Practice variation in the informed consent procedure for thrombolysis in acute ischemic stroke: a survey among neurologists and neurology residents.
Acute ischemic stroke
Acute stroke therapy
Clinical practice
Informed consent
Thrombolysis
tPA
Journal
BMC medical ethics
ISSN: 1472-6939
Titre abrégé: BMC Med Ethics
Pays: England
ID NLM: 101088680
Informations de publication
Date de publication:
25 08 2021
25 08 2021
Historique:
received:
02
06
2021
accepted:
18
08
2021
entrez:
26
8
2021
pubmed:
27
8
2021
medline:
28
9
2021
Statut:
epublish
Résumé
Obtaining informed consent for intravenous thrombolysis in acute ischemic stroke can be challenging, and little is known about if and how the informed consent procedure is performed by neurologists in clinical practice. This study examines the procedure of informed consent for intravenous thrombolysis in acute ischemic stroke in high-volume stroke centers in the Netherlands. In four high volume stroke centers, neurology residents and attending neurologists received an online questionnaire concerning informed consent for thrombolysis with tissue-type plasminogen activator (tPA). The respondents were asked to report their usual informed consent practice for tPA treatment and their considerations on whether informed consent should be obtained. From the 203 invited clinicians, 50% (n = 101) completed the questionnaire. One-third of the neurology residents (n = 21) and 21% of the neurologists (n = 8) reported that they always obtain informed consent for tPA treatment. If a patient is not capable of providing informed consent, 30% of the residents (n = 19) reported that they start tPA treatment without informed consent. In these circumstances, 53% of the neurologists (n = 20) reported that the resident under their supervision would start tPA treatment without informed consent. Most neurologists (n = 21; 55%) and neurology residents (n = 45; 72%) obtained informed consent within one minute. None of the respondents used more than five minutes for informed consent. Important themes regarding obtaining informed consent for treatment were patients' capacity, and medical, ethical and legal considerations. The current practice of informed consent for thrombolysis in acute ischemic stroke varies among neurologists and neurology residents. If informed consent is obtained, most clinicians stated to obtain informed consent within one minute. In the future, a shortened information provision process may be applied, making a shift from informed consent to informed refusal, while still considering the patient's capacity, stroke severity, and possible treatment delays.
Sections du résumé
BACKGROUND
Obtaining informed consent for intravenous thrombolysis in acute ischemic stroke can be challenging, and little is known about if and how the informed consent procedure is performed by neurologists in clinical practice. This study examines the procedure of informed consent for intravenous thrombolysis in acute ischemic stroke in high-volume stroke centers in the Netherlands.
METHODS
In four high volume stroke centers, neurology residents and attending neurologists received an online questionnaire concerning informed consent for thrombolysis with tissue-type plasminogen activator (tPA). The respondents were asked to report their usual informed consent practice for tPA treatment and their considerations on whether informed consent should be obtained.
RESULTS
From the 203 invited clinicians, 50% (n = 101) completed the questionnaire. One-third of the neurology residents (n = 21) and 21% of the neurologists (n = 8) reported that they always obtain informed consent for tPA treatment. If a patient is not capable of providing informed consent, 30% of the residents (n = 19) reported that they start tPA treatment without informed consent. In these circumstances, 53% of the neurologists (n = 20) reported that the resident under their supervision would start tPA treatment without informed consent. Most neurologists (n = 21; 55%) and neurology residents (n = 45; 72%) obtained informed consent within one minute. None of the respondents used more than five minutes for informed consent. Important themes regarding obtaining informed consent for treatment were patients' capacity, and medical, ethical and legal considerations.
CONCLUSION
The current practice of informed consent for thrombolysis in acute ischemic stroke varies among neurologists and neurology residents. If informed consent is obtained, most clinicians stated to obtain informed consent within one minute. In the future, a shortened information provision process may be applied, making a shift from informed consent to informed refusal, while still considering the patient's capacity, stroke severity, and possible treatment delays.
Identifiants
pubmed: 34433444
doi: 10.1186/s12910-021-00684-6
pii: 10.1186/s12910-021-00684-6
pmc: PMC8390276
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
114Informations de copyright
© 2021. The Author(s).
Références
Stroke. 2018 Mar;49(3):765-767
pubmed: 29440586
Fam Pract. 2009 Feb;26(1):65-8
pubmed: 19074758
Cerebrovasc Dis. 2008;25(5):457-507
pubmed: 18477843
Stroke. 2019 Jan;50(1):34-37
pubmed: 30566036
Emerg Med Clin North Am. 2006 Aug;24(3):605-18
pubmed: 16877132
Emerg Med J. 2013 Jun;30(6):467-71
pubmed: 22764171
Front Neurol. 2012 Aug 27;3:128
pubmed: 23015805
Cerebrovasc Dis. 2005;19(2):65-8
pubmed: 15644623
J Eval Clin Pract. 2013 Dec;19(6):1107-12
pubmed: 23781948
Stroke. 2019 Jun;50(6):1595-1597
pubmed: 31084320
J Stroke Cerebrovasc Dis. 2017 Jun;26(6):1274-1279
pubmed: 28189569
Can J Surg. 2017 Feb;60(1):69-70
pubmed: 28234594
N Engl J Med. 2007 Nov 1;357(18):1834-40
pubmed: 17978292
Neurology. 2007 Oct 9;69(15):1528-35
pubmed: 17923615
Eur Stroke J. 2021 Mar;6(1):I-LXII
pubmed: 33817340
N Engl J Med. 2019 May 9;380(19):1795-1803
pubmed: 31067369
Stroke. 2011 Jul;42(7):1952-5
pubmed: 21636813
N Engl J Med. 2018 Aug 16;379(7):611-622
pubmed: 29766770
JAMA. 2013 Nov 27;310(20):2191-4
pubmed: 24141714
Neurology. 2018 Dec 11;91(24):e2276-e2279
pubmed: 30530564
J Clin Ethics. 2019 Fall;30(4):338-346
pubmed: 31851625
Stroke. 2006 Jan;37(1):263-6
pubmed: 16339467
Ann Neurol. 2014 Aug;76(2):296-304
pubmed: 24980651
N Engl J Med. 1995 Dec 14;333(24):1581-7
pubmed: 7477192
Stroke Res Treat. 2013;2013:562564
pubmed: 24083048
Stroke. 2006 Jul;37(7):1917-22
pubmed: 16728683
Circ Cardiovasc Qual Outcomes. 2015 Oct;8(6 Suppl 3):S69-72
pubmed: 26515212
Cerebrovasc Dis. 2007;24(1):1-10
pubmed: 17519538
Stroke. 2018 Mar;49(3):e46-e110
pubmed: 29367334
Emerg Med J. 2015 May;32(5):357-63
pubmed: 24838424
Stroke. 2009 Jun;40(6):2079-84
pubmed: 19372447
Stroke. 2019 Dec;50(12):e344-e418
pubmed: 31662037
PLoS One. 2012;7(6):e37066
pubmed: 22675477