Treatment decision-making during the early stages of heart attack: a case for the role of body and self in influencing delays

A majority of individuals with the symptoms of heart attack (or myocardial infarction) delay for significant periods before seeking medical assistance . These delays are often lengthy and adversely affect mortality by compromi sing the efficacy of thrombolytic therapy. This qualitative study examined prehospital decision-making retrospectively in a sample of Scottish myocard ial infarction (MI) patients (n = 14). From interviews with participants 48 hours after admittance to hospital, decision making was interpreted as fol lowing a five-stage pattern. The phases were: Experiencing symptoms as fami liar sensations, moving from the everyday, responding to breakdown, increas ing crisis and decisions and dialogue. Throughout these phases, participant s drew on aspects of the body, self and society in order to understand and react to what was happening to them. Phenomenologically, echoing movements associated with chronic illness, participants experienced the body and self differently during the different stages of decision making. Their decision making was influenced by their views of the self, interpretations of the b ody and the symptoms of MI and conceptions of personal and general risk.