AbstractBackground : An abdominal aortic aneurysm (AAA) is an abnormal widening (≥3 cm) and weakening of the abdominal part of the aorta. It is a relatively common condition in the older male population. Notably, males have a higher risk of developing the condition if they previously used or currently use tobacco. Increasing age and a family history of AAA also increases the risk of developing this condition. Most AAAs are asymptomatic until rupture. AAA rupture is a major consequence associated with high mortality. Therefore, screening of the abdominal aorta via ultrasound has been introduced in some countries. In Sweden, all 65-year-old men are invited for AAA screening. If an AAA is found, they remain under surveillance with regular follow-ups until the AAA reaches a diameter of 55 mm. Thereafter, they are offered an elective surgery of the aneurysm. Through screening, the men become aware of a potentially threatening diagnosis that can affect and change their life situation and impact their quality of life. Life-threatening diagnoses affect patients' and their families' lives in various ways. Since an AAA diagnosis can be considered life-threatening, it can affect an entire family. However, it remained unclear how the lives of AAA patients' partners are affected. The overall aim of the thesis was to explore, describe and contrast experiences and perspectives of screening-detected AAA in a Swedish context from the perspective of affected men, their partners and health care professionals. Method : To meet the aims of this study, a qualitative single case study with embedded units was used. The case was described as "Perspectives of screening-detected AAA" and the three embedded units were the men, the partners and health care professionals. The data were collected through individual interviews and focus group interviews. The men were purposively recruited from a local screening database (Filemaker). Although a total of 27 interviews were conducted, the analysis was based on 25 interviews since two were excluded due to technical problems and one man was unaware of his aneurysm. The partners were recruited using a convenient sampling method after obtaining consent from the men. In total, 21 interviews were conducted with partners. Health care professionals were recruited through a purposive sampling method. Invitations containing a brief explanation of the study were distributed to contacts at vascular clinics in Sweden. A total of five interviews were conducted with professionals working with AAA screening. The interviews were conducted following semi-structured interview guides. After obtaining consent from the participants, the interviews were digitally recorded and verbally transcribed in Swedish. The goal of qualitative data analysis extends beyond the visible data gathered from interviews by searching for patterns. Qualitative content analysis is a commonly used method for analysing data to gain a deeper understanding of a phenomenon. Data analysis for the present study was conducted within each embedded units and followed by a cross embedded units analysis. An inductive approach was used for within analyses of data collected from partners. The data were divided into chunks and labelled with codes that reflected the meaning of each chunk. The codes were compared and chunks with the same meaning were organised into subcategories and categories. The within analysis for the men was conducted in a similar manner. Chunks were labelled with codes and then organised under the same labelled categories as the partners. Furthermore, based on the categories created from the two aforementioned within analyses, a deductive manifest analysis was performed using data from interviews with health care professionals. Finally, a cross-analysis was conducted to compare content from the three embedded units. Portions of the analysed text from the men and partners were combined in matrices, and their differences were highlighted. These contrasts were summarised in a common text. Based on this text, the health care professionals' viewpoints, descriptions and opinions were deductively highlighted. The cross-analysis was presented as an interpretive text followed by short narratives.
Findings : The findings related to partners' perspectives of AAA were presented under three categories: 1) Experiencing the unexpected, 2) Being reminded of fragility and 3) Balancing a changing relationship. The category "Experiencing the unexpected" consists of two subcategories: 1) Shock and emotional reactions and 2) Peripheral to first-hand information. The category "Being reminded of fragility" consists of three subcategories: 1) Reminders during daily activities, 2) Waiting in uncertainty and 3) Ambivalent feelings about surgical treatment. The third category, "Balancing a changing relationship", consists of three subcategories: 1) Supporting a healthy lifestyle, 2) Protecting roles and 3) Preparing for the worst. For the partners, living with men diagnosed with an AAAs involved experiencing widespread recurrent worries. Furthermore, the analysis of the men's experiences of living with a screening-detected AAA is described under the three aforementioned categories that are common to the men and the same with the health care professionals' deductive manifest analysis. The cross-analysis of the three embedded units is illustrated as a screening surveillance journey and presented under two subcategories: 1) Navigating through a new life situation, 2) Anchoring to a life with an AAA. Under each subcategory, an interpretation focusing on the contrasts between the embedded units is presented, which is followed by a short narrative story that aims to illustrate the participants' experiences. Conclusion : This study has revealed a deeper understanding of three perspectives on screening-detected AAAs. Awareness of a screening-detected AAA affected the diagnosed men and their partners' lives in various ways. While the experiences were recurrent, they also moved patients towards adjusting to a new lifestyle. Although uncertainty existed among the men and the partners during the process of adjusting to a new life situation, this uncertainty was appraised as either dangerous or an opportunity, which affected their outcome. Since the participants are affected by the screening surveillance and the awareness of the AAA, it indicates the need for further interventions by health care professionals to improve support and information for further interventions by health care professionals to improve support and information for those living with a screening-detected AAA.
|Date of Award||2021|
|Supervisor||Siu Yin Ching (Co-supervisor)|