Tissue Plasminogen Activator Non-Treatment in First-Time Ischemic Stroke

Purpose/Background: Strokes are a significant problem in America; as about every 40 seconds someone experiences a stroke. Eighty-seven percent of all cerebrovascular events are ischemic in origin and could possibly be treated with tissue plasminogen activator (tPA). However, whether at a stroke certified organization or a small community hospital, tPA’s use is extremely conservative. Since its inception, the use of tPA has been controversial among cerebrovascular and emergency clinicians. However, it remains the most timely and conventional treatment for acute ischemic stroke. The purpose of this proposed qualitative research study is to evaluate physicians’ attitudes toward tPA and how their attitudes negate its use in first-time ischemic stroke treatment.

Research Questions: (a) What are physicians’ attitudes toward tPA usage in first time ischemic stroke? (b) How do physicians describe their comfort level in prescribing tPA in a first-time stroke victim? (c)  Does the unfamiliarity/non-use of tPA among physicians lead them to apply a non-credible exclusion criteria to the decision process?

Sample/Methodology: Descriptive phenomenology will be utilized to examine why physicians underutilize tPA as a treatment modality for first-time ischemic stroke. The lived experiences of the physicians are incredibly valuable in this proposed research study. The sample for this proposed study will include emergency department physicians from various medical centers in Alabama. Focused interviews will be employed to collect research information.

Theoretical Framework: Dr. Albert Bandura’s social cognitive theory will guide the research study. In Bandura’s theory, he described human beings as adaptive learners. The model is based upon three areas: cognitive/personal, behavioral, and environmental. These three domains compose the triadic reciprocal causation and states that each area is interchangeable Essentially, Bandura found that humans learn behavior by watching and learning from others. Have physician’s learned negative behaviors about tPA from their mentors and continue to use them in their own practice? One of the strongest driving forces is behavior. Just one adverse outcome from tPA can haunt the clinician and negate its use for years to come.