Explaining Perceptions of Discharge Against Medical Advice as a  Patient’s Legal Right: A Qualitative Study

Hossein  Motaarefi; Shahriar  Sakhaei; Amin  Soheili; Hassan Ebrahimpour  Sadagheyani

doi:10.18502/ijme.v18i12.19657

Hossein Motaarefi Assistant Professor, Department of Nursing, Khoy University of Medical Sciences, Khoy, Iran..
Shahriar Sakhaei Instructor, Department of Nursing, Khoy University of Medical Sciences, Khoy, Iran.
Amin Soheili Assistant Professor, Department of Nursing, Khoy University of Medical Sciences, Khoy, Iran..
Hassan Ebrahimpour Sadagheyani Associate Professor, Department of Health Information Technology, Khoy University of Medical Sciences, Kho; Associate Professor, Department of Health Information Technology, Neyshabur University of Medical Sciences, Neyshabur, Iran.

DOI: https://doi.org/10.18502/ijme.v18i12.19657

Keywords: Clinical ethics, Patient discharge, Patient rights, Medical staff.

Abstract

Patients’ perceptions of healthcare service quality and satisfaction with their legal rights constitute the primary objective of the care team and should be considered a criterion for accreditation evaluation. In this regard, a thorough examination of healthcare providers’ and patients’ perceptions, emotions, and experiences regarding the reasons for ‘Discharge Against Medical Advice’—as a patient’s legal right—can help identify hidden factors influenced by temporal and spatial conditions. This qualitative study employed a conventional content analysis approach, involving semi-structured interviews with 24 healthcare providers and patients selected purposively. Researchers repeatedly reviewed recorded content and notes to code the data. Subsequently, key codes and themes were clustered, categorized into specific topics, and labeled. Finally, an interpretation of the obtained data reflecting the study’s approach was presented. Through conventional content analysis, 203 codes were extracted. After categorization, four subthemes, including human factors, processes, facilities, and environment, were identified under the core theme of “uncertainty and distrust” as reasons for discharge against medical advice. Discharge against medical advice is recognized as both a challenge for hospital accreditation and an adverse outcome for patients. Addressing uncertainty-related issues and fostering public trust through team collaboration and implementing novel policies can mitigate discharge against medical advice.