Abstract
Objective: The objective of this national survey of clinicians providing acute stroke care was to examine current practice patterns regarding the informed consent process for tPA as well as ERT. Background: Improvement in the consent process for stroke interventions has been a suggested target to further reduce delays in timely reperfusion. Currently there is no standard means of obtaining informed consent for acute stroke interventions. Methods: A survey instrument was distributed nationally to 809 neurologists, emergency medicine physicians, interventionists, internal medicine physicians, and nursing staff via email. Analysis was then performed using descriptive statistics, Chi-square test for categorical comparisons, and multivariable logistic regression analyses to determine independent factors contributing to consent practices. Free-text entries were separately analyzed for thematic content. Results: The survey response rate was 33% (268/809). Respondents were in practice an average of 13.1 (+/- 9.5) years. Only 21% of respondents reported never requiring informed consent for tPA given within the 3-hour time window, whereas 37% always require informed consent. In multivariable models, practicing emergency medicine (OR 5.8, 95% CI [2.9-11.5]) and working at a non-academic medical center (OR 2.1, 95% CI [1.0-4.3]) were associated with always requiring informed consent. Over half of respondents (52%) reported experiencing delays because of informed consent for tPA. Waiting for a patient’s family to reach consensus about treatment was the most often reported delay. Almost all providers (90.5%) identified the risk of intracranial hemorrhage as necessary content to disclose, and the majority (87.4%) reported a verbal description of risk and benefits as the preferred means of delivering information. Most respondents (56%) always obtain informed consent for ERT and most (59%) did not experience delays because of informed consent. Conclusions: Most respondents to a national survey typically obtain informed consent for acute stroke therapies and most have encountered delays in administering tPA because of the informed consent process. Decreasing the time to obtain informed consent may be a future target to improve stroke outcomes.
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