Patient’s perceptions may delay stroke treatment
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People who think they can control their dizziness, speech disturbance or other symptoms that suggest they have had a stroke are less likely to seek immediate medical care, a team of Israeli researchers reports.
Delays in seeking treatment for stroke may not be due to patients’ inability to identify stroke symptoms, as has been thought, but may also be influenced by patients’ perceptions of those symptoms, according to the findings of a study in the current issue of the medical journal Stroke.
“Delay in seeking medical help in response to the appearance of stroke symptoms is a complex issue, which we believe is affected by many different types of factors including demographic, clinical, perceptual, social and behavioral variables,” Dr. Lori Mandelzweig, of Sheba Medical Center in Tel Hashomer, told Reuters Health.
Consequently, “educational efforts to reduce the time interval between symptom onset and seeking medical assistance must extend beyond providing information about symptoms and the need to call EMS, and should address the problem of symptom interpretation and perception and the need for the intervention of others,” she and her colleagues write.
Ischemic strokes are caused by a blockage in blood flow to the brain. Tissue plasminogen activator (tPA), a clot-busting drug, is an effective therapy to restore blood flow and reduce brain damage, but it must be given within three hours of the stroke onset for maximum effect. Therefore many patients are ineligible for treatment because they delay seeking help.
Mandelzweig and her colleagues conducted interviews of 209 patients hospitalized for stroke between September 2000 and December 2002. Thirty-four percent of the patients had a history of heart disease and 19 percent had previously experienced stroke.
Patients who believed they were experiencing severe symptoms, those who were advised by others to seek help, and those who contacted an ambulance, were more likely to seek prompt medical care than other patients.
Patients who perceived themselves as being in control of their symptoms, however, were more than twice as likely as their peers to delay seeking medical care, the report indicates.
“Stroke is a bit tricky when it comes to patient’s perceptions, because the organ that is affected is the brain,” Mandelzweig noted. Therefore, “perception may be altered to some extent in some cases” as a result of the stroke.
Altogether, factors associated with a significant—more than three hours—delay in seeking help included patient’s perceived control of symptoms, older age (70 years or older), male gender, and a gradual, rather than sudden, onset of stroke symptoms.
If a patient does not recognize that the symptoms are serious, “others must advise the patient about the urgency of the situation and make the necessary arrangements for seeking treatment as soon as possible,” Mandelzweig added.
SOURCE: Stroke, May 2006.
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