Department of Neurology, University of Michigan, Ann Arbor, MI 48109, USA.
BMC Emerg Med. 2013 Nov 13;13:18. doi: 10.1186/1471-227X-13-18.
Over one third of stroke patients have cognitive or language deficits such that they require surrogate consent for acute stroke treatment or enrollment into acute stroke trials. Little is known about the agreement of stroke patients and surrogates in this time-sensitive decision-making process. We sought to determine patient and surrogate agreement in 4 hypothetical acute stroke scenarios.
We performed face to face interviews with ED patients at an academic teaching hospital from June to August 2011. Patients and the surrogates they designated were asked to make decisions regarding 4 hypothetical stroke scenarios: 2 were treatment decisions; 2 involved enrollment into a clinical trial. Percent agreement was calculated as measures of surrogate predictive ability.
A total of 200 patient/surrogate pairs were interviewed. Overall patient/surrogate percent agreement was 76.5%. Agreement for clinical scenarios ranged from 87% to 96% but dropped to 49%-74% for research scenarios.
Surrogates accurately predict patient preferences for standard acute stroke treatments. However, the accuracy decreases when predicting research participation suggesting that the degree of surrogate agreement is dependent on the type of decision being made. Further research is needed to more thoroughly characterize surrogate decision-making in acute stroke situations.
超过三分之一的中风患者存在认知或语言障碍，因此他们需要代理人同意进行急性中风治疗或参加急性中风试验。对于在这个时间敏感的决策过程中中风患者和代理人的意见一致情况，我们知之甚少。我们试图确定 4 种假设的急性中风情况下患者和代理人的意见一致情况。
我们在 2011 年 6 月至 8 月期间在一家学术教学医院对 ED 患者进行了面对面访谈。要求患者及其指定的代理人就 4 种假设的中风情况做出决定：2 种是治疗决策；2 种涉及参加临床试验。百分比一致被用作代理人预测能力的衡量标准。
共访谈了 200 对患者/代理人。总体上，患者/代理人的百分比一致率为 76.5%。临床情况下的一致性范围为 87%至 96%，但研究情况下的一致性下降到 49%-74%。
代理人准确地预测了患者对标准急性中风治疗的偏好。然而，当预测研究参与度时，准确性会降低，这表明代理人的一致性程度取决于正在做出的决策类型。需要进一步研究以更全面地描述急性中风情况下的代理人决策。
