Fred Murphy

'I thought it was just an x-ray': a qualitative investigation of patient experiences in cardiac SPECT-CT imaging.

BackgroundPatients attending for complex imaging examinations may experience anxiety and discomfort with associated poor satisfaction and reduced compliance. This may lead to poor quality imaging, repeat scans and nonattendance. Analysing and understanding patient experience to improve the quality of care is of paramount importance within the National Health Service; yet, little published evidence of patient experience research exists within nuclear medicine. This qualitative study aimed to explore the experience of patients referred for cardiac single-photon emission computed tomography–computed tomography (SPECT-CT) in two different clinical environments. Methods and resultsTwenty-two patients (13 women, nine men; mean age 63.9 years) were interviewed before and after the procedure to determine their prior knowledge, concerns, expectations and experiences. Thematic analysis demonstrated seven recurring themes: justification, validity of patient information, fear (of their condition, of harm and of the procedure), compliance, role of significant others, mitigation of anxiety, and coping strategies. In most cases an expectation–reality divide was apparent, with the actual experiences of the procedure being in some cases a pleasant surprise, or in other cases a shock. ConclusionCardiac SPECT-CT patients are often poorly informed and present with a range of anxieties that may ultimately affect examination quality. The imaging team requires an awareness of potential expectation–reality divides, even when there are no overt signs of worry and distress. Written patient information is undoubtedly helpful, but there is no substitute for ongoing and repeated explanations and reassurance by staff. These findings are likely to have implications for other complex nuclear medicine procedures, including noncardiac SPECT-CT examinations and emerging PET-CT applications.

A qualitative analysis of staff-client interactions within a breast cancer assessment clinic

OBJECTIVES Breast screening clients recalled to an assessment clinic experience high levels of anxiety. The culture of the assessment clinic may impact upon client experience, which may influence their future re-engagement in screening. This study aimed to explore the culture of staff-client interactions within a breast cancer assessment clinic. MATERIALS AND METHODS Following an ethnographic approach, twenty-three client journeys were observed, followed by semi-structured interviews with the clients. The observation and interview data were analysed to produce research themes, which were then explored within two focus groups to add a practitioner perspective. RESULTS Multiple staff-client interaction events were observed over a period of several weeks. Client interview feedback was overwhelmingly positive. Three recurrent and sequential themes emerged: breaking down barriers, preparing the ground and sign-posting. These themes outline the changing focus of staff-client interactions during the clients clinic journey, encompassing how anxieties were expressed by clients, and responded to by practitioners. CONCLUSION This study was the first to explore in depth the staff-client interaction culture within a breast assessment clinic using an ethnographic approach. A new perspective on professional values and behaviours has been demonstrated via a model of staff-client interaction. The model documents the process of guiding the client from initial confusion and distress to an enhanced clarity of understanding. A recommendation most likely to have a positive impact on the client experience is the introduction of a client navigator role to guide the clients through what is often a lengthy, stressful and confusing process.

Client-practitioner interactions within breast care services

United Kingdom (UK) breast care services are delivered within one of two models. Clients presenting with breast symptoms (symptomatic) are assessed within a ‘one stop’ (all done at one hospital attendance) out-patient setting whilst asymptomatic clients currently aged 50–70 (screening) are invited for 3 yearly breast screening by the National Health Service Breast Screening Programme (NHSBSP). A proportion of the latter are recalled for further assessment should a mammographic abnormality be suspected (assessment clients). Many other health care systems around the world also offer these three breast care approaches (symptomatic, screening and assessment services), though the timeframe between screening invitations and the age range of clients varies within the screening services (see Chap. 8).