Delay in seeking medical help following Transient Ischemic Attack (TIA) or "mini-stroke": a qualitative study

• Published in: PloS one Vol. 9; no. 8; p. e104434
• Main Authors: Mc Sharry, Jennifer, Baxter, Alison, Wallace, Louise M, Kenton, Anthony, Turner, Andrew, French, David P
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 19-08-2014; Public Library of Science (PLoS)
• Subjects: Aged; Aged, 80 and over; Analysis; Awareness; Biology and Life Sciences; Cancer; Decisions; Delay; Delayed Diagnosis; England; Female; Health care; Health Knowledge, Attitudes, Practice; Health psychology; Health risks; Health services; Heart attacks; Hospitals; Humans; Illnesses; Ischemia; Ischemic Attack, Transient - diagnosis; Ischemic Attack, Transient - physiopathology; Ischemic Attack, Transient - psychology; Lifestyles; Male; Medical personnel; Medicine and Health Sciences; Middle Aged; Patient Acceptance of Health Care - psychology; Patient Acceptance of Health Care - statistics & numerical data; Patients; Qualitative Research; Recognition; Research and Analysis Methods; Risk; Risk reduction; Stroke; Studies; Systematic review; Time Factors; Transient ischemic attack; England; United Kingdom > UK
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0104434

Prompt treatment following Transient Ischemic Attack (TIA) can reduce the risk of subsequent stroke and disability. However, many patients delay in making contact with medical services. This study aimed to explore TIA patients' accounts of delay between symptom onset and contacting medical services including how decisions to contact services were made and the factors discussed in relation to delay.
Twenty interviews were conducted with TIA patients in England. Using a previous systematic review as an initial framework, interview data were organised into categories of symptom recognition, presence of others and type of care sought. A thematic analysis was then conducted to explore descriptions of care-seeking relevant to each category.
Delay in contacting medical services varied from less than an hour to eight days. Awareness of typical stroke symptoms could lead to urgent action when more severe TIA symptoms were present but could lead to delay when experienced symptoms were less severe. The role of friends and family varied widely from deciding on and enacting care-seeking decisions to simply providing transport to the GP practice. When family or friends played a greater role, and both made and enacted care-seeking decisions, delays were often shorter, even when patients themselves failed to identify symptoms. Healthcare professionals also impacted on patients' care-seeking with greater delays in seeking further care for the same episode described when patients perceived a lack of urgency during initial healthcare interactions.
This study provides new information on patients' decisions to contact medical services following TIA and identifies overlapping factors that can lead to delay in receiving appropriate treatment. While recognition of symptoms may contribute to delay in contacting medical services, additional factors, including full responsibility being taken by others and initial healthcare interactions, can over-ride or undermine the importance of patients' own identification of TIA.