Vicious Spiral in Seeking Medical Care: Decision Trajectory of Acute Ischemic Stroke Patients

急性缺血性中風患者的就醫決策軌跡

陳龍(Lung Chan) ； 陳凱倫(Kai-Ren Chen)

《台灣中風醫誌》 2卷2期 (2020/06) Pp. 146-159

https://doi.org/10.6318/FJS.202006_2(2).0006

摘要

Background and Purpose: Studies on medical seeking behavior of acute ischemic stroke patients are mostly quantitative analysis, and have concluded many causes of delay. We conducted a qualitative study using semi-structured interviews to identify the circumstances during decision making process to seek medical help in patients with acute ischemic stroke. Methods: Twenty patients with acute ischemic stroke and delayed thrombolytic therapy were recruited by purposeful and theoretical sampling strategies in a single medical center. Their family and/or caregivers who had involved in decision making were also invited to the interview. We analyzed their experiences of acute ischemic stroke, including the perception and recognition of the symptoms, and the actions toward the symptoms in decision-making process to seek appropriate medical help. Results: Ten males and ten females with age from 41 to 89 years old were recruited. Twelve patients were minor stoke with NIHSS ≤ 6, and 8 with NIHSS 7-18. Only 5 were illiterate. Hypertension was the most common underlying disease, followed by diabetes, heart disease, and past cerebrovascular disease history. Motor system was the most common symptom presentation (85%), followed by subjective sensory (35%) and other non-specific symptoms in 2 patients (10%). The findings displayed four areas of patients' experiences including illustrative quotes from twenty in-depth interviews. The decision-making procedure during acute stroke is a very complex process. Most common initial action toward the symptoms was 'wait and see'. We found that individual perception and interpretation of symptoms influenced the course of decision-making process. Knowledge of stroke only helped to recognize other people's symptoms, but not for themselves. The fear of role changes among patients caused them hesitate to admit the fact that they have had a stroke, and this directly led to a delay in making decisions. Conclusion: A vicious spiral model was developed to interpret the decision-making process in acute ischemic stroke patients, who were delayed for thrombolytic therapy. More aggressive health education is needed to break the vicious spiral in decision-making process. Augmenting patient confidence to receive prompt acute stroke treatment, and early acceptance of a role exchange should be a principle concept in future educational programs for such individuals.

關鍵字

acute ischemic stroke ； delay medical seeking ； trajectory ； vicious spiral model

並列摘要

背景及目的：腦血管疾病一直是國人十大死亡原因之一。急性梗塞型中風可於發病4.5小時內靜脈注射血栓溶解治療法，但大多病患無法於「黃金治療時間」內趕到醫院，錯失接受治療的良機。方法：本研究採質性研究，以深度訪談法探討20位急性梗塞性腦中風住院病患從發生症狀到就醫過程的行為模式。結果：整個就醫過程是由症狀詮釋、反應行動及成效評估的循環所合成，而多數病患的就醫過程是由兩個或以上的循環構成。第一次的循環是個人內在的思路，對行動、反應的成效評估是本身或其家屬、朋友認定，第二及第三次循環的症狀詮釋及反應行動大多由非本人進行。 循環所須時間隨著整個就醫過程有縮短之傾向。結論：本研究提出一個針對急性梗塞性腦中風病患的就醫行為模式。就醫時程會因為經過的循環次數愈多而變長，且病患及其家屬對腦中風的詮釋正確與否乃影響就醫時程的關鍵。建議未來應針對中風高危險族群及其家人提供更清楚之教育介入，以減少就醫延遲之發生。

並列關鍵字

急性缺血性腦中風 ； 延遲 ； 就醫行為 ； 軌跡