Abstract

People who are well may regard survival with disability as being worse than death. However, this is often not the case when those surviving with disability (e.g. stroke survivors) are asked the same question. Many routine treatments provided after an acute stroke (e.g. feeding via a tube) increase survival, but with disability. Therefore, clinicians need to support patients and families in making informed decisions about the use of these treatments, in a process termed shared decision-making. This is challenging after acute stroke: there is prognostic uncertainty, patients are often too unwell to participate in decision-making, and proxies may not know the patients’ expressed wishes (i.e. values). Patients’ values also change over time and in different situations. There is limited evidence on successful methods to facilitate this process. Changes targeted at components of shared decision-making (e.g. decision aids to provide information and discussing patient values) increase patient satisfaction. How this influences decision-making is unclear. Presumably, a ‘shared decision-making tool’ that introduces effective changes at various stages in this process might be helpful after acute stroke. For example, by complementing professional judgement with predictions from prognostic models, clinicians could provide information that is more accurate. Decision aids that are personalised may be helpful. Further qualitative research can provide clinicians with a better understanding of patient values and factors influencing this at different time points after a stroke.
The evaluation of this tool in its success to achieve outcomes consistent with patients’ values may require more than one clinical trial.
Original languageEnglish
JournalInternational Journal of Stroke
Early online date12 Sep 2017
DOIs
Publication statusE-pub ahead of print - 12 Sep 2017

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