A Place to Get Worse

Much of what is known about delay in seeking medical care has been from patients with acute coronary syndromes. Less is known about why patients living with chronic cardiopulmonary illnesses delay seeking care for worsening symptoms. The aim of this study was to describe the perspectives of patients with end-stage heart failure or chronic obstructive pulmonary disease about their timing in seeking medical care for worsening symptoms. Two semistructured interviews were conducted with 20 participants and were audio recorded and transcribed verbatim. Avoiding the hospital was the central theme among participants in this study. Returning to the hospital invoked an underlying fear, symbolizing negative things. These included a perceived hassle and setback associated with hospitalization and a fear of not returning home following another admission, either from loss of independence or death. This study sheds light on findings from previous research that delay results from the inability to recognize worsening symptoms. Participants in this study clearly recognized worsening symptoms, yet waited to seek care until it was unbearable in effort to avoid the hospital. The incorporation of palliative alongside disease-driven care within this population would alleviate symptoms, which could decrease the need for emergent care and subsequent hospitalization.