Decision-making psychological state and characteristic of proxies of thrombolytic patients: a pilot study

Abstract

Intravenous thrombolysis is the preferred treatment modality for acute ischemic stroke. In China, written informed consent from patients or proxies must be obtained before intravenous thrombolysis is performed, which always leads to in-hospital delay of thrombolysis. To explore the relationship between characteristics of thrombolysis decision-making and psychological states of proxies of AIS patients. This was a pilot study. 231 proxies of AIS patients were recruited, including 147 males and 84 females. STAI, WFPTS, CAOT, CPS, C-DCS and time-consuming of decision-making were collected by trained nurses during the period from signing informed consent to thrombolysis finished. The general information was collected within 24 h after admission. Pearson correlation analysis and the Ridge regression analysis were used to explore the correlation and causality between psychological indicators (STAI, WFPTS, CAOT, CPS) and decision-making characteristics (C-DCS, Time consuming). Structural equation modeling was used to explore the direct and indirect effect of psychological factors on decision-making characteristics. The mean of anxiety, trust in physicians, and decision conflict were 49.20 ± 9.50, 37.83 ± 6.63 and 30.60 ± 14.77, respectively. The CAOT was associated with C-DCS through the mediation of STAI and WFPTS (p < 0.001). The CAOT was associated with time-consuming through the mediation of STAI, WFPTS and CPS (p < 0.05). The CAOT, STAI and WFPTS were associated with C-DCS (p < 0.05), and STAI, WFPTS and CPS were associated with time-consuming (p < 0.01). The proxy of patients with acute ischemic stroke had severe decision conflict in thrombolysis decision-making. The psychological state was associated with decision conflict and the time-consuming. Medical staff should explore methods to release the anxiety and increase the trust in physicians to reduce the decision-making conflict and time-consuming, which could promote the smooth progress of the informed consent.

Characteristic Clustering of Thrombolytic Agent Decision-making in Acute Ischemic Stroke and Analysis of Influencing Factors

“…As a result, before the administration of thrombolysis, the patient's family must sign informed consent. However, this requirement is not explicitly stated [9] .…”

“…Analyzing the causes, this may be related to the personality tendencies of different genders. Women are delicate, sensitive, often pessimistic about uncertain events, and tend to be more risk-averse in their decision-making [9,33] . When their physician informs that thrombolysis presents a risk of bleeding, female decision-makers may be hesitant to make decisions for concern that their decision will lead to adverse consequences, which may ultimately result in delayed decision-making.…”

“…However, due to the uncertainty of the bene ts and risks of thrombolysis, it is di cult for proxy decisionmakers to sign informed consent within a short time, resulting in delayed thrombolysis [6] . Our previous studies found that most thrombolysis proxy decision-makers suffered from decision-making dilemmas, which correlated with their multiple psychosocial factors [9,12,13] . Meanwhile, shared decision-making is important to address the thrombolysis decision dilemma.…”