title: How best to obtain consent to thrombolysis: Individualized decision-making.
abstract: OBJECTIVE
  To investigate the factors that influence the preferences of patients and their proxies concerning thrombolytic therapy and to determine how best to convey information.
  
  
  METHODS
  A total of 613 participants were randomly assigned to a positively or negatively framed group. Each participant completed a series of surveys. We applied latent class analysis (LCA) to explore participants' patterns of choices of thrombolysis and to classify the participants into different subgroups. Then we performed regression analyses to investigate predictors of classification of the participants into each subgroup and to establish a thrombolytic decision-making model.
  
  
  RESULTS
  LCA indicated an optimal 3-subgroup model comprising intermediate, favorable to thrombolysis, and aversion to thrombolysis subgroups. Multiple regression analysis revealed that 10 factors predicted assignment to the intermediate subgroup and 4 factors predicted assignment to the aversion to thrombolysis subgroup compared with the favorable to thrombolysis subgroup. The χ(2) tests indicated that the information presentation format and the context of thrombolysis influenced participants' choices of thrombolysis and revealed a framing effect in different subgroups.
  
  
  CONCLUSIONS
  The preference for thrombolysis was influenced by the positive vs negative framing scenarios, the format of item presentation, the context of thrombolysis, and individual characteristics. Inconsistent results may be due to participant heterogeneity and the evaluation of limited factors in previous studies. Based on a decision model of thrombolysis, physicians should consider the effects of positive vs negative framing and should seek a neutral tone when presenting the facts, providing an important reference point for health persuasion in other clinical domains.
authors.affiliation: From the Departments of Neurology (J.G., J.F., W.Z., W.Y., Y. Huang) and Radiology (X.W.), General Hospital of Beijing Command PLA; Centre of Psychology (Y.Z.), Air Force Aviation Medicine Research Institute; Department of Psychological Medicine (Y. Hou), 309 Hospital of PLA, Beijing; School of Psychology (H.L.), Beijing Normal University; and Department of Medical Psychology (D.M.), Fourth Military Medical University, Xi'an, China. neuropsych@126.com neurohuangyonghua@163.com bnuliuhy@126.com fmmumiaodm@126.com.
authors.forename: Jingjing
authors.initials: J
authors.lastname: Gong
authors.affiliation: From the Departments of Neurology (J.G., J.F., W.Z., W.Y., Y. Huang) and Radiology (X.W.), General Hospital of Beijing Command PLA; Centre of Psychology (Y.Z.), Air Force Aviation Medicine Research Institute; Department of Psychological Medicine (Y. Hou), 309 Hospital of PLA, Beijing; School of Psychology (H.L.), Beijing Normal University; and Department of Medical Psychology (D.M.), Fourth Military Medical University, Xi'an, China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: From the Departments of Neurology (J.G., J.F., W.Z., W.Y., Y. Huang) and Radiology (X.W.), General Hospital of Beijing Command PLA; Centre of Psychology (Y.Z.), Air Force Aviation Medicine Research Institute; Department of Psychological Medicine (Y. Hou), 309 Hospital of PLA, Beijing; School of Psychology (H.L.), Beijing Normal University; and Department of Medical Psychology (D.M.), Fourth Military Medical University, Xi'an, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Feng
authors.affiliation: From the Departments of Neurology (J.G., J.F., W.Z., W.Y., Y. Huang) and Radiology (X.W.), General Hospital of Beijing Command PLA; Centre of Psychology (Y.Z.), Air Force Aviation Medicine Research Institute; Department of Psychological Medicine (Y. Hou), 309 Hospital of PLA, Beijing; School of Psychology (H.L.), Beijing Normal University; and Department of Medical Psychology (D.M.), Fourth Military Medical University, Xi'an, China.
