title: Experiences of patients identifying with chronic Lyme disease in the healthcare system: a qualitative study.
abstract: BACKGROUND
  Chronic Lyme disease is a term that describes a constellation of persistent symptoms in patients with or without evidence of previous Borrelia burgdorferi infection. Patients labeled as having chronic Lyme disease have a substantial clinical burden. Little is known about chronic Lyme disease patient experiences in the healthcare system and their relationships with healthcare providers. The purpose of this study was to gather insights about the experiences of patients who carry a diagnosis of chronic Lyme disease in the United States healthcare system.
  
  
  METHODS
  Qualitative, phenomenological study in 12 adult participants who identified themselves as having chronic Lyme disease. Semi-structured face-to-face in-depth interviews were conducted, 60-90 minutes in length, focusing on perceptions of disease burden and of their healthcare providers, using the dimensions of the Health Belief Model. Transcribed interviews were analyzed for emergent topics and themes in the categories of beliefs/understanding, personal history/narrative, consequences/limitations, management, and influences on care.
  
  
  RESULTS
  Enrollment continued until theoretical saturation was obtained. Four major themes emerged from participants' descriptions of their experiences and perceptions: 1) changes in health status and the social impact of chronic Lyme disease, 2) doubts about recovery and the future, 3) contrasting doctor-patient relationships, 4) and the use of unconventional therapies to treat chronic Lyme disease.
  
  
  CONCLUSIONS
  Participants reported a significant decline in health status associated with chronic Lyme disease and were often unsatisfied with care in conventional settings. Negative experiences were associated with reports of dismissive, patronizing, and condescending attitudes. Positive experiences were associated with providers who were reported to be attentive, optimistic, and supportive. Consultations with CAM practitioners and use of CAM therapies were common. Actively engaged and sympathetic clinical encounters may foster greater satisfaction in healthcare settings.
authors.affiliation: Department of Pediatrics, Yale School of Medicine, P,O, Box 208064, New Haven, CT 06520-8064, USA. ather.ali@yale.edu.
authors.forename: Ather
authors.initials: A
authors.lastname: Ali
authors.forename: Lawrence
authors.initials: L
authors.lastname: Vitulano
authors.forename: Robert
authors.initials: R
authors.lastname: Lee
authors.forename: Theresa R
authors.initials: TR
authors.lastname: Weiss
authors.forename: Eve R
authors.initials: ER
authors.lastname: Colson
mesh_terms: D000328:Adult; D000368:Aged; D002908:Chronic Disease; D003237:Connecticut; D005260:Female; D006304:Health Status; D006801:Humans; D007407:Interviews as Topic; D008193:Lyme Disease / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D010817:Physician-Patient Relations; D036301:Qualitative Research