Sociocultural study on the self-perception of stroke and an analysis of doctor-patient communication

Abstract

Background

Stroke was historically attributed to magical and religious conceptions. We analyse the self-perception of stroke in stroke patients, the knowledge of vascular risk factors (VRF), and doctor-patient communication efficacy from an anthropological perspective.

Material and methods

Prospective study of stroke patients by semi-structured, in-depth interviews. Those with modified Rankin Scale>3, aphasia or severe dysarthria were excluded. The quality of the information from health staff to the patients, as well as the evaluation of this information by the health staff themselves, were analysed.

Results

The study included 100 patients (56 men), with a mean age of 61 (SD 16) years. Low educational level was present in 51%. Up to 83% did not know what was happening with the first stroke symptoms, and only 56% went to an emergency department initially. Only 19% could identify all their vascular risk factors (VRF), and up to 57% thought that the cause was due to a fortuitous factor. Poor knowledge of stroke was associated with low educational level (OR: 2.81; 95% CI, 1.14–6.90, P=.024). Up to 75% of the patients did not understand the information provided by their doctor, but 65% felt well informed. Furthermore, up to 69% of physicians thought that patients were well informed; the same percentage felt that low educational level made communication difficult.

Conclusions

The knowledge of stroke and its VRF in stroke patients is low. They perceive it as something fortuitous associated to a strong emotional impact. Communication between doctors and stroke patients is relatively poor, although neither physicians nor patients detect this fact. This poor knowledge of stroke and VRF could have a negative influence on secondary prevention compliance.

Resumen

Introducción

Históricamente el ictus se vinculó a concepciones mágico-religiosas. Analizamos la autopercepción del ictus en los pacientes, el conocimiento sobre factores de riesgo vascular (FRV) o desencadenantes, y la eficacia de la comunicación médico-paciente, desde un punto de vista antropológico.

Material y métodos

Estudio prospectivo de pacientes con ictus, mediante entrevistas en profundidad y observación participante. Excluimos pacientes con una escala de Rankin modificada > 3, afasia o disartria grave. Analizamos la calidad de la información ofrecida por el personal sanitario y su propia valoración, mediante encuestas abiertas.

Resultados

Se entrevistaron 100 pacientes (56 hombres), edad media 61 (DE 16). El 51% tenía un nivel educativo inferior o igual al básico. El 83% no reconocía que ocurría al sufrirlo y sólo el 56% acudió directamente a Urgencias. Un 19% identifica sus FRV y hasta el 57% piensa que lo desencadenó un factor fortuito. El desconocimiento de la enfermedad se asoció con un nivel educativo bajo (OR 2,81; IC 95%: 1,14–6,90; p = 0,024). Un 75% no entiende el discurso biomédico, pero un 65% afirma sentirse bien informado. Por otro lado, el 69% del personal sanitario facultativo piensa que los pacientes están bien informados; similar porcentaje considera que el “bajo nivel cultural” dificulta la comunicación.

Conclusiones

El conocimiento de la enfermedad y sus FRV en los pacientes con ictus es escaso. Suelen percibirlo como algo fortuito asociado a un fuerte impacto emocional. La comunicación médico-paciente es ineficaz, ni profesionales ni pacientes detectan esta realidad. Esta falta de conocimiento de su enfermedad y sus FRV podría influir negativamente en una buena prevención secundaria.