title: Understanding clinicians' decisions to offer intravenous thrombolytic treatment to patients with acute ischaemic stroke: a protocol for a discrete choice experiment.
abstract: BACKGROUND
  Intravenous thrombolysis is an effective emergency treatment for acute ischaemic stroke for patients meeting specific criteria. Approximately 12% of eligible patients in England, Wales and Northern Ireland received thrombolysis in the first quarter of 2013, yet as many as 15% are eligible to receive treatment. Suboptimal use of thrombolysis may have been largely attributable to structural factors; however, with the widespread implementation of 24/7 hyper acute stroke services, continuing variation is likely to reflect differences in clinical decision-making, in particular the influence of ambiguous areas within the guidelines, licensing criteria and research evidence. Clinicians' perceptions about thrombolysis may now exert a greater influence on treatment rates than structural/service factors. This research seeks to elucidate factors influencing thrombolysis decision-making by using patient vignettes to identify (1) patient-related and clinician-related factors that may help to explain variation in treatment and (2) associated trade-offs in decision-making based on the interplay of critical factors.
  
  
  METHODS
  A discrete choice experiment (DCE) will be conducted to better understand how clinicians make decisions about whether or not to offer thrombolysis to patients with acute ischaemic stroke. To inform the design, exploratory work will be undertaken to ensure that (1) all potentially influential factors are considered for inclusion; and (2) to gain insights into the 'grey areas' of patient factors. A fractional factorial design will be used to combine levels of patient factors in vignettes, which will be presented to clinicians to allow estimation of the variable effects on decisions to offer thrombolysis.
  
  
  BACKGROUND
  Ethical approval for this study was obtained from the Newcastle University Research Ethics Committee. The results will be disseminated in peer review publications and at national conferences. Findings will be translated into continuing professional development activities and will support implementation of a computerised decision aid for thrombolysis (COMPASS) in acute stroke care.
authors.affiliation: Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK.
authors.forename: Aoife
authors.initials: A
authors.lastname: De Brún
authors.affiliation: Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK.
authors.forename: Darren
authors.initials: D
authors.lastname: Flynn
authors.affiliation: Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK.
authors.forename: Kerry
authors.initials: K
authors.lastname: Joyce
authors.affiliation: Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK.
authors.forename: Laura
authors.initials: L
authors.lastname: Ternent
authors.affiliation: Northumbria Healthcare NHS Foundation Trust, Ashington, UK.
authors.forename: Christopher
authors.initials: C
authors.lastname: Price
authors.affiliation: Institute for Ageing and Health (Stroke Research Group), Newcastle University, Newcastle upon Tyne, UK.
authors.forename: Helen
authors.initials: H
authors.lastname: Rodgers
authors.affiliation: Oxford University Hospitals NHS Trust, Oxford, UK.
authors.forename: Gary A
authors.initials: GA
authors.lastname: Ford
authors.affiliation: Centre for Health Economics, Monash University, Clayton, Melbourne, Victoria, Australia.
authors.forename: Emily
authors.initials: E
authors.lastname: Lancsar
authors.affiliation: Northumbria Healthcare NHS Foundation Trust, Ashington, UK.
authors.forename: Matthew
authors.initials: M
authors.lastname: Rudd
authors.affiliation: Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK.
authors.forename: Richard G
authors.initials: RG
authors.lastname: Thomson
mesh_terms: D061605:Administration, Intravenous; D002545:Brain Ischemia / Q000150:complications / Q000188:drug therapy*; D000066491:Clinical Decision-Making; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006801:Humans; D012107:Research Design; D020521:Stroke / Q000188:drug therapy* / Q000209:etiology
chemical_list: D005343:Fibrinolytic Agents
keywords: decision-making; discrete choice experiment; thrombolysis