中风溶栓知情同意书获取的全国实践模式。
National Practice Patterns of Obtaining Informed Consent for Stroke Thrombolysis.
作者信息
Mendelson Scott J, Courtney D Mark, Gordon Elisa J, Thomas Leena F, Holl Jane L, Prabhakaran Shyam
机构信息
From the Department of Neurology (S.J.M., S.P.); Center for Healthcare Studies (S.J.M., E.J.G., L.F.T., J.L.H., S.P.); Feinberg School of Medicine (S.J.M., D.M.C., J.L.H., S.P.); and Department of Emergency Medicine (D.M.C.); Department of Surgery (E.J.G.); Department of Pediatrics (J.L.H.), Northwestern University, Chicago, IL (S.J.M., L.F.T., S.P.).
出版信息
Stroke. 2018 Mar;49(3):765-767. doi: 10.1161/STROKEAHA.117.020474. Epub 2018 Feb 12.
BACKGROUND AND PURPOSE
No standard approach to obtaining informed consent for stroke thrombolysis with tPA (tissue-type plasminogen activator) currently exists. We aimed to assess current nationwide practice patterns of obtaining informed consent for tPA.
METHODS
An online survey was developed and distributed by e-mail to clinicians involved in acute stroke care. Multivariable logistic regression analyses were performed to determine independent factors contributing to always obtaining informed consent for tPA.
RESULTS
Among 268 respondents, 36.7% reported always obtaining informed consent and 51.8% reported the informed consent process caused treatment delays. Being an emergency medicine physician (odds ratio, 5.8; 95% confidence interval, 2.9-11.5) and practicing at a nonacademic medical center (odds ratio, 2.1; 95% confidence interval, 1.0-4.3) were independently associated with always requiring informed consent. The most commonly cited cause of delay was waiting for a patient's family to reach consensus about treatment.
CONCLUSIONS
Most clinicians always or often require informed consent for stroke thrombolysis. Future research should focus on standardizing content and delivery of tPA information to reduce delays.
背景与目的
目前尚无针对使用组织型纤溶酶原激活剂（tPA）进行中风溶栓获取知情同意的标准方法。我们旨在评估目前全国范围内获取tPA知情同意的实践模式。
方法
设计了一项在线调查，并通过电子邮件分发给参与急性中风护理的临床医生。进行多变量逻辑回归分析，以确定始终获取tPA知情同意的独立因素。
结果
在268名受访者中，36.7%报告始终获取知情同意，51.8%报告知情同意过程导致治疗延迟。作为一名急诊医学医生（比值比，5.8；95%置信区间，2.9 - 11.5）以及在非学术性医疗中心执业（比值比，2.1；95%置信区间，1.0 - 4.3）与始终需要知情同意独立相关。最常被提及的延迟原因是等待患者家属就治疗达成共识。
结论
大多数临床医生在中风溶栓时总是或经常需要获取知情同意。未来的研究应专注于规范tPA信息的内容和传达方式以减少延迟。
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