Data from: How do patients and health workers interact around malaria rapid diagnostic testing, and how are the tests experienced by patients in practice? A qualitative study in western Uganda

Background: Successful scale-up in the use of malaria rapid diagnostic tests (RDTs) requires that patients accept testing and treatment based on RDT results and that healthcare providers treat according to test results. Patient-provider communication is a key component of quality care, and leads to improved patient satisfaction, higher adherence to treatment and better health outcomes. Voiced or perceived patient expectations are also known to influence treatment decision-making among healthcare providers. While there has been a growth in literature on provider practices around rapid testing for malaria, there has been little analysis of inter-personal communication around the testing process. We investigated how healthcare providers and patients interact and engage throughout the diagnostic and treatment process, and how the testing service is experienced by patients in practice. Methods: This research was conducted alongside a larger study which explored determinants of provider treatment decision-making following negative RDT results in a rural district (Kibaale) in mid-western Uganda, ten months after RDT introduction. Fifty-five patients presenting with fever were observed during routine outpatient visits at 12 low-level public health facilities. Observation captured communication practices relating to test purpose, results, diagnosis and treatment. All observed patients or caregivers were immediately followed up with in-depth interview. Analysis followed the ‘framework’ approach. A summative approach was also used to analyse observation data. Results: Providers failed to consistently communicate the reasons for carrying out the test, and particularly to RDT-negative patients, a diagnostic outcome or the meaning of test results, also leading to confusion over what the test can detect. Patients appeared to value testing, but were frustrated by the lack of communication on outcomes. RDT-negative patients were dissatisfied by the absence of information on an alternative diagnosis and expressed uncertainty around adequacy of proposed treatment. Conclusions: Poor provider communication practices around the testing process, as well as limited inter-personal exchange between providers and patients, impacted on patients’ perceptions of their proposed treatment. Patients have a right to health information and may be more likely to accept and adhere to treatment when they understand their diagnosis and treatment rationale in relation to their perceived health needs and visit expectations.研究背景：疟疾快速诊断检测（RDTs）的成功推广应用，需要患者能够接受基于RDT结果的检测与治疗，同时医疗服务提供者需依据检测结果开展诊疗行为。医患沟通是优质诊疗的核心组成部分，可提升患者满意度、提高治疗依从性并改善健康结局。此外，患者明确表达或隐含的就医期望，也会对医疗服务提供者的诊疗决策产生影响。尽管目前针对疟疾快速检测的医疗服务提供者诊疗行为的相关研究文献日益增多，但针对检测过程中医患人际沟通的分析却相对匮乏。本研究旨在探究医疗服务提供者与患者在整个诊断与治疗过程中的互动与参与情况，以及患者在实际诊疗中对检测服务的体验。 研究方法：本研究依托一项更大规模的研究开展，该大型研究在乌干达中西部基巴莱（Kibaale）农村地区——即在RDT推广应用10个月后——探究了RDT结果阴性时医疗服务提供者诊疗决策的影响因素。研究人员在12家基层公立医疗卫生机构的常规门诊就诊过程中，对55名发热患者进行了观察。观察内容涵盖了与检测目的、检测结果、诊断及治疗相关的沟通行为。所有被观察的患者或其陪护人员均在观察结束后立即接受了深度访谈。数据分析采用框架分析法，同时辅以总结性分析法对观察数据进行分析。 研究结果：医疗服务提供者未能始终如一地向患者说明开展检测的缘由，尤其未向RDT结果阴性的患者告知诊断结局或检测结果的含义，这也使得患者对该检测可检出的疾病范围产生困惑。患者看似认可检测服务，但因缺乏检测结果相关的沟通而倍感沮丧。RDT结果阴性的患者因未获得替代诊断的相关信息而心生不满，并对所推荐治疗方案的合理性存在疑虑。 研究结论：检测过程中医务人员沟通行为的欠缺，以及医患间人际交流的不足，均会影响患者对所推荐治疗方案的认知。患者享有健康信息知情权，当患者能够结合自身健康需求与就医期望，明晰自身的诊断结果及治疗依据时，更有可能接受并坚持治疗。