'Communication Is Crucial': A Qualitative Study of Patient Expectations of Diagnostic Tests in Emergency Medicine Practice

Value-based diagnostic tests improve patient safety. Understanding patient expectations can enhance the value of diagnostic tests in Emergency Departments. The aim of this study was to explore patient expectations about diagnostic tests to inform diagnostic stewardship in emergency medicine practice.

A qualitative study of adult patients who had received care at Townsville University Hospital Emergency Department was conducted. The study was promoted through e-mail and social media. A convenience sample of consenting participants was recruited until data adequacy was achieved. Data were collected using focus groups with a pilot-tested guide to ensure clarity and consistency. Data were analysed by lead author using inductive content analysis to generate codes and themes. Themes were validated for credibility, transferability, dependability and confirmability using the following trustworthiness criteria: reflexivity, rich description, audit trail and participant validation.

Five focus groups were conducted with 22 participants. Therapeutic relationship, communication, patient-centred care and quality of care were identified as the major themes of patient expectations when seeking Emergency Department care. Diagnostic test deliberations were expected to be respectful, trustworthy, empathetic and culturally safe. Patient engagement in decision making about diagnostic tests was considered essential to address individual symptoms and concerns. Participants expressed varied expectations regarding discussion about rationale and risks of tests. Questioning clinicians about tests was perceived to be a challenge due to power imbalance. Participants disagreed with defensive tests performed to minimise medicolegal liability. Timeliness of tests was acknowledged as resource dependent. Clinician-patient conflicts about tests were thought to be best resolved through a collaborative approach.

Patients have diverse and nuanced expectations of diagnostic tests in emergency departments. Patients trust emergency clinicians to listen empathetically, explain carefully and choose tests wisely. Patient values, preferences, life experiences and vulnerability should be factored into decision-making about tests. Clinician-patient partnerships grounded in effective communication are essential for diagnostic stewardship.

Two patients with lived experience were involved in study design, data collection and review of final manuscript.