Decision-Making in Seeking Emergency Care for Stroke Symptoms

Previous studies have shown that rapid treatment for stroke, especially ischemic stroke, reduces mortality and disability. The focus has mainly been on reducing time from arrival at hospital to start of treatment. However, the main reason for delay is often time from symptom onset to arrival at hospital. This study therefore aimed to explore decision-making processes after the onset of stroke symptoms in patients experiencing a first-time stroke.

We included 36 patients aged 18 and older, all of whom were hospitalized with a first-time stroke between October 2018 and April 2020. All patients were interviewed once within 4 weeks of symptom onset and before hospital discharge. Eligible patients were identified retrospectively through a targeted review of medical records. The data were collected and analyzed according to the grounded theory methodology.

In total, 43 potential patients were identified and asked to participate. Overall, 36 patients were included in the study: 17 women (median age 77.0 years, interquartile range 17.5) and 19 men (median age 65.7 years, interquartile range 17.2). All interviewees felt fear, and this affected their decision to seek emergency care. The decision-making processes were described by the core category of "Acting on fear." The reason for feeling frightened determined the actions taken. The reasons were sorted into 3 main categories: (1) "seeking care"-recognized stroke symptoms and acted immediately; (2) "pending and reluctance"-suspected stroke but awaited to seek care; and (3) "seeking an explanation"-confused by symptoms.

We found that decision-making when experiencing stroke symptoms was complex. All patients felt fear, which determined their actions. Some patients knew about stroke symptoms and acted immediately. Others suspected stroke but still chose to wait, whereas others were confused and tried to find answers. These results could contribute to form future awareness campaigns.