title: COAST (Coordinating Options for Acute Stroke Therapy): An Advance Directive for Stroke.
abstract: BACKGROUND
  Stroke is a worldwide problem with a limited number of approved treatments. Obtaining informed consent for acute stroke therapy is complicated by the breadth of information that must be communicated in a short period of time, the hectic nature of the emergency environment, the possible lack of understanding by the patient and/or family, and the critically time-sensitive nature of treatment for stroke. Complicating matters even further, patients are often unable to consent for themselves, placing the burden on surrogates to infer patients' wishes regarding treatment, and potentially limiting acute treatment by practitioners.
  
  
  METHODS
  An advance directive for acute stroke therapy was created, entitled COAST (Coordinating Options for Acute Stroke Therapy). This clinical initiative is being piloted at a large comprehensive stroke center, including the development of the advance directive form, integration of the form with electronic medical records, training healthcare providers, and outreach to patients.
  
  
  CONCLUSIONS
  COAST is an advance directive for stroke designed to make stroke care more efficient, optimize patients' autonomy, improve the quality of healthcare, and streamline the ethical management of complex care decisions in acute stroke. The inherent benefit of COAST is in providing patients and their families with more information regarding stroke and its treatment options, allowing them to take a more active role in their care.
authors.affiliation: University of California, San Diego, Department of Neurology, 200 West Arbor Drive -- 8465, San Diego, California 92103-8465 USA. ilana.spokoyny@gmail.com.
authors.forename: Ilana
authors.initials: I
authors.lastname: Spokoyny
authors.affiliation: University of California, San Diego, Department of Internal Medicine, San Diego, California USA. lcederquist@ucsd.edu.
authors.forename: Lynette
authors.initials: L
authors.lastname: Cederquist
authors.affiliation: University of California, San Diego, Department of Internal Medicine, San Diego, California USA. bclay@ucsd.edu.
authors.forename: Brian
authors.initials: B
authors.lastname: Clay
authors.affiliation: University of California, San Diego, Stroke Center, San Diego, California USA. bcmeyer@ucsd.edu.
authors.forename: Brett C
authors.initials: BC
authors.lastname: Meyer
mesh_terms: D032722:Advance Care Planning / Q000941:ethics / Q000592:standards / Q000639:trends; D016223:Advance Directives / Q000941:ethics / Q000639:trends; D032962:Consent Forms / Q000592:standards / Q000639:trends; D003657:Decision Making / Q000941:ethics; D006801:Humans; D007258:Informed Consent / Q000941:ethics; D057240:Patient Preference; D026684:Personal Autonomy; D011787:Quality of Health Care; D020521:Stroke / Q000453:epidemiology / Q000628:therapy*; D014481:United States / Q000453:epidemiology