authors.forename: Weiwei
authors.initials: W
authors.lastname: Zhang
authors.affiliation: From the Departments of Neurology (J.G., J.F., W.Z., W.Y., Y. Huang) and Radiology (X.W.), General Hospital of Beijing Command PLA; Centre of Psychology (Y.Z.), Air Force Aviation Medicine Research Institute; Department of Psychological Medicine (Y. Hou), 309 Hospital of PLA, Beijing; School of Psychology (H.L.), Beijing Normal University; and Department of Medical Psychology (D.M.), Fourth Military Medical University, Xi'an, China.
authors.forename: Weimin
authors.initials: W
authors.lastname: Yin
authors.affiliation: From the Departments of Neurology (J.G., J.F., W.Z., W.Y., Y. Huang) and Radiology (X.W.), General Hospital of Beijing Command PLA; Centre of Psychology (Y.Z.), Air Force Aviation Medicine Research Institute; Department of Psychological Medicine (Y. Hou), 309 Hospital of PLA, Beijing; School of Psychology (H.L.), Beijing Normal University; and Department of Medical Psychology (D.M.), Fourth Military Medical University, Xi'an, China.
authors.forename: Xinhuai
authors.initials: X
authors.lastname: Wu
authors.affiliation: From the Departments of Neurology (J.G., J.F., W.Z., W.Y., Y. Huang) and Radiology (X.W.), General Hospital of Beijing Command PLA; Centre of Psychology (Y.Z.), Air Force Aviation Medicine Research Institute; Department of Psychological Medicine (Y. Hou), 309 Hospital of PLA, Beijing; School of Psychology (H.L.), Beijing Normal University; and Department of Medical Psychology (D.M.), Fourth Military Medical University, Xi'an, China.
authors.forename: Yanhong
authors.initials: Y
authors.lastname: Hou
authors.affiliation: From the Departments of Neurology (J.G., J.F., W.Z., W.Y., Y. Huang) and Radiology (X.W.), General Hospital of Beijing Command PLA; Centre of Psychology (Y.Z.), Air Force Aviation Medicine Research Institute; Department of Psychological Medicine (Y. Hou), 309 Hospital of PLA, Beijing; School of Psychology (H.L.), Beijing Normal University; and Department of Medical Psychology (D.M.), Fourth Military Medical University, Xi'an, China. neuropsych@126.com neurohuangyonghua@163.com bnuliuhy@126.com fmmumiaodm@126.com.
authors.forename: Yonghua
authors.initials: Y
authors.lastname: Huang
authors.affiliation: From the Departments of Neurology (J.G., J.F., W.Z., W.Y., Y. Huang) and Radiology (X.W.), General Hospital of Beijing Command PLA; Centre of Psychology (Y.Z.), Air Force Aviation Medicine Research Institute; Department of Psychological Medicine (Y. Hou), 309 Hospital of PLA, Beijing; School of Psychology (H.L.), Beijing Normal University; and Department of Medical Psychology (D.M.), Fourth Military Medical University, Xi'an, China. neuropsych@126.com neurohuangyonghua@163.com bnuliuhy@126.com fmmumiaodm@126.com.
authors.forename: Hongyun
authors.initials: H
authors.lastname: Liu
authors.affiliation: From the Departments of Neurology (J.G., J.F., W.Z., W.Y., Y. Huang) and Radiology (X.W.), General Hospital of Beijing Command PLA; Centre of Psychology (Y.Z.), Air Force Aviation Medicine Research Institute; Department of Psychological Medicine (Y. Hou), 309 Hospital of PLA, Beijing; School of Psychology (H.L.), Beijing Normal University; and Department of Medical Psychology (D.M.), Fourth Military Medical University, Xi'an, China. neuropsych@126.com neurohuangyonghua@163.com bnuliuhy@126.com fmmumiaodm@126.com.
authors.forename: Danmin
authors.initials: D
authors.lastname: Miao
mesh_terms: D003657:Decision Making; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage; D006801:Humans; D007258:Informed Consent / Q000523:psychology*; D008297:Male; D010358:Patient Participation / Q000379:methods / Q000523:psychology*; D011897:Random Allocation; D020521:Stroke / Q000188:drug therapy / Q000453:epidemiology / Q000523:psychology*; D015912:Thrombolytic Therapy / Q000379:methods / Q000523:psychology*
chemical_list: D005343:Fibrinolytic Agents