Gong Jingjing, Zhang Yan, Gao Hongyan, Wei Wei, Lv Jing, Liu Hongyun, Huang Yonghua
Department of Neurology, PLA Army General Hospital, Beijing, China.
Center of Psychology, Air Force Aviation Medicine Research Institute, Beijing, China.
Front Neurol. 2017 Nov 7;8:589. doi: 10.3389/fneur.2017.00589. eCollection 2017.
Although thrombolysis is the most effective medical treatment for acute ischemic stroke, many stroke patients eligible for thrombolysis miss this treatment as a result of delay or refusal by the patients and/or their proxies. To explore the influences of prognostic information for different intervals from stroke onset to the start of thrombolytic treatment (OTT) and other factors on the preferences of patients/proxies regarding thrombolytic therapy, a cross-sectional, discrete-choice experiment was performed between August 2013 and September 2014. A total of 613 Chinese inpatients or their immediate family members were consecutively recruited at the Department of Neurology. After random assignment to a negative-framing group or a positive-framing group, the subjects completed a series of surveys, including nine items about thrombolysis. Latent class analysis (LCA) was used to examine participants' preference paradigms for thrombolysis and to categorize the participants into different subgroups. Subsequently, regression analyses were conducted to explore predictors of categorization of the participants into each subgroup and to construct a thrombolytic decision-making model. LCA revealed an optimal 3-subgroup model including a consent to thrombolysis subgroup and objection to thrombolysis subgroups 1 and 2. Multiple regression analysis demonstrated that compared with assignment to the consent to thrombolysis subgroup, assignment to objection to thrombolysis subgroup 1 or 2 could be predicted by different factors. χ tests indicated effects of framing and other factors on participants' choices regarding thrombolysis. Choices regarding thrombolysis were modified by not only prognostic information for different OTT intervals but also message framing, presentation format, and sociodemographic characteristics. To facilitate consent to thrombolysis, physicians should convey prognostic information to patients/proxies on the basis of patient OTT interval and should order the presentation of therapies according to the classification of patients/proxies. Individualized decision-making (IDM) might be an optimal strategy to increase the selection of thrombolysis, which providing important reference points for IDM in other clinical domains.
尽管溶栓是急性缺血性卒中最有效的药物治疗方法，但许多符合溶栓条件的卒中患者由于患者和/或其代理人的延误或拒绝而错过这种治疗。为了探讨从卒中发作到开始溶栓治疗（OTT）的不同时间间隔的预后信息以及其他因素对患者/代理人关于溶栓治疗偏好的影响，于2013年8月至2014年9月进行了一项横断面离散选择实验。在神经内科连续招募了613名中国住院患者或其直系亲属。在随机分配到消极框架组或积极框架组后，受试者完成了一系列调查，包括9项关于溶栓的项目。采用潜在类别分析（LCA）来检查参与者对溶栓的偏好模式，并将参与者分为不同的亚组。随后，进行回归分析以探索参与者分类到每个亚组的预测因素，并构建溶栓决策模型。LCA揭示了一个最佳的3亚组模型，包括溶栓同意亚组以及溶栓反对亚组1和亚组2。多元回归分析表明，与分配到溶栓同意亚组相比，分配到溶栓反对亚组1或亚组2可由不同因素预测。χ检验表明框架和其他因素对参与者关于溶栓的选择有影响。关于溶栓的选择不仅受到不同OTT时间间隔的预后信息的影响，还受到信息框架、呈现形式和社会人口统计学特征的影响。为了促进溶栓同意，医生应根据患者的OTT时间间隔向患者/代理人传达预后信息，并应根据患者/代理人的分类安排治疗的呈现方式。个体化决策（IDM）可能是增加溶栓选择的最佳策略，这为其他临床领域的IDM提供了重要参考点。
