Prior research suggests that uncertainty related to symptoms is a driver of emergency department (ED) use, and that patients often leave the ED with uncertainty not being addressed. Our objective was to engage patients to identify domains that contribute to feelings of uncertainty and decisions to use the ED.
We used Group Concept Mapping, a quasi-qualitative/quasi-quantitative method, to elicit patients’ views on how uncertainty related to experiencing symptoms contributes to decisions to access the ED. Purposive sampling was used to recruit participants who either sought treatment at the ED twice within a 30-day period, or visited both the ED and a primary care provider at least once within the past year.
Thirty-four participants engaged in two rounds of Group Concept Mapping during which participants participated in structured brainstorming of ideas, followed by ranking and clustering of ideas into domains. The first round generated 47 idea statements reflecting uncertainty about consequences, severity, emergency room services, primary care options, finances, and psychologic concerns. The second round generated 52 idea statements reflecting uncertainty about self-management, causation, diagnosis and treatment plan, trust in the provider and institution, accessibility, and alternative care options.
Factors that contribute to uncertainty and decision-making about ED use are both intrinsic (ie, cause, symptom severity) and extrinsic (ie, finances, accessibility). These domains can inform approaches to measure the uncertainty that patients experience, and to design and test interventions for nurses and other providers to help manage patient uncertainty during acute illness.
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Kristin L. Rising is Associate Professor and Director of Acute Care Transitions, Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, PA.
Shannon K. Doyle is in the Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, PA.
Rhea E. Powell is Assistant Professor, Department of Internal Medicine, Thomas Jefferson University, Philadelphia, PA.
Amanda M.B. Doty is in the Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, PA.
Marianna LaNoue is Research Associate Professor, Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, PA.
Angela M. Gerolamo is Associate Professor, College of Nursing, Thomas Jefferson University, Philadelphia, PA.
Published online: June 27, 2018
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?©?2017 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.