对急性中风治疗的知情同意实践:原则,挑战和新兴机会
Amir Mbonde1,2, Michael J Young3, Adam A Dmytriw3,3
1Harvard Medical School, Boston, MA, USA. Mbonde.amir@mayo.edu.
Journal of neurology
|October 10, 2023
概括
对急性中风治疗的知情同意,如静脉输血栓溶解 (IVT) 和内血管血栓切除术 (EVT),显示出显著的差异和知识差距. 标准化实践和改善患者信息对于提高护理和患者自主性至关重要.
科学领域:
- 神经学 神经学
- 医学伦理 医学伦理
- 医疗保健服务研究 医疗服务研究
背景情况:
- 在急性中风治疗中,知情同意 (IC) 是至关重要的,但目前对静脉血栓溶解 (IVT) 和内血管血栓切除 (EVT) 的做法尚不清楚.
- 在IVT的IC程序中存在显著的变化,受患者能力,治疗紧迫性和机构因素的影响.
研究的目的:
- 审查目前在IVT和EVT急性缺血性中风管理中的知情同意实践.
- 确定需要改进的领域和策略,以加强急性中风治疗中的IC过程.
主要方法:
- 关于IVT和EVT在急性缺血性中风中的知情同意实践现有数据的叙述性综述.
- 分析影响IC的因素,包括患者容量,治疗方案和医生特征.
主要成果:
- 对IVT的IC实践差异很大 (21-37%总是需要同意),对于时间敏感的治疗 (3-4.5小时窗口) 有更严格的要求.
- 在关于中风诊断,IVT机制,益处和风险的信息披露中发现的差异.
- 关于EVT的IC实践的研究显著缺乏,这突出了关键的证据缺口.
结论:
- 对于IVT和EVT,IC存在大量的变化和知识差距.
- 挑战包括评估患者的能力和缺乏标准化指导.
- 未来的努力应集中在简化信息,开发能力评估工具,标准化伦理框架和协调IC标准,以提高患者自主性和及时治疗.
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