title: 'I thought it was just an x-ray':  a qualitative investigation of patient experiences in cardiac SPECT-CT imaging.
abstract: BACKGROUND
  Patients attending for complex imaging examinations may experience anxiety and discomfort with associated poor satisfaction and reduced compliance. This may lead to poor quality imaging, repeat scans and nonattendance. Analysing and understanding patient experience to improve the quality of care is of paramount importance within the National Health Service; yet, little published evidence of patient experience research exists within nuclear medicine. This qualitative study aimed to explore the experience of patients referred for cardiac single-photon emission computed tomography-computed tomography (SPECT-CT) in two different clinical environments.
  
  
  RESULTS
  Twenty-two patients (13 women, nine men; mean age 63.9 years) were interviewed before and after the procedure to determine their prior knowledge, concerns, expectations and experiences. Thematic analysis demonstrated seven recurring themes: justification, validity of patient information, fear (of their condition, of harm and of the procedure), compliance, role of significant others, mitigation of anxiety, and coping strategies. In most cases an expectation-reality divide was apparent, with the actual experiences of the procedure being in some cases a pleasant surprise, or in other cases a shock.
  
  
  CONCLUSIONS
  Cardiac SPECT-CT patients are often poorly informed and present with a range of anxieties that may ultimately affect examination quality. The imaging team requires an awareness of potential expectation-reality divides, even when there are no overt signs of worry and distress. Written patient information is undoubtedly helpful, but there is no substitute for ongoing and repeated explanations and reassurance by staff. These findings are likely to have implications for other complex nuclear medicine procedures, including noncardiac SPECT-CT examinations and emerging PET-CT applications.
authors.affiliation: Directorate of Radiography, School of Health Sciences, University of Salford, Salford, Greater Manchester, UK. J.Nightingale@salford.ac.uk
authors.forename: Julie M
authors.initials: JM
authors.lastname: Nightingale
authors.forename: Fred J
authors.initials: FJ
authors.lastname: Murphy
authors.forename: Christine
authors.initials: C
authors.lastname: Blakeley
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety; D001291:Attitude of Health Personnel; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011369:Professional-Patient Relations; D036301:Qualitative Research; D015899:Tomography, Emission-Computed, Single-Photon / Q000523:psychology*; D014057:Tomography, X-Ray Computed / Q000523:psychology*