The outcome wheel: a potential tool for shared decision-making in ischemic stroke thrombolysis

A stroke can be a catastrophic experience. Patients are confronted with alarming symptoms and then a devastating diagnosis, after which they are expected to make an "informed decision" regarding intervention. Informed decision-making is a term that, unlike informed consent, implies that the decision is made by the physician, the patient and the family based on available evidence and information. The 3-hour treatment window for thrombolysis in ischemic stroke imparts very little time for a clinician to sit down with a patient and present information in an unbiased, useful manner. The purpose of this paper is to offer a tool that may assist the physician, the patient and the family in making an informed decision in a time-sensitive manner for thrombolytic intervention in stroke. This tool visually displays outcomes and the role of chance in an intuitive "spin the wheel" type fashion. Until at least May 2011, an interactive version of this clinical tool kit will be available for download at www.sem-bc.com/cvatoolkit.