Opening the Door to Funny Turns: A Constructivist Thematic Analysis of Patient Narratives after TIA

Introduction : It is crucial to enhance timely treatment and secondary prevention following a transient ischaemic attack (TIA) and one way to ensure this is to improve the accuracy and promptness of diagnosis. Unfortunately, initiating timely treatment can be difficult due to patients’ lack of knowledge of symptoms and their need for urgency, and difficulties in obtaining this diagnosis. Understanding the TIA event from the patient’s perceptive may open the door to a better understanding of TIA symptomology and improve current difficulties with diagnosis. Method: Narratives of 123 participants, adjudicated to have experienced a TIA, were selected from a TIA/minor stroke cohort assembled by the International Study of Systems of Care in Minor Stroke and TIA [InSiST] study. This National Health and Medical Research Council (NHMRC) funded study is currently underway in NSW, Australia. The participants’ TIA experiences were transcribed into narratives, and using constructivist thematic analysis, an insightful description of patient perceptions of, and responses to, their TIA symptoms was obtained. Results: Participants described mental checklists they created in response to their symptoms that reflected the scope of what they knew about TIA/stroke symptoms. Deficits in TIA-specific knowledge were apparent in these lists, which influenced the participants’ responses to their symptoms. Surprisingly, many participants felt they needed to experience all the symptoms on their checklist before they acted. Confusion also arose around additional symptoms, inability to describe symptoms and temporary nature of symptoms, which tended to de-escalate the seriousness of symptoms. These disparities also aided self-attribution of a range of erroneous diagnoses and inhibited appropriate actions. Commonalities in the shared experience of participants also emerged which hindered the participants physical or cognitive capabilities to seek medical treatment. These commonalities included sudden loss of language and bodily control, inability to complete tasks, no awareness of symptoms, or loss of consciousness. This rendered the participants reliant on significant others to gain urgent medical treatment. Conclusion : Health professionals’ identification and acknowledgement of these subjective experiences may add a broader awareness of TIA symptoms at presentation and contribute to more accurate detection or diagnoses of TIA events. The identification of knowledge deficits in people’s utilisation of stroke checklists has implications for both current and future public health stroke campaigns in raising awareness of TIA symptoms. Further studies to explore the subjective experiences of TIA would be beneficial to enhance our understanding of TIA.