Hermann Neugebauer1,2, Matthias Schnabl3, Dorothée Lulé4, Peter U Heuschmann5,6, Eric Jüttler4,7. 1. Department of Neurology, University of Ulm, Ulm, Germany. Hermann.Neugebauer@uni-ulm.de. 2. RKU - University and Rehabilitation Hospitals Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany. Hermann.Neugebauer@uni-ulm.de. 3. Department of Trauma Surgery and Orthopedics, Community Hospital Kliniken Nordoberpfalz AG Klinikum Weiden, Weiden in der Oberpfalz, Germany. 4. Department of Neurology, University of Ulm, Ulm, Germany. 5. Institute for Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany. 6. Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany. 7. Department of Neurology, Ostalb-Klinikum Aalen, Aalen, Germany.
Abstract
BACKGROUND: Attitudes among patients and relatives toward the degree of acceptable disability and the importance of aphasia are critical in deciding on decompressive hemicraniectomy (DHC) in malignant middle cerebral artery infarction (MMI). However, most MMI patients are not able to communicate their will. Furthermore, attitudes of healthy individuals and relatives may not correspond to those of stroke patients. METHODS: This is a multicenter survey among 355 patients and 199 relatives during treatment for acute minor or moderate severe ischemic stroke in Germany. Questions address the acceptance of disability, importance of aphasia, and the preferred treatment in the hypothetical case of future MMI. RESULTS: mRS scores of 2 or better were considered acceptable by the majority of all respondents (72.9-88.1%). A mRS of 3, 4, and 5 was considered acceptable by 56.0, 24.5, and 6.8%, respectively. Except for a mRS of 1, relatives indicated each grade of disability significantly more often acceptable than patients. Differences regarding acceptable disability and treatment decision were depending on family status, housing situation, need of care, and disability. The presence of aphasia was considered important for treatment decision by both patients (46.5%) and relatives (39.2%). Older respondents more often refrained from DHC (p < 0.001). CONCLUSION: In Germany, there is substantial heterogeneity in patients and relatives regarding acceptable disability, aphasia, and treatment decision in the hypothetical case of MMI. Relatives significantly overestimate the degree of disability that is acceptable to stroke patients. Further studies are warranted to determine whether differences in attitudes impact on the decision to undergo DHC.
BACKGROUND: Attitudes among patients and relatives toward the degree of acceptable disability and the importance of aphasia are critical in deciding on decompressive hemicraniectomy (DHC) in malignant middle cerebral artery infarction (MMI). However, most MMI patients are not able to communicate their will. Furthermore, attitudes of healthy individuals and relatives may not correspond to those of strokepatients. METHODS: This is a multicenter survey among 355 patients and 199 relatives during treatment for acute minor or moderate severe ischemic stroke in Germany. Questions address the acceptance of disability, importance of aphasia, and the preferred treatment in the hypothetical case of future MMI. RESULTS: mRS scores of 2 or better were considered acceptable by the majority of all respondents (72.9-88.1%). A mRS of 3, 4, and 5 was considered acceptable by 56.0, 24.5, and 6.8%, respectively. Except for a mRS of 1, relatives indicated each grade of disability significantly more often acceptable than patients. Differences regarding acceptable disability and treatment decision were depending on family status, housing situation, need of care, and disability. The presence of aphasia was considered important for treatment decision by both patients (46.5%) and relatives (39.2%). Older respondents more often refrained from DHC (p < 0.001). CONCLUSION: In Germany, there is substantial heterogeneity in patients and relatives regarding acceptable disability, aphasia, and treatment decision in the hypothetical case of MMI. Relatives significantly overestimate the degree of disability that is acceptable to strokepatients. Further studies are warranted to determine whether differences in attitudes impact on the decision to undergo DHC.
Authors: Eric Jüttler; Stefan Schwab; Peter Schmiedek; Andreas Unterberg; Michael Hennerici; Johannes Woitzik; Steffen Witte; Ekkehart Jenetzky; Werner Hacke Journal: Stroke Date: 2007-08-09 Impact factor: 7.914
Authors: Nils Hecht; Hermann Neugebauer; Ingo Fiss; Alexandra Pinczolits; Peter Vajkoczy; Eric Jüttler; Johannes Woitzik Journal: J Cereb Blood Flow Metab Date: 2017-06-30 Impact factor: 6.200
Authors: Kelly L Sloane; Julie J Miller; Amanda Piquet; Brian L Edlow; Eric S Rosenthal; Aneesh B Singhal Journal: J Stroke Cerebrovasc Dis Date: 2022-01-07 Impact factor: 2.136