Abstract TP305: Patient Expectations and Physician Preferences of Informed Consent for tPA

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Scott J Mendelson ◽  
Elisa Gordon ◽  
Christopher Richards ◽  
Jane Holl ◽  
Shyam Prabhakaran
Keyword(s):  
Decision Making ◽  
Informed Consent ◽  
Focus Groups ◽  
Shared Decision Making ◽  
Patient Expectations ◽  
Informed Consent Process ◽  
Shared Decision ◽  
Stroke Patients ◽  
Risks And Benefits ◽  
Decision Making Model

Objective: To assess the optimal content and contextual parameters, based on patient and physician input, of the informed consent process for tPA in acute ischemic stroke patients. Background: Consent-related delays may contribute to worse outcomes, as any delay in tPA eligible patients is associated with worse outcomes. Informed consent, an under-studied barrier to timely tPA delivery, potentially delays or results in a refusal of therapy in up to 20% of eligible patients. Methods: A mixed-methods qualitative study identified patient and caregiver information expectations and physician preferences in describing risks and benefits of tPA during acute stroke patient evaluations. Through interviews of stroke patients and caregivers who provided informed consent for tPA, and of neurologists and emergency medicine physicians, several themes were identified. These themes as well as strategies to standardize the informed consent process were further explored with mixed focus groups of stroke patients who received tPA, stroke patients who did not receive tPA, and caregivers. Results: Interviewed stroke patients or their surrogates (n=15) who provided informed consent preferred a shared decision-making model of informed consent while recognizing the time urgency of tPA therapy. Interviewed physicians (n=9) expressed a desire to include patients or their surrogates in decision-making and stressed the importance of describing tPA risks, such as intracerebral hemorrhage. Stroke patients and caregivers (n=22) participating in focus groups (n=4) expressed varying information expectations. The majority of focus group participants expressed minimal information needs and preferred a verbal description of risks and benefits as compared with detailed pictographs. A minority desired a greater amount of information regarding the risk, benefits, and indication for tPA when deciding upon treatment. Conclusions: Qualitative analyses of informed consent for tPA suggest that a standardized shared decision-making model which includes descriptions of risks could be developed to meet patient expectations and physician preferences. Optimizing the shared decision-making process for tPA could reduce consent-related delays and refusals of tPA.

Enhancing the Informed Consent Process Using Shared Decision Making and Consent Refusal Data from the CLEAR III Trial

2019 ◽  
Vol 32 (1) ◽  
pp. 340-347
Author(s):  
Amanda L. Porter ◽  
James Ebot ◽  
Karen Lane ◽  
Lesia H. Mooney ◽  
Amy M. Lannen ◽  
...  
Keyword(s):  
Decision Making ◽  
Informed Consent ◽  
Shared Decision Making ◽  
Informed Consent Process ◽  
Consent Process ◽  
Shared Decision

Abstract 276: A Qualitative Analysis of Shared Decision Making in Cardiac Surgery

2013 ◽  
Vol 6 (suppl_1) ◽  
Author(s):  
Ryan Gainer ◽  
Karen Buth ◽  
Jennie David ◽  
Rose Garson ◽  
Hani Mufti ◽  
...  
Keyword(s):  
Decision Making ◽  
Cardiac Surgery ◽  
Informed Consent ◽  
Focus Groups ◽  
Shared Decision Making ◽  
Institutional Care ◽  
Consent Process ◽  
Patient Specific ◽  
Shared Decision ◽  
Patient Groups

OBJECTIVES Comprehension of risks, benefits, and alternative treatment options is poor among patients referred for cardiac interventions. We have previously demonstrated that frail, elderly patients undergoing cardiac surgery require complex procedures and are at markedly increased risk of postoperative death and prolonged institutional care. An effective informed consent process is critical in this population. We suggest this vulnerable patient population may benefit from the institution of a formalized shared decision making (SDM) process. METHODS Three focus groups were convened for CABG, Valve, or CABG +Valve patients over 70 who were either within two years post-op, within 4-8 weeks post-op or had had a complicated post-operative course. Two focus groups were convened for the caretaker group: IMCU nurses & ICU nurses and surgeons, anesthesiologists & cardiac intensivists. In a semi-structured interview format, groups were asked questions regarding personal experience with informed consent, comprehension of discussions prior to surgery, potential improvements to the consent process, and SDM in cardiac surgery. Transcribed audio data was analyzed to develop consistent and comprehensive themes. RESULTS Patient groups were supportive of changing standard consent by including patient-specific risk factors through graphics, reduced language complexity and increased font size as means to improve comprehension and discussion. Patient groups felt access to this information earlier on in their care would allow time to identify personal values and desires for treatment. Both care provider groups supported a consent process that would provide patients with information earlier through decisional aids presented in a structured SDM process. All groups were supportive of a dedicated RN employed as a decisional coach to meet with patients and families prior to surgery to discuss their values, concerns, and questions to facilitate SDM with the care team. CONCLUSIONS Data from these groups will aid in the development of decision aids that serve to educate patients about their disease, the procedure proposed, and its risks and alternatives. Utilizing validated risk prediction models from our own experience allows us to provide patient specific risks for in-hospital mortality, major morbidity, and prolonged institutional care as well as long term outcomes freedom from mortality and re-hospitalization for cardiac cause.

