Assessing capacity and obtaining consent for thrombolysis for acute stroke

Akinsanya, Jonathan; Diggory, Paul; Heitz, Elizabeth; Jones, Valerie A.

doi:10.7861/clinmedicine.9-3-239

Cited by 15 publications

(15 citation statements)

References 2 publications

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“…Even very high-functioning patients can have difficulty understanding the risk–benefit analysis of thrombolysis in the physical, cognitive and psychological chaos that is acute stroke 5. In this setting, a patient’s autonomy can reasonably be questioned,5 particularly if it can be established that their decision is out of keeping with their usual beliefs 6. If a patient’s autonomy has come into question, then delaying treatment until a relative or carer can make a decision about care may feel appropriate.…”

Section: Ethical Considerationsmentioning

confidence: 99%

Treatment of the unknown patient: insights from acute stroke

et al. 2017

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When an unidentified patient who cannot communicate presents with symptoms and signs suggesting an acute stroke, the decision to thrombolyse is a particular challenge. In a time-pressured environment, clinicians need clear thought processes for diagnosis and treatment. Ethical considerations, diagnosis, identity and previous history, contraindications, time of symptom onset (EDICT) can help decision-making in this situation.

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Section: Ethical Considerationsmentioning

confidence: 99%

Treatment of the unknown patient: insights from acute stroke

et al. 2017

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“…During this period, stroke survivors must evaluate the trial and make decisions about risk‐benefit. This represents a delicate trade‐off and one that may be compromised during the acute recovery period.…”

Section: Discussionmentioning

confidence: 99%

Regenerative medicine: Stroke survivor and carer views and motivations towards a proposed stem cell clinical trial using placebo neurosurgery

Cunningham

Abhyankar

Galinsky

et al. 2017

Health Expectations

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BackgroundFew studies explore stroke survivor views and motivations towards stem cell therapy (SCT). This qualitative study explores the views and motivations of both stroke survivors and their partners/carers towards a proposed 2‐arm Phase III Randomised Controlled Trial (RCT) comparing intracerebral insertion of stem cells with placebo neurosurgery in stroke survivors with disability.ObjectiveTo explore views and motivations towards a proposed 2‐arm stem cell trial and identify factors that may impede and enhance participation.DesignThis study adopts a naturalistic design to explore the complexity of this field, employing a participatory action‐research approach comprising a specialized Conversation (World) Café form of focus group. Data were collected via 5 Conversation Cafés with stroke survivors (age 40‐75) and partners/carers between June and October 2016. Of 66 participants, 53 (31 male, 22 female) were stroke survivors and 13 (6 female, 7 male) were partners/carers. Qualitative data were analysed using a thematic approach.Discussion and ConclusionStroke survivor views and motivations reflect anticipation of the personal and future benefits of regenerative medicine. Partners/carers sought to balance the value of stroke survivor hope with carrying the weight of hope as carer, a conflict burden adding to known caregiver burden. All participants expressed the need for during and post‐trial psychological support. This study provides a rare opportunity to explore the prospective views and motivations of stroke survivors and their partners/carers towards a proposed Phase III 2‐arm RCT. This adds weight to qualitative evidence exploring capacity, consent, decision making, perceptions of treatment risk and supports required for clinical trial participation.

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“…The risk of haemorrhagic stroke is consistently around 2% among haemodynamically stable patients, according to the existing data 12. We know that this risk increases with age (>75 years), however, the risk of mortality from PE also increases with age and other comorbidities, such as cancer and neurological disease, causing immobility 15 Box 1. further elaborates on risk factors for mortality in VTE.…”

Section: Discussionmentioning

confidence: 99%

Controversy and consent: achieving patient autonomy in thrombolysis for acute submassive pulmonary embolism

2015

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Acute pulmonary embolism (PE) is associated with a wide variation in patient outcome ranging from completely asymptomatic to cardiac failure and death. This presents a challenge to clinicians in ensuring the correct treatment for individual patients is given and that adverse events secondary to treatment complications are minimised. The evidence for those with massive PEs and non-massive PEs is clear for and against the use of thrombolysis, respectively. However, in those with 'sub-massive' PE there is no clear consensus on whether there is a treatment benefit. We present the case of a patient who presented with a non-haemodynamically significant PE but with evidence of right ventricular dilatation, and discuss the difficulties in treatment decisions in such cases, including the ethical and legal principles of consent, and how clinicians might best allow their patients to make informed decisions when in clinical equipoise.

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Assessing capacity and obtaining consent for thrombolysis for acute stroke

Cited by 15 publications

References 2 publications

Treatment of the unknown patient: insights from acute stroke

Treatment of the unknown patient: insights from acute stroke

Regenerative medicine: Stroke survivor and carer views and motivations towards a proposed stem cell clinical trial using placebo neurosurgery

Controversy and consent: achieving patient autonomy in thrombolysis for acute submassive pulmonary embolism

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