The English National Stroke Strategy clearly emphasises that stroke must be treated as a medical emergency as rapid access to appropriate treatment for people with acute stroke is vital for improving patient outcomes.
This study set out to explore what factors influence people's decisions to seek medical assistance following the onset of stroke symptoms.
In total, 19 people who had experienced a stroke and 26 ‘witnesses’ (friends/family/ bystanders who were either there at the time of the stroke or who found the patient with stroke) who made the initial contact with the medical services participated in semi-structured interviews within 14 days of the stroke event.
The interview topic guide included areas such the context of the stroke, the symptoms experienced/ witnessed, people's responses to the event, participants’ level of knowledge of stroke and treatment of stroke, views as to the role and function of the medical services in these situations, and perceptions about the Department of Health's public education campaign ‘Stroke— Act FAST’ which started in 2009.
Patients were recruited from three stroke units in the North East of England and included people who had either initially called the emergency ambulance service or gone to the emergency department, as well as people who had called primary care services first, for example, the GP or NHS Direct.
Both groups had patients/ witnesses who had taken this action in under an hour from onset of symptoms, as well as people who had delayed taking any action for at least an hour.
Framework analysis facilitated identification of five major themes: interpreting the signs and symptoms of stroke; responses to stroke symptoms; deflection and delay; prior knowledge and awareness of the ‘Act FAST’ campaign; roles and responses of different medical services.
Findings indicate that how people interpreted the signs/symptoms determined their initial actions (for example) people who had a familial history of stroke, or those experiencing severe symptoms and a drastic change in their abilities, accessed emergency medical services (EMS) quickly. Some people described waiting to see if the symptoms went away; and others reported having symptoms that did not match their preconception of what it would be like to have a stroke hence they did not access the EMS; with others reporting that they did not want to ‘bother’ the EMS.
Some patients reported contacting friends or relatives first to gain their affirmation before taking any action (deflection and delay); with witnesses frequently describing taking rapid action and contacting the EMS as they wanted to transfer the responsibility for the consequences of the stroke to healthcare professionals as quickly as possible.
The impact of the ‘Act FAST’ campaign was variable with some participants reporting an increased knowledge of stroke symptoms as a result of the campaign and others seemingly delaying access to the EMS as they were not experiencing the same signs and symptoms as shown in ‘Act FAST’.
Participants reported that their beliefs as to the role of the various healthcare services impacted on their initial decisions. For some participants initiating a call for an emergency ambulance was only believed to be appropriate in cases of complete collapse or trauma. For others (especially those with a known chronic condition who already had an established rapport with local medical services) the GP was their first port of call to seek advice as to the next step.
The authors identify some limitations of the study including challenges to patients in terms of recall of events post stroke. However, there are also evident strengths such as engagement with witness accounts, and the inclusion of people who sought help via different routes and in different time frames.
This is an important study which increases awareness and subsequent understanding of what motivates people to treat stroke either as a medical emergency or not. These decisions need to be understood so that healthcare professionals can develop and target appropriate educational interventions and/or systems that support patients to receive rapid and timely access to appropriate emergency treatment for stroke in order, ultimately, to improve patient outcomes.