An exploration of the help-seeking experiences of men and women referred to a rapid access chest pain clinic (a cardiac physiologist-managed clinic)

Background Coronary Heart Disease (CHD) is one of the leading causes of death in both men and women worldwide. It is well documented that early diagnosis and treatment of CHD is associated with better outcomes. This has led to the establishment of targets to ensure prompt access to services for potential CHD (e.g. Rapid Access Chest Pain Clinics). Research has shown that these public health targets have caused decreases in morbidity and mortality rates for CHD in the UK. However, despite these improvements health services are still limited by help-seeking practices of patients as they can only act once a patient has presented for treatment. A number of studies have explored the reasons why patients delay help-seeking for CHD symptoms in an emergency context (i.e. having a heart attack). Many studies have focused on gender and have often suggested that women with emergency CHD symptoms delay help-seeking, although this is controversial. Other studies have suggested help-seeking delay is influenced by multiple intersecting factors (e.g. age, ethnicity and contextual influences) and not just gender. No studies have examined help-seeking for suspected CHD symptoms in the context of accessing Rapid Access Chest Pain Clinics (RACPC). Given the lack of understanding in this area, an explorative qualitative study was undertaken to answer the research question: what are the help-seeking experiences of men and women referred to a rapid access chest pain clinic? Methods A total of 30 men and women with a range of ages and ethnicities referred to a RACPC for the investigation of their symptoms were enrolled in this study. Participants took part in semi-structured interviews that focused on attribution of symptoms and how that, amongst other things, influenced help-seeking decisions for their symptoms. The data was analysed thematically to explore men’s and women’s experiences and the help-seeking decisions they made. The study findings and relevant literature were used to inform the development of a patient information leaflet to assist with recognition of potential CHD symptoms and to promote help-seeking. Results The study found, in general, that: attribution of symptoms was linked to contextual factors; reluctance to seek help and response to symptoms contributed to delay; the influence of others acted as enablers of help-seeking; and barriers were linked to accessibility of GP services and time off work. Additionally, some participants had mixed reactions to a negative diagnosis at the end of RACPC assessment (i.e. symptoms not of CHD origin). Some participants expressed frustration at not having an answer for their symptoms, whereas others said they felt like a ‘fraud’ for wasting NHS resources. Not all participants had negative reactions and many were delighted that their symptoms were not heart-related. When it came to perceptions of risk of CHD, most believed the ‘male lifestyle’ was more risky and therefore increased CHD risks in men, but that increasingly women were living ‘male-like lifestyles’ (e.g. working full time, smoking, drinking and eating a poor diet), thus increasing their risk of CHD. Conclusion This novel study based in the RACPC context has produced important findings in this previously unexplored area. Earlier qualitative research based in the emergency CHD context has highlighted the challenges around symptom attribution, attitudes to help-seeking and response to symptoms, and how these factors contribute to delay. This current study showed that there were many similarities between the two different contexts (emergency and non-emergency). These findings can be used to produce health promotion literature to encourage early help-seeking for non-emergency CHD in the RACPC context in both men and women. The output of the current research makes a contribution to practice in my profession through the development of a lay patient resource to promote help-seeking in the RACPC context

Gender comparisons in non-acute cardiac symptom recognition and subsequent help-seeking decisions: a mixed methods study protocol

Introduction: Coronary heart disease (CHD) is one of the leading causes of death in both men and women worldwide. Despite the common misconception that CHD is a ‘man's disease’, it is now well accepted that women endure worse clinical outcomes than men following CHD-related events. A number of studies have explored whether or not gender differences exist in patients presenting with CHD, and specifically whether women delay seeking help for cardiac conditions. UK and overseas studies on help-seeking for emergency cardiac events are contradictory, yet suggest that women often delay help-seeking. In addition, no studies have looked at presumed cardiac symptoms outside an emergency situation. Given the lack of understanding in this area, an explorative qualitative study on the gender differences in help-seeking for a non-emergency cardiac events is needed. Methods and analysis: A purposive sample of 20–30 participants of different ethnic backgrounds and ages attending a rapid access chest pain clinic will be recruited to achieve saturation. Semistructured interviews focusing on help-seeking decision-making for apparent cardiac symptoms will be undertaken. Interview data will be analysed thematically using qualitative software (NVivo) to understand any similarities and differences between the way men and women construct help-seeking. Findings will also be used to inform the preliminary development of a cardiac help-seeking intentions questionnaire. Ethics and dissemination: Ethical approvals were sought and granted. Namely, the University of Westminster (sponsor) and St Georges NHS Trust REC, and the Trust Research and Development Office granted approval to host the study on the Queen Mary's Roehampton site. The study is low risk, with interviews being conducted on hospital premises during working hours. Investigators will disseminate findings via presentations and publications. Participants will receive a written summary of the key findings