Informed consent practices for acute stroke therapy: principles, challenges and emerging opportunities

Area of Science:

• Neurology
• Medical Ethics
• Health Services Research

Background:

• Informed consent (IC) is vital in acute stroke care, yet current practices for intravenous thrombolysis (IVT) and endovascular thrombectomy (EVT) are not well understood.
• Significant variability exists in IC procedures for IVT, influenced by patient capacity, treatment urgency, and institutional factors.

Purpose of the Study:

• To review current informed consent practices in acute ischemic stroke management for IVT and EVT.
• To identify areas for improvement and strategies to enhance the IC process in acute stroke treatment.

Main Methods:

• A narrative review of existing data on informed consent practices for IVT and EVT in acute ischemic stroke.
• Analysis of factors influencing IC, including patient capacity, treatment protocols, and physician characteristics.

Main Results:

• IC practices for IVT vary widely (21-37% always require consent), with stricter requirements for time-sensitive treatments (3-4.5h window).
• Discrepancies noted in information disclosure regarding stroke diagnosis, IVT mechanism, benefits, and risks.
• A significant lack of research on IC practices for EVT highlights a critical evidence gap.

Conclusions:

• Substantial variability and knowledge gaps exist in IC for both IVT and EVT.
• Challenges include assessing patient capacity and the absence of standardized guidance.
• Future efforts should focus on simplifying information, developing capacity assessment tools, standardizing ethical frameworks, and harmonizing IC standards to improve patient autonomy and timely treatment.