The experiences of patients ill with COVID-19-like symptoms and the role of testing for SARS-CoV-2 in supporting them: A qualitative study in eight European countries during the first wave of the pandemic

Access to testing during the first wave of the COVID-19 pandemic was limited, impacting patients with COVID-19-like symptoms. Current qualitative studies have been limited to one country or were conducted outside Europe. To explore - in eight European countries - the experiences of patients consulting in primary care with COVID-19-like symptoms during the first wave of the pandemic. Sixty-six semi-structured interviews, informed by a topic guide, were conducted by telephone or in person between April and July 2020. Patients with COVID-19-like symptoms were purposively recruited in primary care sites in eight countries and sampled based on age, gender, and symptom presentation. Deductive and inductive thematic analysis techniques were used to develop a framework representing data across settings. Data adequacy was attained by collecting rich data. Seven themes were identified, which described the experiences of patients consulting. Two themes are reported in this manuscript describing the role of COVID-19 testing in this experience. Patients described significant distress due to their symptoms, especially those at higher risk of complications from COVID-19, and those with severe symptoms. Patients wanted access to testing to identify the cause of their illness and minimise the burden of managing uncertainty. Some patients testing positive for COVID-19 assumed they would be immune from future infection. Patients experiencing novel and severe symptoms, particularly those with comorbidities, experienced a significant emotional and psychological burden due to concerns about COVID-19. Testing provided reassurance over health status and helped patients identify which guidance to follow. Testing positive for SARS-CoV-2 led to some patients thinking they were immune from future infection, thus influencing subsequent behaviour.

新冠肺炎（COVID-19）大流行第一波疫情期间，检测资源可及性受限，对出现新冠肺炎样症状的患者诊疗造成了负面影响。现有相关定性研究多局限于单一国家，或研究开展地点不在欧洲。本研究旨在覆盖八个欧洲国家，探究该轮大流行第一波期间，出现新冠肺炎样症状并前往基层医疗（primary care）就诊的患者的就诊经历。

2020年4月至7月间，研究人员以主题指南（topic guide）为指导，通过电话或线下面对面的方式，共开展了66场半结构化访谈（semi-structured interviews）。研究人员在八个国家的基层医疗站点中，按照年龄、性别及症状表现进行目的性抽样，招募出现新冠肺炎样症状的患者参与研究。本研究采用演绎与归纳结合的主题分析（thematic analysis）技术，构建了覆盖所有研究场景的数据框架，并通过收集详实丰富的研究数据确保了数据充分性。

本次研究共识别出七个用以描述患者就诊经历的主题，本论文仅报告其中两个主题，即新冠病毒检测在该就诊经历中所发挥的作用。

患者自述因自身症状承受了显著的痛苦，其中尤以感染新冠后并发症风险更高、或症状较为严重的群体为甚。患者普遍希望通过检测明确自身的病因，以尽可能降低因应对病情不确定性所带来的负担。部分新冠病毒检测呈阳性的患者认为，自己将对未来的新冠感染产生免疫力。

出现新发且严重症状的患者，尤其是伴有基础疾病者，因对新冠疫情的担忧承受了沉重的情绪与心理负担。检测结果为患者的健康状况提供了安心保障，并帮助其明确应遵循的防疫指导。部分严重急性呼吸综合征冠状病毒2型（SARS-CoV-2）检测呈阳性的患者认为自己可免于未来感染，进而影响了后续的行为模式。