Prognosis, uncertainty and decision-making in acute ischemic stroke, a qualitative study
Détails
Sous embargo indéterminé.
Accès restreint UNIL
Etat: Public
Version: Après imprimatur
Licence: Non spécifiée
Accès restreint UNIL
Etat: Public
Version: Après imprimatur
Licence: Non spécifiée
ID Serval
serval:BIB_FF22B41096A7
Type
Mémoire
Sous-type
(Mémoire de) maîtrise (master)
Collection
Publications
Institution
Titre
Prognosis, uncertainty and decision-making in acute ischemic stroke, a qualitative study
Directeur⸱rice⸱s
JOX R.
Détails de l'institution
Université de Lausanne, Faculté de biologie et médecine
Statut éditorial
Acceptée
Date de publication
2021
Langue
anglais
Nombre de pages
31
Résumé
Introduction: Ischemic stroke is a leading cause of disability and mortality worldwide. As acute stroke patients often lose decisional capacity, the acute situation is fraught with complicated and sometimes conflictive decision making between the patients’ relatives and clinicians. We aimed to explore the medico-ethical challenges with regard to three essential elements of acute stroke care: prognosis, decision- making and management of uncertainty.
Methods: Four focus groups were conducted; two in a university hospital and two in a regional hospital. Twenty-one physicians (13 residents and fellows and 8 attending physicians), working in neurology and neuro-rehabilitation, participated. The discussions were audio- recorded and transcribed verbatim. Transcripts were analysed thematically according to Braun and Clarke’s (2006) reflexive thematic analysis guidelines. Two of the four transcripts were double-coded to establish consistency in the coding framework.
Results: We identified multiple reasons for prognostic uncertainty, arising from limitations in the available information and processes. While multiple tools for improving prognostication seem available, these were not commonly used in clinical practice. In decision making, physicians make use of prudential judgement and affective forecasting. In both prognostication and decision making, time plays a crucial role. We found evidence for a major role of cognitive biases, along with strategies for dealing with this uncertainty, communicating with families and in promoting shared decision making.
Conclusion: The results highlight opportunities to improve stroke care through use of prognostic tools and the need to develop communication strategies for discussing uncertainly, goal-concordant care and promoting shared decision making with patients and families.
Methods: Four focus groups were conducted; two in a university hospital and two in a regional hospital. Twenty-one physicians (13 residents and fellows and 8 attending physicians), working in neurology and neuro-rehabilitation, participated. The discussions were audio- recorded and transcribed verbatim. Transcripts were analysed thematically according to Braun and Clarke’s (2006) reflexive thematic analysis guidelines. Two of the four transcripts were double-coded to establish consistency in the coding framework.
Results: We identified multiple reasons for prognostic uncertainty, arising from limitations in the available information and processes. While multiple tools for improving prognostication seem available, these were not commonly used in clinical practice. In decision making, physicians make use of prudential judgement and affective forecasting. In both prognostication and decision making, time plays a crucial role. We found evidence for a major role of cognitive biases, along with strategies for dealing with this uncertainty, communicating with families and in promoting shared decision making.
Conclusion: The results highlight opportunities to improve stroke care through use of prognostic tools and the need to develop communication strategies for discussing uncertainly, goal-concordant care and promoting shared decision making with patients and families.
Mots-clé
Ischemic stroke, Prognosis, Uncertainty, Decision-making, Cognitive biases
Création de la notice
07/09/2022 14:47
Dernière modification de la notice
27/09/2023 5:59