The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Sci Rep. 2022 Jun 20;12(1):10345. doi: 10.1038/s41598-022-14124-x.
Intravenous thrombolysis is the preferred treatment modality for acute ischemic stroke. In China, written informed consent from patients or proxies must be obtained before intravenous thrombolysis is performed, which always leads to in-hospital delay of thrombolysis. To explore the relationship between characteristics of thrombolysis decision-making and psychological states of proxies of AIS patients. This was a pilot study. 231 proxies of AIS patients were recruited, including 147 males and 84 females. STAI, WFPTS, CAOT, CPS, C-DCS and time-consuming of decision-making were collected by trained nurses during the period from signing informed consent to thrombolysis finished. The general information was collected within 24 h after admission. Pearson correlation analysis and the Ridge regression analysis were used to explore the correlation and causality between psychological indicators (STAI, WFPTS, CAOT, CPS) and decision-making characteristics (C-DCS, Time consuming). Structural equation modeling was used to explore the direct and indirect effect of psychological factors on decision-making characteristics. The mean of anxiety, trust in physicians, and decision conflict were 49.20 ± 9.50, 37.83 ± 6.63 and 30.60 ± 14.77, respectively. The CAOT was associated with C-DCS through the mediation of STAI and WFPTS (p < 0.001). The CAOT was associated with time-consuming through the mediation of STAI, WFPTS and CPS (p < 0.05). The CAOT, STAI and WFPTS were associated with C-DCS (p < 0.05), and STAI, WFPTS and CPS were associated with time-consuming (p < 0.01). The proxy of patients with acute ischemic stroke had severe decision conflict in thrombolysis decision-making. The psychological state was associated with decision conflict and the time-consuming. Medical staff should explore methods to release the anxiety and increase the trust in physicians to reduce the decision-making conflict and time-consuming, which could promote the smooth progress of the informed consent.
静脉溶栓是急性缺血性脑卒中的首选治疗方法。在中国，在进行静脉溶栓之前，必须获得患者或其代理人的书面知情同意书，这通常会导致院内溶栓延迟。本研究旨在探讨急性缺血性脑卒中患者代理人的溶栓决策特征与心理状态之间的关系。这是一项试点研究。共招募了 231 名急性缺血性脑卒中患者的代理人，其中男 147 例，女 84 例。在签署知情同意书至溶栓结束期间，由经过培训的护士收集 STAI、WFPTS、CAOT、CPS、C-DCS 和决策耗时。一般信息在入院后 24 小时内收集。采用 Pearson 相关分析和 Ridge 回归分析探讨心理指标（STAI、WFPTS、CAOT、CPS）与决策特征（C-DCS、耗时）之间的相关性和因果关系。采用结构方程模型探讨心理因素对决策特征的直接和间接影响。焦虑、对医生的信任和决策冲突的平均值分别为 49.20±9.50、37.83±6.63 和 30.60±14.77。CAOT 通过 STAI 和 WFPTS 的中介作用与 C-DCS 相关（p<0.001）。CAOT 通过 STAI、WFPTS 和 CPS 的中介作用与耗时相关（p<0.05）。CAOT、STAI 和 WFPTS 与 C-DCS 相关（p<0.05），STAI、WFPTS 和 CPS 与耗时相关（p<0.01）。急性缺血性脑卒中患者的代理人在溶栓决策中存在严重的决策冲突。心理状态与决策冲突和耗时有关。医务人员应探索减轻焦虑和增加对医生信任的方法，以减少决策冲突和耗时，这有助于知情同意的顺利进行。
