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

IF 2 4区医学 Q2 NURSING

International Journal of Nursing Practice Pub Date : 2025-09-07 DOI:10.1111/ijn.70054

Yuanli Guo, Xinyu Cao, Wenfeng Fan, Xiaofang Dong, Caixia Yang, Min Wang, Huanhuan Gao, Peihua Lv, Keke Ma

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引用次数: 0

Abstract

Background

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.

Method

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.

Results

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.

Conclusion

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.

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急性缺血性脑卒中患者溶栓决策过程中的代理决策冲突

背景：尽管溶栓治疗对急性缺血性卒中有效，但由于无法获得患者的知情同意，溶栓治疗经常被推迟。决策冲突可能是造成这种延迟的重要原因；然而，其影响因素尚不清楚。本研究旨在调查急性缺血性脑卒中患者的代理决策冲突，并探讨其影响因素。方法对急性缺血性脑卒中接受静脉溶栓治疗的患者进行相关性研究。问卷包括患者和代理人的一般信息问题、疾病和发病情况、焦虑水平、社会支持、医生信任水平、控制偏好和代理人的决策冲突水平等问题。采用SPSS 22.0进行Spearman’s、Pearson相关分析和ridge回归分析，探讨影响因素。本研究采用STROBE检查表。结果共有343名患者及其代理人参与了本研究，其中55.98%的患者在进行溶栓决策过程中出现了决策冲突。当代理人为女性、较年轻、受教育程度较低、该治疗的支付者且报告负担较重、社会支持高、焦虑严重、对医生信任度低，以及当患者年龄较大、经济负担较低（即患者的经济资源基本能满足日常需求，负担最小）时，代理人的决策冲突较高。当患者不参与决策过程、决策者人数较少、患者脑卒中严重程度较高时，代理人的决策冲突也较高。结论在急性缺血性脑卒中患者的溶栓决策过程中，许多决策者存在决策冲突。护士在决策过程中应考虑其心理特点，并根据其特点运用有效的沟通技巧和决策辅助工具。

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来源期刊

International Journal of Nursing Practice NURSING-

CiteScore

4.10

自引率

0.00%

发文量

审稿时长

3 months

期刊介绍： International Journal of Nursing Practice is a fully refereed journal that publishes original scholarly work that advances the international understanding and development of nursing, both as a profession and as an academic discipline. The Journal focuses on research papers and professional discussion papers that have a sound scientific, theoretical or philosophical base. Preference is given to high-quality papers written in a way that renders them accessible to a wide audience without compromising quality. The primary criteria for acceptance are excellence, relevance and clarity. All articles are peer-reviewed by at least two researchers expert in the field of the submitted paper.