“I think we should wait and see”: A qualitative study of call-takers’ decision-making in consultations with patients suffering unrecognized myocardial infarction

• Published in: Patient education and counseling 2024-11, Vol.128, p.108376, Article 108376
• Main Authors: Jensen, Britta, Vardinghus – Nielsen, Henrik, Mills, Elisabeth Helen Anna, Møller, Amalie Lykkemark, Gnesin, Filip, Zylyftari, Nertila, Kragholm, Kristian, Folke, Fredrik, Christensen, Helle Collatz, Blomberg, Stig Nikolaj, Torp-Pedersen, Christian, Bøggild, Henrik
• Format: Article
• Language: English
• Subjects: Adult; Aged; Atypical symptoms; Communication; Decision Making; Denmark; Emergency Medical Services; Female; Humans; Male; Middle Aged; Myocardial infarction; Myocardial Infarction - diagnosis; Myocardial Infarction - therapy; Qualitative content analysis; Qualitative Research; Referral and Consultation; Systems theory; Telephone; Watchful Waiting
• ISSN: 0738-3991; 1873-5134; 1873-5134
• DOI: 10.1016/j.pec.2024.108376

Call-takers face a complex situation when assessing medical problems in emergency medical services calls. Patients with myocardial infarction experiencing atypical symptoms risk misinterpretation. We examined development in call-takers' decision-making process in telephone consultations with patients having imminent myocardial infarction. Recording of 38 calls among 19 patients (two per patient) who contacted Copenhagen Emergency Medical Services (Denmark) at least twice within one week before myocardial infarction diagnosis. The penultimate and last call were compared using qualitative content analysis. Call-takers’ assessment of the condition changed from unclear symptom picture and dismissal of heart disease in penultimate call to severe condition, not heart-related, and possible heart disease in last call. Call-takers recommended watchful waiting in the penultimate call. Both calls involved response negotiation, while caution regarding misinterpretation was only seen in the penultimate call. Call-takers used different decision-making approaches when the caller’s symptom descriptions appeared unclear and not corresponding with the medical understanding of severe conditions. Call-takers did not negotiate the condition's assessment but engaged in discussions about the response choice. A protocol to negotiate response choice with callers having unclear clinical conditions should be developed. Clarifying watchful waiting as a recommendation may assist call-takers’ decision-making. •Qualitative content analysis examined myocardial infarction-related calls•Medical helpline call-takers’ decision-making is challenged by unclear symptoms•Protocol for call-takers to negotiate response in unclear symptoms is needed•Standardizing watchful waiting might expedite recognition of myocardial infarction