title: Myocardial infarction, patient decision delay and help-seeking behaviour: a thematic analysis.
abstract: OBJECTIVE
  To explore patient decision delay, the symptom experience and factors that motivated the patient experiencing myocardial infarction to go to the emergency department.
  
  
  BACKGROUND
  Reperfusion for myocardial infarction is more effective if performed as soon as possible after the onset of symptoms. Multiple studies show that prehospital delay is long and can average several hours.
  
  
  METHODS
  A qualitative descriptive design using semi-structured interviews.
  
  
  METHODS
  All consecutive myocardial infarction patients who between July 2013-January 2014 at a single-centre metropolitan tertiary hospital in Western Australia were included. Patient responses to an open-ended question were recorded and transcribed verbatim. Data were analysed using Braun & Clarke (Qual Res Psychol, 3, 2006, 77-101) thematic analysis method.
  
  
  RESULTS
  Of the 367 eligible, 255 provided consent. Three themes emerged from the qualitative analyses: (1) onset and response to symptoms, and this included three subthemes: context of the event, diversity of symptom interpretation and response to symptoms; (2) help-seeking behaviour, and this included the patient seeking help from various lay and professional sources; and (3) help-seeking outcomes, which include calling the emergency ambulance, going to emergency department, seeing a general practitioner, seeing a general practitioner who advised them to go home.
  
  
  CONCLUSIONS
  The context of the event, their symptomatology and the layperson who was the first point of contact influenced the decision for the patient to go to the emergency department. Many patients used private transport or contacted their general practitioner. New knowledge from this study emphasises the importance of the layperson understanding the appropriate response is to seek prompt care through immediate emergency transport by ambulance to emergency department.
  
  
  CONCLUSIONS
  This study highlights the need to educate both the patient and the wider public, not only to seek prompt care but to also to call the emergency ambulance to arrange transport to the emergency department.
authors.affiliation: Centre for Nursing Research, Sir Charles Gairdner Hospital, Nedlands, WA, Australia.|School of Nursing and Midwifery, Edith Cowan University, Joondalup, WA, Australia.
authors.forename: Linda L
authors.initials: LL
authors.lastname: Coventry
authors.affiliation: Centre for Nursing Research, Sir Charles Gairdner Hospital, Nedlands, WA, Australia.
authors.forename: Johanna W
authors.initials: JW
authors.lastname: van Schalkwyk
authors.affiliation: Sir Charles Gairdner Hospital and Deputy Director Harry Perkins Institute of Medical Research and Clinical Professor of Medicine, The University of Western Australia, Perth, WA, Australia.
authors.forename: Peter L
authors.initials: PL
authors.lastname: Thompson
authors.affiliation: Sir Charles Gairdner Hospital, Nedlands, WA, Australia.
authors.forename: Scott A
authors.initials: SA
authors.lastname: Hawkins
authors.affiliation: Centre for Nursing Research, Sir Charles Gairdner Hospital, Nedlands, WA, Australia.|Central Queensland University, North Rockhamptom, Qld, Australia.|School of Nursing and Midwifery, The University of Southern Queensland, Toowoomba, Qld, Australia.|School of Nursing, Adelaide University, Adelaide, SA, Australia.
authors.forename: Desley G
authors.initials: DG
authors.lastname: Hegney
mesh_terms: D000368:Aged; D003657:Decision Making; D004636:Emergency Service, Hospital; D005260:Female; D000066505:Help-Seeking Behavior; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000523:psychology*; D011446:Prospective Studies; D036301:Qualitative Research; D011795:Surveys and Questionnaires; D013997:Time Factors; D061665:Time-to-Treatment
keywords: decision-making; emergency care; heart disease; patients’ experience; qualitative study