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Surveys of Stroke Patients and Their Next of Kin on Their Opinions towards Decision-Making and Consent for Stroke Thrombolysis.

Abstract 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.
PMID
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Authors

Mayor MeshTerms

Attitude to Health

Decision Making

Proxy

Thrombolytic Therapy

Keywords
Journal Title annals of the academy of medicine, singapore
Publication Year Start




PMID- 28263342
OWN - NLM
STAT- MEDLINE
DA  - 20170306
DCOM- 20170314
LR  - 20170314
IS  - 0304-4602 (Print)
IS  - 0304-4602 (Linking)
VI  - 46
IP  - 2
DP  - 2017 Feb
TI  - Surveys of Stroke Patients and Their Next of Kin on Their Opinions towards
      Decision-Making and Consent for Stroke Thrombolysis.
PG  - 50-63
AB  - INTRODUCTION: 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. MATERIALS AND METHODS: 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. RESULTS: 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. CONCLUSION: 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.
FAU - Angamuthu, Nithia
AU  - Angamuthu N
AD  - Department of Neurology, National Neuroscience Institute, Singapore General
      Hospital, Singapore.
FAU - Queck, Kian Kheng
AU  - Queck KK
FAU - Menon, Sumytra
AU  - Menon S
FAU - Ho, Shu Swen
AU  - Ho SS
FAU - Ang, Elaine
AU  - Ang E
FAU - De Silva, Deidre Anne
AU  - De Silva DA
LA  - eng
PT  - Journal Article
PL  - Singapore
TA  - Ann Acad Med Singapore
JT  - Annals of the Academy of Medicine, Singapore
JID - 7503289
SB  - IM
MH  - *Attitude to Health
MH  - Brain Ischemia/complications/psychology/*therapy
MH  - *Decision Making
MH  - Dissent and Disputes
MH  - Humans
MH  - Informed Consent
MH  - Mental Competency
MH  - *Proxy
MH  - Singapore
MH  - Stroke/etiology/psychology/*therapy
MH  - Surveys and Questionnaires
MH  - *Thrombolytic Therapy
MH  - Time-to-Treatment
EDAT- 2017/03/07 06:00
MHDA- 2017/03/16 06:00
CRDT- 2017/03/07 06:00
PST - ppublish
SO  - Ann Acad Med Singapore. 2017 Feb;46(2):50-63.

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