Experiences of patient-initiated discharge from an inpatient withdrawal management service: a qualitative descriptive study

Background: Patient-initiated discharges, also known as against medical advice discharges, are a common occurrence in inpatient withdrawal management settings. The purpose of this qualitative descriptive study was to gain an understanding of patient perspectives of their reasons for and experiences of patient-initiated discharge from an inpatient withdrawal management service.Methods: A consecutive sample of patients were recruited from an inpatient withdrawal management service. Qualitative descriptive methodology was used with semi-structured telephone interviews as the method of data collection. Interviews were transcribed and then analyzed following the principles of conventional content analysis.Results: Interviews were conducted with 13 participants. Factors that precipitated patient-initiated discharge were related to external pressures experienced by the patient, dissatisfaction with treatment or the hospital environment, and difficulties related to the COVID-19 pandemic. Participants often experienced strong emotions prior to leaving early and found conversations with staff about patient-initiated discharge difficult. Overall, participants had mixed perceptions of their discharge experience.Conclusions: This study is an important addition to the literature as the first to qualitatively examine patient perspectives of patient-initiated discharge from an inpatient withdrawal management service. Future studies should explore interventions to mitigate patient-initiated discharges or improve the associated processes when they cannot be avoided.