Exploring health professionals' perspectives and preferences in the treatment of post-stroke fatigue and mental health disorders: an Australian qualitative vignette-based study.

BACKGROUND

Post-stroke fatigue and mental health disorders are common but often overlooked. Health professionals' perspectives play a critical role in recognizing, assessing, and managing these symptoms, which significantly influence recovery and quality of life.

OBJECTIVES

To explore health professionals' perspectives of post-stroke treatments and identify factors influencing treatment preferences.

METHODS

Vignette-based semi-structured interviews were conducted either in person or online/by telephone with health professionals, who were asked for their perspectives on four treatment vignettes using a 5-point Likert scale. Qualitative data were analysed thematically, and quantitative data were compared using non-parametric tests. Key themes were mapped to the Bio-Psycho-Social-Systems (BPSS) model to explore factors influencing treatment preferences.

KEY FINDINGS: Sixteen of 20 health professionals provided numerical ratings. There were no significant differences in 'liking' ratings for any fatigue or mental health vignette. CBT was most frequently the most preferred option for managing fatigue (90.0%), followed by modafinil (10.0%). For mental health, nortriptyline was most frequently the most preferred treatment (37.5%), followed by herbal medicines plus fluoxetine and acupuncture (25.0% each) and repetitive transcranial magnetic stimulation (12.5%). Five influencing themes were mapped to the BPSS model: therapeutic side effects and safety concerns (biological); evidence base and perceived efficacy (biological); accessibility and system practicality (systems); patient preferences (psychological/social); and professional scope and confidence (psychological/systems).

CONCLUSION

Whilst health professionals were open to non-pharmacological strategies for managing post-stroke complications, conventional pharmacotherapy was preferred, either alone or in combination with other therapies, especially for severe mental health disorders.