TY - JOUR
T1 - Advance preferences regarding thrombolysis in patients at risk for stroke
T2 - A cross-sectional study
AU - Ó Flatharta, T.
AU - Khan, A.
AU - Walsh, T.
AU - O'Donnell, M.
AU - O'Keeffe, S. T.
N1 - Publisher Copyright:
© The Author 2014.
PY - 2015/1/1
Y1 - 2015/1/1
N2 - Background: It is difficult to obtain informed consent for thrombolysis in stroke patients given the emergency setting, the need for a speedy decision and the effects of neurological deficits. Aim: To determine the advance preferences for thrombolysis of patients at risk for stroke following discussion of the potential risks and benefits. Design: Cross-sectional survey. Methods: Data on benefits and risks of thrombolysis within 3 h and between 3 and 4.5 h after stroke were presented orally, in writing and pictorially to patients attending geriatric and stroke services in a teaching hospital with specified stroke risk factors and preferences for thrombolysis were recorded. Results: Of the 121 participants, 108 (89.3%; 95% confidence interval [CI] 82.4-93.7) would opt for thrombolysis within the 3-h period and 100 (82.6%; 95% CI 74.9-88.4) within the 3- to 4.5-h period after acute stroke (P = 0.04, McNemar's test for correlated proportions). Previous stroke or transient ischaemic attack was more common among those who agreed to thrombolysis (54.1% vs. 30.4%, P = 0.04) and those who opted for thrombolysis were significantly more likely to agree to have their preferences recorded and used in the event of a stroke than those who refused thrombolysis (88.8% vs. 30.4%, P = 0.002). Conclusion: Advance discussion of the potential risks and benefits of thrombolysis in at-risk patients may improve decision making if thrombolysis is being considered and the patient can no longer make a decision.
AB - Background: It is difficult to obtain informed consent for thrombolysis in stroke patients given the emergency setting, the need for a speedy decision and the effects of neurological deficits. Aim: To determine the advance preferences for thrombolysis of patients at risk for stroke following discussion of the potential risks and benefits. Design: Cross-sectional survey. Methods: Data on benefits and risks of thrombolysis within 3 h and between 3 and 4.5 h after stroke were presented orally, in writing and pictorially to patients attending geriatric and stroke services in a teaching hospital with specified stroke risk factors and preferences for thrombolysis were recorded. Results: Of the 121 participants, 108 (89.3%; 95% confidence interval [CI] 82.4-93.7) would opt for thrombolysis within the 3-h period and 100 (82.6%; 95% CI 74.9-88.4) within the 3- to 4.5-h period after acute stroke (P = 0.04, McNemar's test for correlated proportions). Previous stroke or transient ischaemic attack was more common among those who agreed to thrombolysis (54.1% vs. 30.4%, P = 0.04) and those who opted for thrombolysis were significantly more likely to agree to have their preferences recorded and used in the event of a stroke than those who refused thrombolysis (88.8% vs. 30.4%, P = 0.002). Conclusion: Advance discussion of the potential risks and benefits of thrombolysis in at-risk patients may improve decision making if thrombolysis is being considered and the patient can no longer make a decision.
UR - https://www.scopus.com/pages/publications/84928653030
U2 - 10.1093/qjmed/hcu142
DO - 10.1093/qjmed/hcu142
M3 - Article
SN - 1460-2725
VL - 108
SP - 27
EP - 31
JO - QJM: An International Journal of Medicine
JF - QJM: An International Journal of Medicine
IS - 1
ER -
