title: Gender differences in stroke care decision-making.
abstract: BACKGROUND
  Women are less likely than men to receive some stroke care interventions. It is not known whether gender differences in patient preferences explain some of the observed variations in stroke care delivery.
  
  
  METHODS
  Outpatients with and without a history of cerebrovascular disease were recruited from stroke, vascular, and general internal medicine ambulatory clinics between September 2002 and October 2003. Self-administered surveys described hypothetical scenarios, and participants were asked if they would accept therapy with thrombolysis for acute ischemic stroke or carotid endarterectomy for secondary stroke prevention. The surveys also included questions on sociodemographic factors and decision-making preferences.
  
  
  RESULTS
  A total of 586 patients (45% women) completed the survey. Women were less likely than men to accept thrombolysis (79% vs. 86%, P=0.014), even after adjustment for other factors (adjusted odds ratio [OR] 0.58, 95% confidence interval [CI] 0.37-0.92). Women and men were equally likely to accept carotid endarterectomy (82% vs. 84%, P=0.502), even after adjustment for other factors (adjusted OR 0.94, 95% CI 0.58- 1.53). Women were less confident in their decisions, were more risk averse, and would have preferred more information to assist them in their decision-making.
  
  
  CONCLUSIONS
  No gender differences were found in patient preferences for carotid surgery. However, we observed gender differences in patient preferences for thrombolysis and in general attitudes toward stroke care decision-making. Health care providers should be aware that, compared with men, women may be more concerned about risks and may require more information before they make a decision.
authors.affiliation: Institute for Clinical Evaluative Sciences, University Health Network, University of Toronto, Ontario, Canada. moira.kapral@uhn.on.ca
authors.forename: Moira K
authors.initials: MK
authors.lastname: Kapral
authors.forename: Jennifer
authors.initials: J
authors.lastname: Devon
authors.forename: Anne-Luise
authors.initials: AL
authors.lastname: Winter
authors.forename: Julie
authors.initials: J
authors.lastname: Wang
authors.forename: Anne
authors.initials: A
authors.lastname: Peters
authors.forename: Susan J
authors.initials: SJ
authors.lastname: Bondy
mesh_terms: D003625:Data Collection; D003657:Decision Making; D016894:Endarterectomy, Carotid; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009864:Ontario; D017060:Patient Satisfaction; D012737:Sex Factors; D020521:Stroke / Q000188:drug therapy* / Q000601:surgery*; D015912:Thrombolytic Therapy