title: Attitudes and Practices on the Consent Process and Decision-making for Intravenous Stroke Thrombolysis: Physicians' Perspective.
abstract: BACKGROUND
  Earlier treatment with intravenous stroke thrombolysis improves outcomes and lowers risk of bleeding complications. The decision-making and consent process is one of the rate-limiting steps in the duration between hospital arrival and treatment initiation. We aim to describe the attitudes and practices of neurologists in Singapore on the consent and decision-making processes for stroke thrombolysis.
  
  
  METHODS
  A survey of neurologists and neurologists-in-training in 2 large tertiary public hospitals in Singapore was conducted.
  
  
  RESULTS
  Among 46 respondents, 94% of them considered stroke thrombolysis an emergency treatment and 67% of them indicated there is a need for written informed consent. The majority (87%) knew that from a legal perspective, the doctor should be the decision-maker in an emergency treatment for a mentally incapacitated patient. However, 63% of respondents reported that it is the next-of-kin who usually makes the decision in actual practice. If confronted with a mentally incapacitated stroke patient, 57% of them were willing to be the proxy decision-maker and 13% of them were not. In 3 commonly encountered vignettes when a mentally incapacitated patient was being considered for stroke thrombolysis, there was no clear consensus on the respondents' practices.
  
  
  CONCLUSIONS
  The next-of-kin is usually the decision-maker for stroke thrombolysis in practice for a mentally incapacitated patient despite most doctors considering thrombolysis an emergency treatment. This, together with the lack of consensus and variance in decision-making and consent practice amongst neurologists for stroke thrombolysis, demonstrates the need to develop best practice guidelines to standardise healthcare practices for greater consistency in health service delivery.
authors.affiliation: Department of Neurology, Singapore General Hospital Campus, National Neuroscience Institute, Singapore.
authors.forename: Loreto P
authors.initials: LP
authors.lastname: Talabucon
authors.forename: Sumytra
authors.initials: S
authors.lastname: Menon
authors.forename: April J
authors.initials: AJ
authors.lastname: Toh
authors.forename: Daniel C T
authors.initials: DC
authors.lastname: Oh
authors.forename: Deidre Anne
authors.initials: DA
authors.lastname: De Silva
mesh_terms: D001290:Attitude; D003657:Decision Making; D006801:Humans; D007258:Informed Consent / Q000331:legislation & jurisprudence; D010820:Physicians; D020521:Stroke