Patient Decision Making in Prehospital Health Emergencies: Determinants and Predictors of Patient Delay

Background Previous research has identified that cardiac patients tend to delay seeking help for chest pain. This study examined whether help-seeking delay occurred in all health emergencies, and explored what people are doing while they delay. This study also explored patient decision making processes and behaviours that determine how long it takes patients to seek emergency help. Methods This study used a self administered survey, including the Coping Responses Inventory. Participants were a random sample of emergency department attendees, stratified for urgency (high vs medium–low) and mode of transport to the hospital emergency department (ambulance vs other). Additional in-depth patient interviews were also conducted. Results Survey responses showed the median delay from symptom onset to arrival at health care was 4.6 hours. Discriminant Function Analysis identified that gender, pain and coping style predicted delay. Conclusion This study identified that delay is not unique to cardiac emergencies. A process of decision making was undertaken which was common to many health emergencies involving a conscious patient, the outcome of which determined how long each patient took to seek help. Psychosocial, normative and affective factors such as coping style drove patient decisions during a health emergency. The knowledge that patients make decisions in a health emergency based on what they feel, not on what they know is a breakthrough in the understanding of patient motivations to seek medical help in health emergencies, and may explain why traditional patient education using an informative approach has had only limited success.