Asthma Diagnosis in Primary Care: Patient and Professional Priorities – Luke Daines
In the second in his blog series, Luke Daines, discusses patient and professional priorities for asthma diagnosis
One of the priorities of my end of PhD workshop was to create meaningful discussion between the attendees. This was a challenge due to the lockdown enforced due to Covid-19. The use of breakout rooms within Zoom allowed the creation of smaller groups which meant individuals could contribute more significantly.
Two of the groups discussed what features of a decision support system like Asthma Diagnosis Decision Aid (ADxDA) would be most helpful for patients and professionals when weighing up a possible diagnosis.
In the absence of a single test that can confirm (or refute) a diagnosis of asthma 100% of the time, making a diagnosis of asthma often takes time. Clinicians in the group described asthma diagnosis as being a process rather than a one-off event: professionals should be confident to monitor the situation and wait until the diagnosis can be confidently made, rather than labelling a person with asthma when there is still uncertainty. However, from a patient perspective, this diagnostic doubt can be unnerving. Terms such as ‘high’, ‘intermediate’ probability of asthma may not be explained, meaning individuals aren’t always sure what is happening or if they really need to take treatment.
A decision support system may have a role in presenting the likelihood of asthma, and encourage a discussion about the next steps, though as one participant pointed out it shouldn’t attempt to be a substitute for the health professional! Having links to useful resources such as inhaler technique videos, a personal asthma action plan were suggested. Patient information leaflets with (ideally) personalised information in digital or physical forms which could be reviewed after the consultation were also recommended.
Clinicians were quick to point out that ADxDA could be helpful as a diagnosis tool but should only be used to support the clinical decision-making process, and not replace it. Having a well-designed template with variables that pre-populate based on information available from the patient record was felt to be important. The CDSS could reduce variation between health professionals in the assessment of asthma for children and young people and could help consolidate understanding of the factors that make a diagnosis more or less likely.
Developing the relationship between healthcare professionals and people who may have asthma was felt to be key. Patients’ expectations and concerns when discussing an asthma diagnosis have to be carefully considered, and participants re-iterated the need for a two-way conversation between healthcare professionals and patients. Some stakeholders felt that the CDSS could help patient expectations, so they understand professionals don’t always know the answer straightaway.
Taking these learnings forward
Clearly, something that resonates with both groups is the human factor. Those who might have asthma appreciate having a person to talk through a diagnosis with. Professionals felt that trusting relationships between patient and health care workers were important in the asthma diagnosis process. How then could a clinical decision support system for asthma aid both patients and professionals? The final group in my end of PhD workshop discussed just this.