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 scre... read moreening, 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
- Component ID:
- tufts:22751
- To Cite:
- DCA Citation Guide EndNote
