Treatment Seeking Delay in Women w/Acute Myocardial Infarction
Treatment Seeking Delay in Women w/Acute Myocardial Infarction
Background: Women delay seeking treatment for symptoms of acute myocardial infarction longer than men delay. Women's delay time has not been thoroughly characterized.
Objectives: To qualitatively describe the period between the onset of symptoms of myocardial infarction and enactment of the decision to seek care (decision time) and to identify common patterns of cognitive, affective, and behavioral responses to the symptoms (decision trajectories).
Methods: In this qualitative study, 52 women were asked in semistructured interviews to describe the symptoms and related thoughts, decisions, and actions from the onset of symptoms of myocardial infarction to arrival at the hospital. Narrative analysis was used to examine the stories and to identify patterns of decision-making behavior.
Results: Six common patterns of behavior during the decision time were identified: knowing and going, knowing and letting someone take over, knowing and going on the patient's own terms, knowing and waiting, managing an alternative hypothesis, and minimizing. The patterns were further grouped as knowing or managing. Women in the 2 groups (knowing and managing) differed primarily in their awareness and interpretations of the symptoms and in their patterns of behavior in seeking treatment.
Conclusions: Women's delay in seeking treatment for symptoms of myocardial infarction can be categorized into distinct patterns. Clinicians can use knowledge of these patterns to detect responses and situations that can decrease decision time in future cardiac events and to educate women about how to respond to cardiac symptoms. (American Journal of Critical Care. 2005;14:285-293)
More women in the United States die of heart disease than of any other cause, and one form of heart disease, myocardial infarction, is responsible for the majority of these deaths. Moreover, women who survive myocardial infarction are at high risk for recurrent episodes of it and for heart failure. Several medical therapies are available to treat myocardial infarction and can greatly reduce the morbidity and mortality associated with it. In order to be effective, these therapies must be delivered rapidly, within 2 hours of the onset of symptoms. Nevertheless, many patients delay several hours and sometimes days before seeking care for their symptoms of myocardial infarction, and in most studies, women delayed longer than men did.
This period between the onset of symptoms and entry into the healthcare system is termed treatment-seeking delay, and it can be divided into 3 phases: (1) decision time, the interval from onset of acute symptoms to the decision to seek care and subsequent enactment of that decision (eg, calling 911); (2) transport time, the period from the enactment of the decision to seek care to arrival at the emergency department; and (3) therapy time, the period from arrival at the emergency department to initiation of medical treatment. (We use this definition of therapy time because prehospital thrombolytic therapies are in very limited practice in the United States.) Although major advances in transport time and therapy time have been made in the past 2 decades, little progress has been made in reducing patients' delay in seeking treatment, that is, in reducing decision time. Reducing the time between the onset of the symptoms and entry into the healthcare system is an important clinical and research priority.
In our research, we focus on describing the decision time in women, because women delay seeking treatment longer and have worse outcomes from myocardial infarction than do men. The longterm goal is to develop an educational intervention to reduce decision time and improve outcomes for women experiencing myocardial infarction.
Understanding and addressing the decision time is difficult because the target behavior takes place before patients enter the healthcare system. Most researchers have measured decision time as a single outcome variable, documented in minutes and hours, but without any description of what occurred during the decision time. Time is an important variable because of its relationship to morbidity and mortality associated with myocardial infarction, but decision time has been a deceptively simple measure of a complex number of decisions, symptoms, and behaviors that occur during the decision time. A description of the course of the symptoms and the responses that make up that complex time span may be more useful in understanding the phenomenon of delay in seeking treatment, and such a description could lay the foundation for developing an intervention to reduce the delay in women experiencing myocardial infarction.
Women respond to the symptoms of myocardial infarction in a variety of ways, but these responses have not been well characterized. The Purpose of this study was to identify and describe the patterns of cognitive, affective, and behavioral responses of women from the onset of symptoms of myocardial infarction to the decision to obtain medical care to the action of seeking care and entry into the medical system. We call these patterns decision trajectories. Researchers have used various theoretical frameworks to study the delay in seeking treatment and have documented characteristics of the decision time phase, but we still do not have a good understanding of what happenedwhat women were doing and experiencingduring the decision time. We used inductive, qualitative strategies to describe this period.
Decision trajectories (ie, patterns of decision-making behavior) in women who delay seeking treatment for myocardial infarction are dynamic and can be shaped by a number of intrapersonal and social influences. A range of decision times has been documented, and manifestations of symptoms and courses differ among women and between women and men. Therefore, we thought that women experiencing myocardial infarction might follow varied decision trajectories. We conducted focused semistructured interviews to elicit individual stories and then used narrative analysis techniques to identify common patterns of behavior that occurred during the delay in seeking treatment.