Certified Patient Decision Aids: Solving Persistent Problems with Informed Consent Law

2017 ◽  
Vol 45 (1) ◽  
pp. 12-40 ◽  
Author(s):  
Thaddeus Mason Pope
Keyword(s):  
Decision Making ◽  
Informed Consent ◽  
Medical Treatment ◽  
Shared Decision Making ◽  
Decision Aids ◽  
Shared Decision ◽  
Legal Doctrine ◽  
Patient Decision Aids ◽  
Patient Decision ◽  
Decision Making Processes

The legal doctrine of informed consent has overwhelmingly failed to assure that the medical treatment patients get is the treatment patients want. This Article describes and defends an ongoing shift toward shared decision making processes incorporating the use of certified patient decision aids.

Das präoperative anästhesiologische Patientengespräch

2009 ◽  
Vol 66 (7) ◽  
pp. 503-508 ◽  
Author(s):  
Christoph Harms ◽  
Christoph H. Kindler
Keyword(s):  
Decision Making ◽  
Informed Consent ◽  
Shared Decision Making ◽  
Shared Decision

Anästhesisten treffen ihre Patienten häufig in Ausnahmesituationen an, geprägt von Angst und großer Unsicherheit. Selbst zeitlich kurze Kontakte sind daher meist intensiv und bedeutsam. Das persönliche, anästhesiologische Gespräch steht am Beginn der Beziehung von Patient und Anästhesist und soll die geplanten Maßnahmen, welche der Anästhesist durchführen wird, erklären und begleiten. Ein solches Gespräch dauert heute durchschnittlich 20 Minuten. Es beinhaltet die Erhebung der Anamnese, die strukturierte und verständliche Informationsübermittlung zwischen Anästhesist und Patient (inklusive Informationen über die anästhesiologischen Interventionen, Instruktionen zum Verhalten des Patienten und die offene und klare Kommunikation von Vor- und Nachteilen sowie Risiken möglicher Anästhesieverfahren) sowie den professionellen Umgang mit den Emotionen des Patienten, insbesondere seiner präoperativen Angst. Da Patienten heute in der Anästhesiologie vermehrt in den Entscheidungsprozess mit einbezogen werden, entwickelt sich dieses Gespräch zunehmend von einer eher paternalistischen Arzt-Patienten Interaktion zu einer gemeinsamen Entscheidungsfindung, dem so genannten „shared decision making“. Formal sollte das präoperative Gespräch die bekannten Voraussetzungen für eine erfolgreiche Verständigung zwischen Patient und Arzt wie Deutlichkeit, Eindeutigkeit, identische Kodierung, Empathie und Rückmeldung erfüllen und mit dem einholen eines „informed consent“ enden.

scholarly journals Refusal to Travel in the National Ambulance Service. A Patient Care Report examination.

2018 ◽  
Vol 3 (2) ◽  
Author(s):  
Eamonn Byrne ◽  
Sasha Selby ◽  
Paul Gallen ◽  
Alan Watts
Keyword(s):  
Decision Making ◽  
Patient Care ◽  
Shared Decision Making ◽  
Vital Signs ◽  
Ambulance Service ◽  
Guidance Document ◽  
Shared Decision ◽  
Clinical Guidance ◽  
Decision Making Model

<p><strong>Introduction</strong></p><p>Every patient has the right to refuse treatment and, or transport (RTT) to hospital (1). The National Ambulance Service (NAS) has operated under a clinical guidance document that requires an assessment of patient capacity and a baseline amount of data to be gathered on every patient to facilitate the patient making an informed decision (2,3). An increase in the rate of non-conveyance of patients and refusal to travel calls as well as an increasing number of complaints prompted a quality improvement initiative based on improving and facilitating a shared decision-making model.</p><p><strong>Aim</strong></p><p>For patients who RTT, to establish a baseline quality of information collected and recorded on a Patient Care Report.</p><p><strong>Methods</strong></p><p>All NAS incidents closed with a refusal of treatment or transport, from 1<sup>st</sup> Jan 2017 to 9<sup>th</sup> November 2017 were identified from National Emergency Operation Centre (NEOC). A random selection of 75 Patient care reports (52 Paper and 23 Electronic) were identified and reviewed. Compliance with the refusal to travel guidance document was measured.</p><p><strong>Results</strong></p><p>31% of paper PCR’s reviewed were missing a complete set of vital signs. An average of 48.4 % (Median 48.4% Range 36.5% to 61.5%) were missing a complete second set of vital signs. 17.3% of combined forms were missing the patient’s chief complaint and 38.7% had no practitioner clinical impression entered. 24% had no capacity assessment completed.</p><p><strong>Conclusion</strong></p><p>Clinical information recorded by NAS staff did not meet the clinical guidance document requirements. It is impossible to assess what information was given to a patient to facilitate a shared decision-making model. The quality of NAS documentation can be improved for patients who refuse to travel.</p>

scholarly journals Principles for screening: Too few concerns for informed consent and shared decision-making?

2018 ◽  
Vol 190 (37) ◽  
pp. E1115-E1115 ◽  
Author(s):  
Alain Braillon ◽  
Philippe Nicot ◽  
Cécile Bour
Keyword(s):  
Decision Making ◽  
Informed Consent ◽  
Shared Decision Making ◽  
Shared Decision
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