None listed
Conditions
Brief summary
Background: Despite thrombolytic therapy using intravenous tissue Plasminogen Activator (tPA) being a recommended treatment for appropriately selected ischaemic stroke patients, use of this treatment remains low. tPA is only provided to 7% of ischemic stroke patients within Australia. A number of factors including, risk of haemorrhage, limited time-frame of 4.5 hours from stroke onset in which the treatment can be given, and difficulties obtaining informed consent, may be factors limiting the administration of this therapy. Patients with acute stroke are often mentally and physically unable to discuss treatment options, and the challenge of obtaining informed consent is only exacerbated in situations that require immediate action. In such situations alternative forms of consent must be sought and the treatment decision may become the responsibility of the patient’s next of kin. Little attention has been paid to the decision making process for patients and their families in such situations. Given the need for an immediate treatment decision to be made, clinicians need to convey the potential benefits and risks of tPA treatment in order for family members to provide informed consent. Employment of best practice communication guidelines may aid the decision making process for family members and help clinicians to clearly convey the recommended treatment for ischaemic stroke patients. Aims: The purpose of the study was to compare, using a randomised controlled crossover trial among hospital out-patients, the effect of an expert consensus communication strategy compared to a usual care communication strategy (shown via video) on 1) participant knowledge of stroke treatment; 2) treatment decisions for tPA treatment for a) patients and b) a family member; 3) the acceptability of the communication strategies; and 4) the preferred communication strategy.
Interventions
Participants watched a video simulation in which a neurologist informed an individual (actor) that their family member had experienced a stroke, and described tissue Plasminogen Activator (tPA) therapy as an option for treatment. The simulation lasted around 5 minutes, the approximate amount of time clinicians have available to convey stroke treatment information. The neurologist was provided with a hypothetical scenario which involved a stroke patient eligible for tPA. During the simulated cons
Participants watched a video simulation in which a neurologist informed an individual (actor) that their family member had experienced a stroke, and described tissue Plasminogen Activator (tPA) therapy as an option for treatment. The simulation lasted around 5 minutes, the approximate amount of time clinicians have available to convey stroke treatment information. The neurologist was provided with a hypothetical scenario which involved a stroke patient eligible for tPA. During the simulated consultation, the neurologist described the treatment options available to the patient using the essential communication strategies developed by an expert advisory group, which related to: 1) the environment in which the discussion takes place; 2) introduction and purpose of the discussion; 3) information provision; 4) risk communication; 5) addressing emotions and assessing understanding; 6) summarising the discussion. There was no wash-out period between the viewing expert consensus and usual care communication.
Sponsors
University of Newcastle
Study design
Allocation
Randomised controlled trial
Intervention model
Crossover
Primary purpose
Educational / counselling / training
Masking
Blinded (masking used) (Subject, Outcomes Assessor)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Patients attending the out-patient clinic for any type of condition, aged 18 years or older during the study period were eligible to participate.
Exclusion criteria
Patients with insufficient English as determined by a research assistant, or without an email address or internet access were excluded.
Outcome results
None listed