Background
Methods
Recruitment
Data collection
Likely TIA scenarios (lasting 5 min) • Speech disturbance – expressive • Speech disturbance – receptive • Dense hemiplegia +/- dysphasia • Unilateral upper limb paresis • Ataxia and incoordination • Incoordination • Dressing apraxia • Other apraxia • Amaurosis fugax | |
Non-stroke scenarios • Acute coronary syndrome (crushing chest pain for 20 min) • Simple vaso-vagal faint • Classical migraine with fortification spectra • GI upset with diarrhoea and vomiting • Respiratory tract infection/possible pneumonia • Dysphagia without other neurological symptoms |
Data analysis
Results
Spectrum of anticipated action
When things like this happen [amaurosis fugax], you don’t muck about and wonder where you’re going to go. You ring an ambulance automatically. (Interview 26: male, age 80s)in that case [a TIA with ataxia and incoordination] I’d sort of suspect a stroke. And probably whisk them off to hospital…..probably in my car.[…] I’m not sure if it’s worth calling an ambulance for. (Int 4: female age 60s)
I’d probably put them [a friend with a TIA with ataxia and incoordination] in the car and take them down to the local GP…… I’d probably still get them down to the medical practitioner to get them checked over as quickly as possible. (Int 2: male age 60s)So it [amaurosis fugax] resolved …I think I’d still try to make an appointment and get it checked out within a couple of days. (Int 12: female: age 70s)I would certainly mention it [Dressing apraxia] to the doctor next time I saw her. (Int 16: female: age 70s)
I’d be concerned but I’d just monitor it [amaurosis fugax] and just see whether it was just a one off thing that was happening and if it recurred or if it was sustained then I’d need to contact either my GP or the eye fellow. (Int 14: male, age 60s)
Individual set
in circumstances like this the emphasis would be on making decisions as quickly as possible and I’d rather make a wrong decision than be sorry. I’d rather make a decision in haste, erring on the side of caution than not acting and regretting it later. (Int 7: male, age 60s)you can’t just jump every time you see some symptom that vaguely might be connected perhaps with a stroke. (Int 3: female, age 50s)
I wouldn’t be prepared of having the responsibility of it, you know? (Int 8: female, age 50s)
And the ambulance guy said I did the right thing. The only thing to do is immediately to ring the ambulance [an episode of pulmonary embolism]. (Int 1: male, age 40s)I had flashes in my left eye and I saw my opthalmist and he told me it was this, that and the other. Nothing to be concerned about. It was just wear and tear on my body. (Int 14: male, age 60s)
I’ve got type 1 diabetes so I need to know what I should be doing if and when I get the stroke or heart attack. (Int 4: female, age 60s)
as we’re getting older we become more and more aware of the potential for things going wrong, as you’re mixing more and more with people that are older and older. (Int 7: male, age 60s)
I gradually came good. Just by sheer will power. That’s the problem with me. I just accept things and I get on with it and yeah, I’ll deal with it later sort of thing. (Int 5; female, age 70s, describing her response to an actual aphasic TIA)
Discriminatory power
you don’t really know do you? So you need to, you need to address it. (Int 10: female, age 60s)It’s just knowing [or] trying to work out the difference between what needs immediate medical intervention right now and what needs intervention. (Int 3: female, age 50s)
That’s a heart attack. I’d call an ambulance. (Int 6: female, age 70s)[Weakness] on one side, definitely ambulance. (Int 15: female, age 50s)
[I’d think]some sort of massive infection or, again, I had some sort of terrible haemorrhage or something like that.I’d be…I would be really worried about it [migraine with fortification spectra]. (Int 11: female, age 70s)
It [alexia] could be a number of things and I’d monitor it, keep an eye on it. (Int 14: male, age 60s)Probably think nothing of it [dressing dyspraxia]. [I wouldn’t seek help] just for buttons (Int 22: male, age 60s)
If [amaurosis fugax] lasted longer than half an hour I probably would have gone to the polyclinic. (Int 31: female age 40s)Well, after I got better [resolution of expressive dyspahasia] I’d contact and make an appointment with my GP as soon as possible. (Int 14: male, age 60s)
I would consider that [an episode of dressing apraxia followed later in the day by an episode of dyspraxia] serious enough to see a GP [but not a more urgent response]. (Int 16: female, age 70s)
I’d still suggest that they get to the hospital really. [for a TIA with ataxia and in-coordination]. (Int 8: female, age 50s)
So you know, things can happen. I guess people can be a bit blasé about their own health. Particularly if they start feeling better in a few minutes and want to ignore it. Don’t they? Human nature. (Int 21: female, age 50s)
I’d be looking for advice [from the GP] over the phone and then they’d tell me if I needed an urgent appointment. (Int 21: female, age 50s)
Effective access
I guess if the GP wasn’t there [after a TIA with dysphasia] I would have gone into the pharmacy and sat down and got them to check my blood pressure (Int 5: female, age 70s)if you get an ambulance and you go up to the hospital you have to wait there for 8 or 9 h anyway and …and it’s full of infections so why would you rush to the hospital? (Int 5: female, age 70s)‘Cos if you wait for the GP you might have to wait a couple of days get an appointment and you might be dead by then. (Int 1: male, age 40s) and by participants’ distance from services and access to transport.I’m living in [rural area] and I don’t always have a neighbour nearby and we’ve only got one car. So sometimes it can be a little bit isolated. So I would ring an ambulance. (Int 11: female, age 70s)
[GPs] don’t have all the equipment if you need a scan and things like that, they refer you anyway. ‘Oh, you need a scan, need an x-ray’. (Int 9: female, age 50s)