title: Surveys of Stroke Patients and Their Next of Kin on Their Opinions towards Decision-Making and Consent for Stroke Thrombolysis.
abstract: BACKGROUND
  Early initiation of stroke thrombolysis is associated with improved outcomes. Procurement of consent is a key factor in prolonging the door-to-needle duration. This study aimed to determine the attitudes and preferences of stroke patients and their next of kin (NOK) towards decision-making for stroke thrombolysis in Singapore.
  
  
  METHODS
  We surveyed acute ischaemic stroke patients (n = 171) who presented beyond the 4.5-hour therapeutic window and their NOK (n = 140) using a questionnaire with scenarios on obtaining consent for intravenous thrombolysis.
  
  
  RESULTS
  In the patient survey, 83% were agreeable for their NOK to decide on their behalf if mentally incapacitated and 74% were agreeable for the doctor to decide if the NOK was absent. In the NOK survey, the majority (81%) wanted to be consulted before mentally capacitated patients made their decision; 72% and 74%, meanwhile, were willing to decide on behalf of a mentally capacitated and mentally incapacitated patient, respectively. In the scenario where a doctor recommended a mentally incapacitated stroke patient to undergo thrombolysis but the family declined, there was a near equal split in preference to follow the family's or doctor's decision in both the patient and NOK surveys.
  
  
  CONCLUSIONS
  The survey found that in the decision-making process for stroke thrombolysis, there was no clear consensus on the preference for the decision maker of the mentally incapacitated patient. In Singapore, there is a strong influence of the NOK in decision-making for thrombolysis.
authors.affiliation: Department of Neurology, National Neuroscience Institute, Singapore General Hospital, Singapore.
authors.forename: Nithia
authors.initials: N
authors.lastname: Angamuthu
authors.forename: Kian Kheng
authors.initials: KK
authors.lastname: Queck
authors.forename: Sumytra
authors.initials: S
authors.lastname: Menon
authors.forename: Shu Swen
authors.initials: SS
authors.lastname: Ho
authors.forename: Elaine
authors.initials: E
authors.lastname: Ang
authors.forename: Deidre Anne
authors.initials: DA
authors.lastname: De Silva
mesh_terms: D001294:Attitude to Health; D002545:Brain Ischemia / Q000150:complications / Q000523:psychology / Q000628:therapy*; D003657:Decision Making; D034462:Dissent and Disputes; D006801:Humans; D007258:Informed Consent; D016743:Mental Competency; D019727:Proxy; D012846:Singapore; D020521:Stroke / Q000209:etiology / Q000523:psychology / Q000628:therapy*; D011795:Surveys and Questionnaires; D015912:Thrombolytic Therapy; D061665:Time-to-Treatment