Clinicians' and patients' perspectives on incidentally discovered silent brain infarction
Leung, Lester.
2017
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Abstract: Silent brain infarction (SBI) is a common condition found incidentally on neuroimaging studies obtained for other indications. SBI increases risk for symptomatic stroke and dementia. However, despite decades of research on risk factors and outcomes, there is no clear direction regarding optimal treatment or screening practices for SBI. Currently, in the absence of evidence-based screenin... read moreg, the only clinically relevant scenario is when SBI is discovered incidentally in the setting of routine clinical care. To better define this condition and inform future treatment studies, we sought to explore the perspectives of clinicians and patients with incidentally discovered SBI. We performed semi-structured qualitative interviews of patients identified with SBI and clinicians who encounter patients with SBI in routine clinical practice. We used purposeful sampling to attain diversity in the clinician and patient characteristics. Interviews were audio-recorded, transcribed, and analyzed using a constant comparative method to sort emergent themes into a logical coding schema (codebook) and modify the interview guide to explore new themes. Fifteen clinicians and twelve patients were interviewed. The primary themes in the clinician study were uncertainty about SBI and clinical decision making in response to uncertainty. Clinicians from different specialties endorsed variable consistency in disclosing the neuroimaging findings to patients and different levels of aggressiveness in their approach to managing SBI. Although not universal, clinicians from all specialties endorsed a belief in equivalent prognostic significance between SBI and symptomatic stroke: "A stroke is a stroke." Most clinician participants described a willingness to modify clinical practices in response to comparative effectiveness studies, and many had concerns about the feasibility of randomized controlled trials. The primary themes in the patient study were patients' beliefs in the equivalence of SBI and symptomatic stroke and discrepancies between patients' and clinicians' certainty about the significance of SBI. Most patient participants did not distinguish between SBI and symptomatic stroke, viewed SBI as grave, and expressed high levels of distress despite ambiguous messages from clinicians. Many viewed SBI as a "wakeup call," motivating behavioral changes to improve health. In response to clinicians' uncertainty, many interpreted ambiguous messages in a catastrophic way. Incidentally discovered SBI is an unstudied form of an understudied condition, likely with important health consequences. Among clinicians, there remain several areas of uncertainty—diagnostic, prognostic, and therapeutic—that may influence the development of treatment studies for incidentally discovered SBI and the adoption of clinical practice guidelines. Patients with incidentally discovered SBI express fear and concern about the condition, equating its significance with symptomatic stroke. Both clinicians and patients expressed beliefs, attitudes, and preferences that can inform the development of future studies of this condition.
Thesis (M.S.)--Tufts University, 2017.
Submitted to the Dept. of Clinical & Translational Science.
Advisor: David Kent.
Committee: David Thaler, Paul Han, and Robin Ruthazer.
Keywords: Health sciences, and Medicine.read less - ID:
- ns064j818
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