Delay in Seeking Medical Help following Transient Ischemic Attack (TIA) or “Mini-Stroke”: A Qualitative Study

Abstract

BackgroundPrompt 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.MethodsTwenty 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.ResultsDelay 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.ConclusionsThis 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.

Real‐life experiences of people with transient ischaemic attack or minor stroke: A qualitative literature review

“…Several studies reported that the onset of symptoms was not immediately recognised or associated with TIA or minor stroke (Kamara & Singh, ; Mc Sharry et al., ). A thematic analysis of white‐British survivors of TIA suggests one possible reason for this lack of recognition could be that symptoms experienced by survivors were less dramatic than expected, often described as minor or ambiguous (Mc Sharry et al., ). This disparity between expectation and reality was also linked to confusion about whether participants were experiencing a stroke or stroke‐like event (Mc Sharry et al., ).…”

“…A thematic analysis of white‐British survivors of TIA suggests one possible reason for this lack of recognition could be that symptoms experienced by survivors were less dramatic than expected, often described as minor or ambiguous (Mc Sharry et al., ). This disparity between expectation and reality was also linked to confusion about whether participants were experiencing a stroke or stroke‐like event (Mc Sharry et al., ). These same researchers also found that the process of symptom recognition was deeply related to other contextual factors such as the symptom experienced and the presence of others at symptom onset.…”

“…Actions in response to the onset of symptoms were perceived as either proactive or undesirable. Undesirable behaviours including symptom ignorance, downplay and denial were commonly associated with the transient nature of TIAs (Gibson & Watkins, ) and led to inadequate responses such as delaying health service access (Gibson & Watkins, ; Mc Sharry et al., ). This transience of symptoms left many people feeling unjustified in seeking help (Gibson & Watkins, ) or like a fraud due to the speed of their recovery (Hillsdon et al., ).…”

“…(), Green and King (), Gustafsson and Turpin (), Hillsdon, Kersten, and Kirk () and Mc Sharry et al. () did not identify a specific theoretical perspective attached to the research design. However, these studies used conceptually valid techniques to analyse qualitative data.…”

TIA and minor stroke: A qualitative study of long-term impact and experiences of follow-up care

“…(12)(13)(14)(15) Qualitative studies of TIA/minor stroke have predominantly focussed on patients' experiences of initial symptoms, symptom recognition and help seeking behaviour. (16)(17)(18)(19) However, some studies have explored patients' experiences after the acute stage and reported a diverse range of residual impairments, including: anxiety, (20)(21)(22)(23)(24)(25)(26) mood/emotional impact, (20,21,23,26) cognitive impairment, (21,26) fatigue, (23,25,27) physical weakness, (21,23,25) visual impairments (25) and impaired speech. (21) The impact of TIA/minor stroke on patients' ability to return to work, (25)(26)(27) performance at work, (20,25) social activities (20,21,23,26,27) and family relationships has also been reported.…”