School of Nursing and Midwifery, Trinity College, University of Dublin, Ireland.
J Cardiovasc Nurs. 2012 Jul-Aug;27(4):334-44. doi: 10.1097/JCN.0b013e31822071f3.
Patient decision delay continues to be a major factor of delay along the pathway of care for patients with myocardial infarction (MI). Although potentially modifiable, efforts to reduce these delays through educational and media interventions have been relatively unsuccessful. This failure has been due, in part, to the lack of understanding about the complex sociopsychological and clinical dimensions associated with the phenomenon of help-seeking behavior.
The aims of this study were to (1) perform an in-depth analysis of patients' MI symptom experiences and (2) describe their help-seeking behavior in response to these symptom experiences.
In-depth interviews were used to examine the symptom experiences and help-seeking behavior of men and women with MI. Participants (n = 42) were interviewed 2 to 4 days after their admission to 1 of 2 hospitals in Dublin, Ireland.
Two new discrete MI categories emerged from the findings-slow-onset MI and fast-onset MI. Slow-onset MI is characterized by the gradual onset of mild symptoms, whereas fast-onset MI describes the sudden onset of severe chest pain. Most participants (n = 27) experienced slow-onset MI but expected the symptom presentation associated with fast-onset MI. The mismatch of expected and experienced symptoms for participants with slow-onset MI led to the mislabeling of symptoms to a noncardiac cause and protracted help-seeking delays. Participants with fast-onset MI (n = 15) quickly attributed their symptoms to a cardiac cause, which expedited appropriate help-seeking behaviors.
Definitions of MI and the educational information provided to the public need to be reviewed. Slow-onset MI and fast-onset MI provide plausible definition alternatives and, possibly, a more authentic version of real MI events than what is currently used. They also provide a unique "delay" perspective, which may inform future educational initiatives targeted at decision delay reduction.
患者决策延误仍然是心肌梗死（MI）患者护理路径延误的主要因素。尽管可以通过教育和媒体干预来改变这种情况，但这些努力在减少这些延误方面相对不成功。部分原因是缺乏对与寻求帮助行为相关的复杂社会心理和临床维度的理解。
本研究旨在（1）深入分析患者的 MI 症状体验，（2）描述他们对这些症状体验的寻求帮助行为。
采用深入访谈法，对爱尔兰都柏林 2 家医院的 42 名 MI 男性和女性患者的症状体验和寻求帮助行为进行了调查。
从研究结果中出现了两个新的离散 MI 类别-缓慢发作型 MI 和快速发作型 MI。缓慢发作型 MI 的特点是轻度症状逐渐发作，而快速发作型 MI 则描述严重胸痛的突然发作。大多数参与者（n=27）经历了缓慢发作型 MI，但期望出现快速发作型 MI 相关的症状表现。缓慢发作型 MI 参与者的预期症状与实际症状不匹配，导致症状被错误归因于非心脏原因，从而导致寻求帮助的时间延长。快速发作型 MI 参与者（n=15）迅速将症状归因于心脏原因，从而加速了适当的寻求帮助行为。
需要重新审查 MI 的定义以及向公众提供的教育信息。缓慢发作型 MI 和快速发作型 MI 提供了合理的替代定义，并且可能比目前使用的定义更能真实反映实际的 MI 事件。它们还提供了一个独特的“延误”视角，这可能为未来针对决策延误减少的教育计划提供信息。
