Developing A Model of People’s Needs After Transient Ischaemic Attack

Abstract

Transient ischaemic attack (TIA) is a condition which is typified by stroke symptoms that resolve quickly and completely. It could be expected that patients’ needs following TIA would be limited to secondary stroke prevention strategies. However, in clinical practice, it has been observed that people appear to have many unexpected needs following TIA.
The overall aim of this research is to answer the question ‘What are people’s needs following TIA?’ This was achieved by the development of a comprehensive list of potential needs and a model that describes commonly reported needs and how needs change over time. The methodology of this research was pragmatic, using mixed methods within seven inter-linked studies over three distinct phases. A needs assessment framework guided the research and an initial literature search revealed no previous needs assessment following TIA. There has since been limited research looking onto the experience of TIA.
Phase 1 used survey methods to explore TIA service provision at a national level to provide context for the subsequent studies. This comprised an email survey of British Association of Stroke Physicians’ members asking about their services. A total of 73 responses were received from 59 of a possible 213 acute secondary care TIA services (some services provided more than one response). There was variability in access, content and personnel involved in TIA services across the United Kingdom. 97% were run by stroke specialist staff. Only 41% of sites offered routine follow-up, 29% offered investigations and results during first clinic attendance. 29% offered a seven-day service. Only 2 sites (3%) met all four of the above ‘best practice’ criteria devised for this study.
Phase 2 used an existing needs mapping for stroke as a starting point, on the basis that TIA and stroke are part of the same continuum of cerebrovascular disease. Patients were interviewed (n=11), or participated in focus groups (n=10). Health care staff were asked to complete a questionnaire based on the stroke needs mapping (n=96) or were interviewed (n=11). Carers of people who had a TIA, were also asked to complete a questionnaire (n=6). The findings from Phase 2 demonstrated that although many needs previously identified post-stroke are relevant, there are others that appear unique following a TIA diagnosis. There were also mis-matches between staff and carers’ views as compared to the views of patients, suggesting that efforts might be made to meet needs not actually felt by patients. Phase 2 showed that common needs were likely to be identified and addressed, but less common needs might be overlooked and therefore remain unmet. The findings of Phase 2 were combined to develop a draft model of needs following TIA.
Phase 3 aimed to validate the draft model of needs using an expert panel focus group comprising professionals (n=4), patients (n=3) and carers (n=1). The expert panel refined the draft model. Four time-points were identified over which needs changed. These time-points were defined as; onset of symptoms, diagnosis, early (0-28 days), and later (29 days or more).
The research showed the mis-matches between staff and patients’ views of needs following TIA highlight common misconceptions on the part of healthcare professionals. The production of a comprehensive list of potential needs will help professionals to be more open to unexpected, or less obvious needs. The model of needs could be used when planning future services, to ensure needs are identified and where possible met. There were several needs identified following TIA that are not found in the stroke needs mapping, in particular, around recognition of the event and diagnosis of the condition.
The needs assessment framework used to structure the research has not previously been used in a healthcare setting, but it provided an excellent road-map through the needs assessment process. Lee’s framework has previously been used in education but was selected for its compatibility with mixed methods and the focus on the individual rather than using a framework with a more bio-medical slant.
This is the first research to comprehensively explore needs and problems experienced following TIA, rather than reporting specific issues or parts of the TIA experience. TIA is not the benign condition which it was historically thought to be. A range of problems and needs can result from a TIA, some not previously identified in relation to TIA, such as hypervigilance and concern regarding diagnostic uncertainty.