Decision Delay Is a Significant Contributor to Prehospital Delay for Stroke Symptoms

Abstract

Prehospital delay after stroke symptom onset is a primary barrier to eligibility for reperfusion therapies. Decision delay is an understudied contributor to prehospital delay. We aimed to explore decision delay as a component of prehospital delay. For this correlational study, 170 Thai acute stroke patients were interviewed to explore their treatment-seeking decision factors: prior stroke knowledge, onset context, and cognitive, emotional, and behavioral factors. Participants’ mean age was 61.2 years, and 46% were women. Median decision delay and prehospital delay times were 120 and 372 minutes. Decision delay represented 49% of prehospital delays. Factors shortening decision delay were atrial fibrillation, prior stroke knowledge, perceived cause of symptoms as stroke, perceived severity of symptoms, and advice from bystanders to seek treatment. In contrast, seeking support from others and self-treatment affected prolonged decision delay. Shortening decision delay, often under the patient or bystander control, can reduce overall prehospital delay.

Predictive models for delay in medical decision-making among older patients with acute ischemic stroke: a comparative study using logistic regression analysis and lightGBM algorithm

“…However, in this study, the delay rate for medical decision-making in older patients with AIS was 74.76%, which is high. The median decision delay (480 min) in seeking treatment for older patients with AIS in this study is much higher than previous research results [ 15 – 17 , 30 , 31 ]. The main reason is the difference in the study population, which means that the delay in medical decision-making among older AIS patients is more severe than the median delay in decision-making among AIS patients in adult studies [ 15 , 17 , 30 , 31 ] or in rural areas [ 16 ].…”

“…The median decision delay (480 min) in seeking treatment for older patients with AIS in this study is much higher than previous research results [ 15 – 17 , 30 , 31 ]. The main reason is the difference in the study population, which means that the delay in medical decision-making among older AIS patients is more severe than the median delay in decision-making among AIS patients in adult studies [ 15 , 17 , 30 , 31 ] or in rural areas [ 16 ]. Older patients are less sensitive to physical symptoms and have higher pain thresholds, and most older patients fear hospitalization and are unwilling to inconvenience their families, leading to delays in seeking medical care [ 32 ].…”

“…Older people may rest, take medication, and observe themselves at home before going to the hosipital, leading to delayed decision-making in seeking medical attention. In contrast, if the symptoms are severe or older patients perceive them as having a stroke, they may seek medical attention promptly [ 17 ]. As bodily sensations beyond the ‘normal’ range may trigger a self-evaluation process, unfamiliar or severe symptoms can attract the patient’s attention and lead to timely seeking of professional medical assistance [ 39 ].…”

“…However, research on factors influencing delayed medical decision-making in older patients are still lacking. In existing studies, there is still controversy over whether the level of stroke knowledge has an impact on delayed medical decision-making in patients with AIS [ 17 , 18 ]. Researchers consider health literacy as an important prerequisite for health, healthy behavior, and health-related decision-making [ 19 ], however, the predictive role of health literacy on delayed medical decision-making in older patients with AIS is not yet clear.…”

Prehospital delay after acute ischemic stroke among Thai older adults: A cross‐sectional study

“…Regarding perceived severity of stroke, if patients recognized that stroke is a serious and life‐threatening disease, they are more likely to seek medical emergency and urgent treatment. Perceived severity of stroke symptoms has been frequently related to early arrival after the stroke onset (Iversen et al, 2020; Potisopha et al, 2022). Additionally, bystanders also play a critical role in shortening delay time after the onset of stroke, as they usually take action and call for help.…”