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Patient factors that influence variation in clinical decision-making about thrombolysis in the treatment of acute ischaemic stroke: Results of a discrete choice experiment

Lookup NU author(s): Dr Aoife De Brun, Dr Darren Flynn, Dr Laura Ternent, Dr Christopher Price, Professor Helen Rodgers, Professor Gary Ford, Dr Matt Rudd, Dr Richard Thomson

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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0).


Abstract

Introduction: Intravenous thrombolysis treatment rates for acute ischaemic stroke vary across the UK, despite implementation of 24/7 hyper-acute stroke services. This may reflect differences in clinical decision-making on when to offer thrombolysis. We explored factors influencing clinical decision-making in this setting.Method: A discrete choice experiment (DCE) using hypothetical patient vignettes, with variation in 9 patient factors, was conducted with clinicians involved in thrombolysis decisions.Results: 138 clinicians responded. 7 patient factors were individually predictive of increased likelihood of offering thrombolysis (compared to reference levels in brackets): stroke onset time 2hours 30minutes (50mins), pre-stroke dependency mRS3 (mRS4), systolic blood pressure 185 mm/Hg (140 mm/Hg), stroke severity scores of NIHSS 5 without aphasia, NIHSS 14 and NIHSS 23 (NIHSS 2 without aphasia), age 85 (65), Afro-Caribbean (white). Factors predictive of not offering thrombolysis were; age 95, stroke onset time 4hours 15minutes, severe dementia (no memory problems), SBP 200 mm/Hg.Discussion: There was considerable heterogeneity amongst respondents in thrombolysis decision-making, indicating that clinicians differ in their thresholds for treatment across a number of patient-related factors. Clinicians may delay decisions for patients presenting early (<60mins), perhaps indicating this is an unfamiliar presentation or that they may wait to see if symptoms resolve or blood pressure stabilises before decision-making. That respondents were less likely to offer thrombolysis to patients with mild stroke may reflect uncertainty/lack of data around treatment benefit. These findings add to our understanding of decision-making and our capacity to improve it further through using the findings to inform training/CPD and future research.


Publication metadata

Author(s): De BrĂșn A, Flynn D, Ternent L, Price CI, Rodgers H, Ford G, Rudd M, Lancsar E, Simpson S, Teah J, Thomson R

Publication type: Conference Proceedings (inc. Abstract)

Publication status: Published

Conference Name: UK Stroke Forum 2015 Conference

Year of Conference: 2015

Pages: 50-51

Print publication date: 23/10/2015

Online publication date: 23/10/2015

Acceptance date: 01/01/1900

Date deposited: 07/08/2017

Publisher: John Wiley & Sons, Inc.

URL: http://dx.doi.org/10.1111/ijs.12634_19

DOI: 10.1111/ijs.12634_19

Series Title: International Journal of Stroke


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