as understanding what VTE is and whether it can cause a stroke or heart attack, 1 to the expected prognosis and practicalities of when to return to work. 2 …”