Scott J Mendelson1, D Mark Courtney2, Elisa J Gordon2, Leena F Thomas2, Jane L Holl2, Shyam Prabhakaran2. 1. From the Department of Neurology (S.J.M., S.P.); Center for Healthcare Studies (S.J.M., E.J.G., L.F.T., J.L.H., S.P.); Feinberg School of Medicine (S.J.M., D.M.C., J.L.H., S.P.); and Department of Emergency Medicine (D.M.C.); Department of Surgery (E.J.G.); Department of Pediatrics (J.L.H.), Northwestern University, Chicago, IL (S.J.M., L.F.T., S.P.). scott.mendelson@northwestern.edu. 2. From the Department of Neurology (S.J.M., S.P.); Center for Healthcare Studies (S.J.M., E.J.G., L.F.T., J.L.H., S.P.); Feinberg School of Medicine (S.J.M., D.M.C., J.L.H., S.P.); and Department of Emergency Medicine (D.M.C.); Department of Surgery (E.J.G.); Department of Pediatrics (J.L.H.), Northwestern University, Chicago, IL (S.J.M., L.F.T., S.P.).
Abstract
BACKGROUND AND PURPOSE: No standard approach to obtaining informed consent for stroke thrombolysis with tPA (tissue-type plasminogen activator) currently exists. We aimed to assess current nationwide practice patterns of obtaining informed consent for tPA. METHODS: An online survey was developed and distributed by e-mail to clinicians involved in acute stroke care. Multivariable logistic regression analyses were performed to determine independent factors contributing to always obtaining informed consent for tPA. RESULTS: Among 268 respondents, 36.7% reported always obtaining informed consent and 51.8% reported the informed consent process caused treatment delays. Being an emergency medicine physician (odds ratio, 5.8; 95% confidence interval, 2.9-11.5) and practicing at a nonacademic medical center (odds ratio, 2.1; 95% confidence interval, 1.0-4.3) were independently associated with always requiring informed consent. The most commonly cited cause of delay was waiting for a patient's family to reach consensus about treatment. CONCLUSIONS: Most clinicians always or often require informed consent for stroke thrombolysis. Future research should focus on standardizing content and delivery of tPA information to reduce delays.
BACKGROUND AND PURPOSE: No standard approach to obtaining informed consent for stroke thrombolysis with tPA (tissue-type plasminogen activator) currently exists. We aimed to assess current nationwide practice patterns of obtaining informed consent for tPA. METHODS: An online survey was developed and distributed by e-mail to clinicians involved in acute stroke care. Multivariable logistic regression analyses were performed to determine independent factors contributing to always obtaining informed consent for tPA. RESULTS: Among 268 respondents, 36.7% reported always obtaining informed consent and 51.8% reported the informed consent process caused treatment delays. Being an emergency medicine physician (odds ratio, 5.8; 95% confidence interval, 2.9-11.5) and practicing at a nonacademic medical center (odds ratio, 2.1; 95% confidence interval, 1.0-4.3) were independently associated with always requiring informed consent. The most commonly cited cause of delay was waiting for a patient's family to reach consensus about treatment. CONCLUSIONS: Most clinicians always or often require informed consent for stroke thrombolysis. Future research should focus on standardizing content and delivery of tPA information to reduce delays.
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