Abstract
Despite campaigns to increase public awareness of stroke symptoms by advocating FAST (Face-Arms-Speech-Time), some stroke patients still show delays in the recognition of and response to stroke symptoms and miss the golden first 4.5 h to receive rt-PA (recombinant tissue plasminogen activator) treatment. The aim of this study was to explore how acute ischemic stroke patients with prehospital delay seek help and undergo the decision process before arriving at the hospital. A qualitative approach using a grounded theory was applied. There were 24 ischemic stroke patients recruited by purposive sampling. Our main findings were: “Hesitating and puzzling” was the core category to describe and guide the process of acute ischemic stroke patients with prehospital delay. During the process, “Awareness the sudden change of physical sensation and/or function” was the antecedent category. In the prehospital delay experience, the following five interaction categories were identified: (1) “Self-judgment and interpretation according to previous experience,” (2) “Puzzling and doubting—it may only be a minor problem,” (3) “Self-treatment or seeking medical attention nearby,” (4) “Unexpected symptoms getting worse” needing immediate advanced medical help and (5) “Rushing to ER with different transportation—self-alerting that serious disease is coming.” Eventually, the patients “Regret to delay seeking treatment and become a disable person.” The process of prehospital delay provides some hidden cues for patients to increase their knowledge about strokes. The study emphasizes the importance of educating community residents about identifying stroke symptoms, breaking the myth of folk therapy, and seeking medical attention immediately. These results will assist healthcare providers by offering references for designing patient-centric educational strategies for preventing stroke prehospital delay to improve the quality of stroke medical care.
Highlights
IntroductionPrehospital delay is defined as the prolonged time from symptom onset to arrival at a hospital; it can result in the failure to receive rt-PA (recombinant tissue plasminogen activator) on time for patients with ischemic cerebrovascular accidents [1,2]
Prehospital delay is defined as the prolonged time from symptom onset to arrival at a hospital; it can result in the failure to receive rt-PA on time for patients with ischemic cerebrovascular accidents [1,2]
In the prehospital delay experience, the following five interaction categories were identified: (1) “Self-judgment and interpretation according to previous experience,” (2) “Puzzling and doubting—it may only be a minor problem,” (3)“Self-treatment or seeking medical attention nearby,” (4)“Unexpected symptoms getting worse,” and (5) “Rushing to ER with different transportation—self-alerting that serious disease is coming.”
Summary
Prehospital delay is defined as the prolonged time from symptom onset to arrival at a hospital; it can result in the failure to receive rt-PA (recombinant tissue plasminogen activator) on time for patients with ischemic cerebrovascular accidents [1,2]. In the UK, the Department of Health has informed that stroke patients should be treated on time and be assessed using “Stroke-Act FAST (Face-Arms-Speech-Time)” [3,4]. Progress has been made in stroke treatment, the study indicated that only a few patients have access to rt-PA, resulting in thrombolysis rates of 1.3% to 8.4% [5,6]. Many studies have reported on the effectiveness of rt-PA treatment and global guidelines recommending the use of rt-PA in selected patients [8,9]. Only a small proportion of patients (1.05% to 8.6%) receive thrombolysis treatment [10,11,12,13]
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