Hostname: page-component-78c5997874-4rdpn Total loading time: 0 Render date: 2024-11-07T13:30:42.527Z Has data issue: false hasContentIssue false
  • English
  • Français

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

Published online by Cambridge University Press:  21 May 2015

Valorie L. Cunningham
Valorie L. Cunningham*
Affiliation:
Cowichan District Hospital, Duncan, BC
*
Cowichan District Hospital, 3045 Gibbins Rd., Duncan BC V9L 1E5; [email protected]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

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.

Keywords

stroke thrombolysisinformed decisionshared decision-makingrisk/benefitdecision tool
Type
Education • Enseignment
Information
Canadian Journal of Emergency Medicine , Volume 10 , Issue 6 , November 2008 , pp. 545 - 551
Copyright
Copyright © Canadian Association of Emergency Physicians 2008

References

1.Hoffman, JR. Should physicians give tPA to patients with acute ischemic stroke? Against: and just what is the emperor of stroke wearing? West J Med 2000;173:149–50.CrossRefGoogle ScholarPubMed
2.Robinson, DJ. Should physicians give tPA to patients with acute ischemic stroke? For: thrombolytics in stroke: Whose risk is it anyway? West J Med 2000;173:148–9.CrossRefGoogle ScholarPubMed
3.Trotter, G. Why were the benefits of tPA exaggerated? West J Med 2002;176:194–7.CrossRefGoogle ScholarPubMed
4.Hoffman, JR. Tissue plasminogen activator (tPA) for acute is-chaemic stroke: why so much has been made of so little. Med J Aust 2003;179:333–4.CrossRefGoogle Scholar
5.Lelie, A. Decision-making in nephrology: Shared decision making? Patient Educ Couns 2000;39:81–9.Google Scholar
6.Say, RE, Thompson, R. The importance of patient preferences in treatment decisions — challenges for doctors. BMJ 2003;327:542–5.Google Scholar
7.Bogardus, ST Jr., Holmboe, E, Jekel, JF. Perils, pitfalls, and possibilities of talking about medical risk. JAMA 1999;281:1037–41.Google Scholar
8.National Institute of Neurological Disorders and Stroke (NINDS) Study Group. Tissue plasminogen activator for acute ischemic stroke. N Engl J Med 1995;333:1581–8.Google Scholar
9.Ingall, TJ, O’Fallon, WM, Asplund, K, et al.Findings from the reanalysis of the NINDS tissue plasminogen activator for acute ischemic stroke treatment trial. Stroke 2004;35:2418–24.Google Scholar
10.Brown, DL, Barsan, WG, Lisabeth, LD, et al.Survey of emergency physicians about recombinant tissue plasminogen activator for acute ischemic stroke. Ann Emerg Med 2005;46:56–60.CrossRefGoogle ScholarPubMed
11.Katzan, IL, Furlan, AJ, Lloyd, LE, et al.Use of tissue-type plasminogen activator for acute ischemic stroke. The Cleveland area experience. JAMA 2000;283:1151–8.CrossRefGoogle ScholarPubMed
12.Hill, MD, Buchan, AM; Canadian Alteplase for Stroke Effectiveness Study (CASES) Investigators. Thrombolysis for acute ischemic stroke: results of the Canadian Alteplase for Stroke Effectiveness Study. CMAJ 2005;172:1307–12.Google Scholar
13.Albers, GW, Bates, VE, Clark, WM, et al.Intravenous tissue-type plasminogen activator for treatment of acute stroke. The Standard Treatment with Alteplase to Reverse Stroke (STARS) Study. JAMA 2000;283:1145–50.CrossRefGoogle ScholarPubMed
14.Norris, JW, Buchan, A, Cote, R, et al.Canadian guidelines for intravenous thrombolytic treatment in acute stroke. A consensus statement of the Canadian Stroke Consortium. Can J Neurol Sci 1998;25:257–9.CrossRefGoogle ScholarPubMed
15.Kent, DM, Selker, HP, Ruthazer, R, et al.The stroke-thrombolytic predictive instrument: a predictive instrument for intravenous thrombolysis in acute ischemic stroke. Stroke 2006;32:2957–62.Google Scholar
16.Edwards, A, Elwyn, G, Mulley, A. Explaining risks: turning numerical data into meaningful pictures. BMJ 2002;324:827–30.CrossRefGoogle ScholarPubMed
17.Chua, HF, Yates, F, Shah, P. Risk avoidance: graphs versus numbers. Mem Cognit 2006;34:399–410.Google Scholar
18.Hoffman, JR, Wilkes, MS, Day, FC, et al.The roulette wheel: an aid in informed decision making. PLoS Med 2006;3:e137.CrossRefGoogle ScholarPubMed