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Title: Pathways to diagnosis and treatment : TB patients' experiences in London : a narrative enquiry and analysis
Author: Yilma, Lemma
ISNI:       0000 0004 2721 499X
Awarding Body: London School of Hygiene & Tropical Medicine
Current Institution: London School of Hygiene and Tropical Medicine (University of London)
Date of Award: 2011
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The purpose of this study was to understand TB patients' experiential accounts of access to TB diagnosis and treatment and more specifically about their experiences of medical help from health care professionals. METHOD: This narrative enquiry was undertaken in three boroughs of London, including two boroughs with the highest TB notification rates in the UK. The study involved pilot interviews with ten patients to develop the research question. In-depth narrative interviews with 32 additional patients were then undertaken. All participants were over eighteen years of age. The analysis of narratives involved descriptive; holistic-form and categorical content (themes) approaches to identify story 'plot' and 'subplots' and themes covering the whole of the patients' journeys to treatment. RESULTS: Seven narrative plots and thirty subplots were grouped into six categories of medical help and specific themes embedded in them were grouped in three stages of patients' pathways 'before' 'during' and 'after' diagnosis. These themes are listed below sequentially to illustrate these patients' pathways. 1. Symptoms were misinterpreted and misdiagnosed. 2. Kept on ineffective antibiotics/painkillers for many visits. 3. Referred quickly for suspected TB or other serious illnesses. 4. Referred only when critically ill. 5. Referred when antibiotics and pain killers not helping. 6. Referred only after pushing for referral. 7. Sought help from A&E. 8. Diagnosed immediately after TB testing. 9. Referred to wrong specialist and waited too long. 10. Had to fight for TB test. 11. Had lots of tests but no results. 12. Doubts about diagnosis. 13. Felt ignored and had no information. 14. Felt listened and cared for. 15. Quickly began my treatment. 16. Felt better after treatment, no side-effects. 17. Felt better after treatment with side-effects. 18. Felt needed longer treatment. CONCLUSIONS: The accounts of two thirds of the study participants suggest that their doctors' misunderstanding of their illness and miscommunication with them contributed to delayed diagnosis and treatment ranging from one month to twelve months. TB service providers and commissioners need to raise clinical staff awareness about TB and review the factors hindering doctor-patient communication about TB care. The findings in this research indicate that health service related delay is likely to contribute to increased TB transmission rates in the two research settings in London.
Supervisor: Sloggett, A. Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral