[In Monitoring we trust? The role of imaging-based monitoring examinations using echocardiography and carotid duplex...

Regular examinations, including imaging procedures (known as monitoring), have become an established component in the management of chronically ill patients. At the same time, guideline recommendations for monitoring chronic diseases are often based on low-level evidence. Nevertheless, doctors routinely carry out monitoring measures that go beyond the guideline recommendations. Monitoring also appears to be highly valued by patients. This study asks what emotional value monitoring examinations have from the perspective of patients and physicians, respectively, and why.

As part of a qualitative interview study, a secondary analysis of semi-structured interviews with patients and physicians was conducted. The patients had undergone echocardiography or carotid duplex sonography as part of their regular monitoring over the past three years due to CAD or cerebral infarction. The physicians involved in the study provided outpatient care for patients with these conditions. Participants were recruited in Hesse and Bavaria. The interviews were transcribed and then evaluated using Braun and Clarke's reflexive thematic analysis.

Fourteen patients (two women and 12 men aged between 51 and 90) and 22 physicians (five women and 17 men aged between 37 and 86) took part in qualitative interviews. The physicians worked in the fields of cardiology, neurology, and primary care. The physicians surveyed perceived that regular check-ups gave patients a feeling of security. Specialized physicians considered regular ultrasound examinations to be an integral part of their monitoring routine in order to detect relevant findings at an early stage. Monitoring using imaging techniques instills confidence in patients regarding the high quality of their medical care and a feeling of security. The prospect of a reduction in current monitoring routines caused uncertainty among the respondents.

The perceived benefits of monitoring routines are primarily shaped by emotional considerations, regardless of the presence or absence of evidence of their effectiveness. Established monitoring routines, such as echocardiography or carotid duplex sonography, provide patients with a strong sense of trust and control, which is why their reduction is often perceived as a loss. In doctor-patient consultations, risks, benefits, and gaps in the evidence should be communicated transparently and discussed in a reflective manner.