Decisional Conflict of Proxies in the Thrombolysis Decision-Making Process for Acute Ischaemic Stroke Patients

Despite being efficacious for acute ischemic stroke, treatment with thrombolysis is often delayed because of the inaccessibility of informed consent from patient proxies. Decisional conflict could be an important contributor to this delay; however, its influencing factors remain unknown. This study sought to survey the decisional conflict of proxies for sufferers of acute ischaemic stroke and explore the influencing factors.

This was a correlational study including proxies of patients with acute ischaemic stroke receiving intravenous thrombolysis. The questionnaire comprised general information questions about the patients and proxies, and questions about illness and onset, anxiety levels, social support, trust level in physicians, control preference and the decisional conflict level of proxies. To explore the influencing factors, Spearman's and Pearson correlation analyses as well as ridge regression were conducted using SPSS 22.0. The STROBE checklist was used in this study.

In total, 343 patients and their proxies participated in this research, 55.98% of whom experienced decisional conflict in the course of making thrombolysis decisions. When the proxies were female, younger, less educated, the payer of this treatment and reported heavier burden, high social support, severe anxiety and low trust in physicians, and when the patients were older, with low financial burden (i.e., where patients' financial resources generally covered their daily needs, creating minimal burden), the proxies had higher decisional conflict. When the patients did not participate in the decision-making process, when the number of decision-makers was lower and the patients had higher stroke severity, the proxies also had higher decisional conflict.

Many decision makers for acute ischaemic stroke patients experience decisional conflict during thrombolysis decision-making. Nurses should consider their psychological traits and use effective communication skills and decision-making aids according to their characteristics in the decision making process.