Walker, V, Patient Perspectives of Control and Exacerbation in Chronic Rhinosinusitis

Patient Perspectives of Control and Exacerbation in Chronic Rhinosinusitis

Victoria Walker1, UC COM M2 (medical student); Michal Trope, MD1; Adam McCann, MD1; Katie M. Phillips, MD1; Antar Tichavakunda, PhD2; Ahmad Sedaghat, MD, PhD1 (PI).

1Department of Otolaryngology, University of Cincinnati College of Medicine, Cincinnati, Ohio

2Department of Education, University of Cincinnati School of Education, Cincinnati, Ohio

Introduction: Patient perspectives with respect to chronic rhinosinusitis (CRS) disease control and exacerbation are poorly characterized to date. Globally, control is considered “the degree to which all manifestations of a disease are within acceptable limits.” An acute exacerbation of CRS is defined as “a worsening of symptoms that gets better either on its own or with medication.” This study seeks to explore the patient perspective of these concepts in order to inform future development of standard, precise definitions and measures of CRS disease control and CRS exacerbations.

Methods: Six patients who had been seen and treated for CRS in the Rhinology clinics of the UC Department of Otolaryngology were enrolled in the study. Care was taken to ensure that participants were representative of the larger patient population in regards to gender, race and socioeconomic status. Participants were interviewed via phone using semi-structured qualitative interview methods. Interview questions were written by a panel consisting of a medical student, a resident, and an attending physician. Questions were designed to elicit the patient experience of CRS, both as a whole and in regards to control and exacerbation. Interviews were conducted by the medical student to reduce the likelihood that participant responses would be influenced by a preexisting physician-patient relationship. All 6 interviews were recorded, transcribed, and reviewed for a general impression of the patient experiences. To date, one representative transcript has been analyzed using qualitative methods coding techniques.

Results: Each interview lasted an average of 33 minutes (Range:10 - 51 minutes). The transcripts totaled 111 pages of double-spaced (12-point font) text, with an average of 18.5 pages per interview. Topics identified and explored included: patient perception of control and exacerbation, elements of CRS that affect judgement of control, the role of medications and surgery in CRS control, disease manifestations and effects on quality of life, and patient terminology preferences when communicating with the medical team about these aspects of CRS.  Interviews have implied the presence of common themes in the topics explored but also variability in certain elements of the patient experience with CRS. 

Conclusions: Qualitative interviews have revealed novel insights into the patient journey from CRS diagnosis to control – insights while would not have been obtained through quantitative methods.