Background: Women delay seeking treatment for symptoms of acute myocardial infarction longer than men delay. Women's delay time has not been thoroughly characterized.
Objectives: To qualitatively describe the period between the onset of symptoms of myocardial infarction and enactment of the decision to seek care (decision time) and to identify common patterns of cognitive, affective, and behavioral responses to the symptoms (decision trajectories).
Methods: In this qualitative study, 52 women were asked in semistructured interviews to describe the symptoms and related thoughts, decisions, and actions from the onset of symptoms of myocardial infarction to arrival at the hospital. Narrative analysis was used to examine the stories and to identify patterns of decision-making behavior.
Results: Six common patterns of behavior during the decision time were identified: knowing and going, knowing and letting someone take over, knowing and going on the patient's own terms, knowing and waiting, managing an alternative hypothesis, and minimizing. The patterns were further grouped as knowing or managing. Women in the 2 groups (knowing and managing) differed primarily in their awareness and interpretations of the symptoms and in their patterns of behavior in seeking treatment.
Conclusions: Women's delay in seeking treatment for symptoms of myocardial infarction can be categorized into distinct patterns. Clinicians can use knowledge of these patterns to detect responses and situations that can decrease decision time in future cardiac events and to educate women about how to respond to cardiac symptoms. (American Journal of Critical Care. 2005;14:285-293)
More women in the United States die of heart disease than of any other cause, and one form of heart disease, myocardial infarction, is responsible for the majority of these deaths. Moreover, women who survive myocardial infarction are at high risk for recurrent episodes of it and for heart failure. Several medical therapies are available to treat myocardial infarction and can greatly reduce the morbidity and mortality associated with it. In order to be effective, these therapies must be delivered rapidly, within 2 hours of the onset of symptoms. Nevertheless, many patients delay several hours and sometimes days before seeking care for their symptoms of myocardial infarction, and in most studies, women delayed longer than men did.
This period between the onset of symptoms and entry into the healthcare system is termed treatment-seeking delay, and it can be divided into 3 phases: (1) decision time, the interval from onset of acute symptoms to the decision to seek care and subsequent enactment of that decision (eg, calling 911); (2) transport time, the period from the enactment of the decision to seek care to arrival at the emergency department; and (3) therapy time, the period from arrival at the emergency department to initiation of medical treatment. (We use this definition of therapy time because prehospital thrombolytic therapies are in very limited practice in the United States.) Although major advances in transport time and therapy time have been made in the past 2 decades, little progress has been made in reducing patients' delay in seeking treatment, that is, in reducing decision time. Reducing the time between the onset of the symptoms and entry into the healthcare system is an important clinical and research priority.
In our research, we focus on describing the decision time in women, because women delay seeking treatment longer and have worse outcomes from myocardial infarction than do men. The longterm goal is to develop an educational intervention to reduce decision time and improve outcomes for women experiencing myocardial infarction.
Understanding and addressing the decision time is difficult because the target behavior takes place before patients enter the healthcare system. Most researchers have measured decision time as a single outcome variable, documented in minutes and hours, but without any description of what occurred during the decision time. Time is an important variable because of its relationship to morbidity and mortality associated with myocardial infarction, but decision time has been a deceptively simple measure of a complex number of decisions, symptoms, and behaviors that occur during the decision time. A description of the course of the symptoms and the responses that make up that complex time span may be more useful in understanding the phenomenon of delay in seeking treatment, and such a description could lay the foundation for developing an intervention to reduce the delay in women experiencing myocardial infarction.
Women respond to the symptoms of myocardial infarction in a variety of ways, but these responses have not been well characterized. The Purpose of this study was to identify and describe the patterns of cognitive, affective, and behavioral responses of women from the onset of symptoms of myocardial infarction to the decision to obtain medical care to the action of seeking care and entry into the medical system. We call these patterns decision trajectories. Researchers have used various theoretical frameworks to study the delay in seeking treatment and have documented characteristics of the decision time phase, but we still do not have a good understanding of what happenedwhat women were doing and experiencingduring the decision time. We used inductive, qualitative strategies to describe this period.
Decision trajectories (ie, patterns of decision-making behavior) in women who delay seeking treatment for myocardial infarction are dynamic and can be shaped by a number of intrapersonal and social influences. A range of decision times has been documented, and manifestations of symptoms and courses differ among women and between women and men. Therefore, we thought that women experiencing myocardial infarction might follow varied decision trajectories. We conducted focused semistructured interviews to elicit individual stories and then used narrative analysis techniques to identify common patterns of behavior that occurred during the delay in seeking treatment.
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