Degree-of-worry and Illness Perception in Patients Suffering From Acute Illness in the Emergency Department

This study explores whether and how DOW, as a PRO marker, can contribute to triage in the Emergency Departments. The study is designed as a mixed-method study consisting of a survey among acutely ill patients and qualitative semi-structured interviews.

Study Overview

• Status: Completed
• Conditions: Acute Illness
• Intervention / Treatment: Behavioral: DOW and illness perception

Detailed Description

In Emergency Departments (ED) in Denmark and internationally, triage manuals are used to divide incoming patients according to their acute clinical severity, and thus assess who should be examined and treated first. However, the triage manuals are criticized for being imprecise in the intermediate categories. Furthermore, the triage manuals, nationally and internationally, are criticized for not adequately involving the patient's perspective and context. In addition, triage is not independent of personal factors and workload, which may contribute to interprofessional variation. Further, patients themselves express a desire to be even more involved. Also, the relationship between patient and healthcare professional has a direct impact on the quality of health services, however, there are divergent perceptions of what patient involvement entails. Patient-Reported Outcome (PRO) data is one way in which patient involvement can occur. PRO is data reported directly from the patient without interference from the healthcare professional and is thus self-reported data, typically generated through survey studies among patients. A strength of PRO data is that these are often more sensitive which may, for example, demonstrate a higher degree of severity of the patient's symptoms. Furthermore, it is considered a strength that PRO data can be used at both group level, for example in quality assurance, as well as at an individual level to support the decision making of healthcare professionals and thereby ensure efficient use of resources. Due to lack of evidence-based knowledge in the field and despite the potential of using PRO data, the information of patients and / or relatives is not used systematically in the Emergency Department. This also applies in the acute contact, where an imprecise initial evaluation of the patient's overall medical needs can cause both over- and under-triaging to the detriment of the overall patient course. The result is an inappropriate allocation of resources at the organizational level and a poorer quality in the treatment process. This points to the need to use relevant patient-reported measures (PROM), the tool for measuring PROs. One such instrument is Degree-of-Worry (DOW), which measures the patient's self-reported level of worry. DOW is a ten-point score of self-reported worry (from 1 = minimal concern to 10 = maximally concerned), reflecting the patient's own assessment of acute illness and own perception of concern. DOW has been scientifically tested in connection with telephone triage at the medical helpline 1813 (MH1813) as a five-point score. The patient's DOW, measured at the time the patient makes his first call to the MH1813, is strongly associated with the probability of acute hospitalization within 48 hours. However, a pilot test with DOW as a five-point score in the Emergency Department indicates a ceiling effect, by which DOW will be presented as a 10-point score in this setting. DOW has the potential to increase patient safety, create greater patient involvement and increase efficiency so that the lengths of stay reflects the triage level. A previous study suggests that DOW could also be used advantageously in other similar settings, such as Emergency Department, which, however, requires that potential implementation barriers is examined.

• Study Type: Observational
• Enrollment (Actual): 944

Contacts and Locations

Study Locations

• Denmark
  • Hvidovre, Denmark, 2650
    • Copenhagen University Hospital, Hvidovre

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: Yes

• Sampling Method: Non-Probability Sample

Study Population

The survey: 1004 adults (≥18 years of age) who accept to participate in the study. The patients are at the Emergency Department due to acute illness.

The interviews: of the 1004 patients 10 (+/- 10 patients are invited to participate in a semi-structured interview. The recruitment is based on purposeful sampling with maximum variation.

Description

Inclusion Criteria:

• ≥18 years of age
• cognitively intact
• consent to participation.

Exclusion Criteria:

• patients arriving to the ED regarding injury
• patient with the highest triage level
• demented patients
• intoxicated patients

Study Plan

How is the study designed?

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
DOW and illness perception; Exploration of the association between DOW and illness perception	Behavioral: DOW and illness perception; Acutely ill patients are exposed to a survey regarding their degree of worry and illness perception

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
DOW and illness perception	Self-reported degree-of-worry during acute illness scored on a 1-10 scale (1=minimal concern, 10=maximum concern) and illness perception measured using the Brief illness perception Questionnarie	30 minutes

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
DOW and re-presentation in the Emergency Department	Self-reported degree-of-worry during acute illness scored on a 1-10 scale (1=minimal concern, 10=maximum concern) and representation in the Emergency Department during the following 30 days	30 days
DOW and patient barriers	10 (+/- 10) semi-structured interviews to explore potential patient barriers to implement the DOW-scale in Emergency Departments	30 minutes

Collaborators and Investigators

• Sponsor: Hvidovre University Hospital
• Collaborators: University of Southern Denmark

Study record dates

Study Major Dates

• Study Start (Actual): January 13, 2020
• Primary Completion (Actual): December 19, 2020
• Study Completion (Actual): December 19, 2020

Study Registration Dates

• First Submitted: January 9, 2020
• First Submitted That Met QC Criteria: January 9, 2020
• First Posted (Actual): January 13, 2020

Study Record Updates

• Last Update Posted (Actual): May 12, 2023
• Last Update Submitted That Met QC Criteria: May 11, 2023
• Last Verified: May 1, 2023

More Information

Terms related to this study

• Keywords: emergency department; illness perception; acute illness; degree-of-worry
• Additional Relevant MeSH Terms: Pathologic Processes; Disease Attributes; Emergencies
• Other Study ID Numbers: HvidovreDOW1

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No