Surveys of Stroke Patients and Their Next of Kin on Their Opinions towards Decision-Making and Consent for Stroke Thrombolysis
Annals of the Academy of Medicine, Singapore
;
: 50-63, 2017.
Article
in English
| WPRIM
| ID: wpr-349356
ABSTRACT
<p><b>INTRODUCTION</b>Early initiation of stroke thrombolysis is associated with improved outcomes. Procurement of consent is a key factor in prolonging the door-to-needle duration. This study aimed to determine the attitudes and preferences of stroke patients and their next of kin (NOK) towards decision-making for stroke thrombolysis in Singapore.</p><p><b>MATERIALS AND METHODS</b>We surveyed acute ischaemic stroke patients (n = 171) who presented beyond the 4.5-hour therapeutic window and their NOK (n = 140) using a questionnaire with scenarios on obtaining consent for intravenous thrombolysis.</p><p><b>RESULTS</b>In the patient survey, 83% were agreeable for their NOK to decide on their behalf if mentally incapacitated and 74% were agreeable for the doctor to decide if the NOK was absent. In the NOK survey, the majority (81%) wanted to be consulted before mentally capacitated patients made their decision; 72% and 74%, meanwhile, were willing to decide on behalf of a mentally capacitated and mentally incapacitated patient, respectively. In the scenario where a doctor recommended a mentally incapacitated stroke patient to undergo thrombolysis but the family declined, there was a near equal split in preference to follow the family's or doctor's decision in both the patient and NOK surveys.</p><p><b>CONCLUSION</b>The survey found that in the decision-making process for stroke thrombolysis, there was no clear consensus on the preference for the decision maker of the mentally incapacitated patient. In Singapore, there is a strong influence of the NOK in decision-making for thrombolysis.</p>
Full text:
Available
Index:
WPRIM (Western Pacific)
Main subject:
Psychology
/
Singapore
/
Therapeutics
/
Attitude to Health
/
Thrombolytic Therapy
/
Brain Ischemia
/
Surveys and Questionnaires
/
Mental Competency
/
Proxy
/
Stroke
Type of study:
Prognostic study
Limits:
Humans
Country/Region as subject:
Asia
Language:
English
Journal:
Annals of the Academy of Medicine, Singapore
Year:
2017
Type:
Article
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