Informed Consent in the Stroke Care Continuum

Acute stroke management has become increasingly complex, incorporating medical, endovascular, and open surgical treatments that are potentially implemented across multiple hospitals for the same patient. Hospitals work in ever-expanding networks to provide cost-effective stroke care, balancing capital and labor costs, expertise, and catchment reach. As these systems and care pathways become more complex and attention is placed on the need to protect privacy, the importance of engaging patients and the community in medical decisions that carry forward from one institute to the next has likewise increased. As each node in the care pathway requires a varying degree of patient input and fulfillment of legal requirements, clinicians would benefit from a fundamental understanding of informed consent and contemporary shared decision-making. While consent is commonly obtained, clinicians may not be aware of how different levels of consent are appropriate depending on the circumstances. In this essay, we explore the origins of informed consent and its relation to contemporary shared decision-making. We will then review the acute stroke care continuum, and argue when simple consent, informed consent, and shared medical decision-making ought to be used to ensure that care is delivered in a matter consistent with ethical practice. This framework is one particular approach to decision-making and consent that we believe is supported by the arguments in this essay. Unless otherwise stated, the medical practice regarding consent discussed herein is applicable to the United States and may vary in other jurisdictions. Furthermore, consent for research is performed under a different paradigm and will not be explored herein.