EVALUATION COMMITTEE

The Faculty Council has appointed the following adjudication committee to evaluate the thesis and the associated lecture: 

• Prof. Pia Dreyer, Institut for Folkesundhed, Aahus University, Denmark
• Dr. Anna Carin Wahlberg,  Neurobiologi, vårdvetenskap och samhälle, Karolinska Institutet, Stockholm, Sweden
• Prof. Janus Laust Thomsen, Klinisk Institut, Aalborg University, Denmark (Chairman).

Moderator: Prof. Henrik Bøggild, HST, Aalborg University

ABSTRACT

A range of symptoms associated with myocardial infarction or out-of-hospital cardiac arrest has been identified, yet several symptoms are characterized as nonspecific challenging the identification of an evolving myocardial infarction or out-of-hospital cardiac arrest. Telephone triage is challenged by a complex setting where the correct evaluation depends in part on the patient’s descriptions but also on the call-taker’s ability to interpret the severity of the condition. The overall objective of this PhD study is to gain knowledge on how patients observe, describe, understand, and interpret early warning signs expressed in telephone consultations preceding suffering a myocardial infarction or an out-of-hospital cardiac arrest. In addition to this, to gain knowledge on how call-takers react to the patients’ experienced condition through observation of the decision-making process on choice of response. A social systems theoretical approach based on Niklas Luhmann was employed, and qualitative content analysis was applied. Data were collected from 2016 to 2018 among patients who had been in contact with the Copenhagen Emergency Medical Services and had subsequently suffered a myocardial infarction or an out-of-hospital cardiac arrest. Patients were identified through linkage of Danish national registries and administrative data at the Copenhagen Emergency Medical Services and telephone consultations prior to the event were identified. Through stratified purposive sampling strategy, 14 females and 23 males were included, and 60 calls made by the patients were analysed. The findings are reported in three scientific articles on which this thesis is based. The first and second papers explore at least two calls from patients diagnosed with myocardial infarction within a week after the last call. The first article focuses on the penultimate call in 21 patients that ended with a referral to watchful waiting or self-care and explores the patients’ attempt to interpret the experienced condition during the communicative interaction. The second article explores the development of the call-taker’s decision-making process from watchful waiting in the penultimate call to sending an ambulance in the last call expressed in the communicative interaction among 19 patients. The third article examines 20 calls from 17 patients complaining about back pain the day before they suffered out-of-hospital cardiac arrest. Overall, the findings show how the communication was influenced by the preconditions of the call-taker and that communication in consultations where an ambulance was not dispatched was characterized by complex descriptions of symptoms, that did not fit into the health system’s interpretation of severe conditions.