Reducing uncertainty: an exploratory study of people's treatment decisions after transient ischaemic attack or minor stroke

Abstract

Little is known about people's responses to the impact of a transient ischaemic attack or minor stroke on their health status and future risk of stroke. In this thesis my aims are: to explore how the experience of TIA or minor stroke affects people's perception of their health and their uptake of health maintenance measures; to examine people's assessment, interpretation and perceptions of evidence in relation to their stroke risk; to explore the ways in which people reach decisions about treatment options in the light of their personal experience and in the context of evidence-based healthcare; and to explore the effect of anticipated regret in these processes.

I conducted 28 audiotaped one-to one interviews with a purposive sample of 20 participants, each of whom had previously experienced a TIA or minor stroke. Ten of them had carotid endarterectomy in addition to best medical treatment (BMT). The data collection and analysis used a reflexive approach, based on my clinical nursing practice in this field, and was informed by the constant comparative method of grounded theory.

My findings show that the experience of TIA diminishes people's quality of life and leads to a process of acknowledgement versus denial of its potential threat to health. People access evidence from formal and informal sources in the process of reaching decisions about their treatment. Their decisions tend to be deterministic in nature, even when they are aware of the scientific evidence.

I present a theoretical framework, in which the central theme is the person's use of strategies to reduce uncertainty relating to their risk of stroke. I propose that people's primary aim in seeking health care, accessing information, and making treatment choices after TIA or minor stroke, is to reduce their perception of uncertainty about the threat of a future stroke, rather than to reduce stroke risk itself.

I discuss the implications of these findings in relation to directions for future research, health care policy and nursing practice.