Abstract 272: Preliminary Data from RESOLVE (Rapid Evaluation for Stroke Outcomes using Lytics in Vascular Events) Study
Background: Communicating the risks and benefits of recombinant tissue plasminogen activator (rt-PA) for the treatment of acute ischemic stroke (AIS) is complex and often a hurried conversation in the emergency department (ED). Visual decision aids have been shown to be superior to standard treatment decision counseling and useful in emergency decision-making. Current rt-PA tools primarily focus on harmful risks while minimizing the positive benefits of treatment. Despite evidence to support enhancement of patient understanding of rt-PA treatment, use of these materials remains low. This study explored patient and family caregiver (CG) recall of rt-PA information provided, and comprehension of AIS and rt-PA education prior to piloting an enhanced individualized risk and benefit decision tool for rt-PA treatment in the ED.
Methods: The goal is to interview 150 consecutive AIS rt-PA eligible patients and their CG to obtain feedback on the type of information (verbal or visual), comprehension and recall of risks and benefits provided in the ED. Currently 20 individuals (stroke patients = 8 and CG =12) at one large metropolitan medical center have completed the study. The participants were 35% (7/20) male; mean age 55.9 years, and 100% (20/20) of the survivors received rt-PA.
Findings: All participants (20/20) received information on treatment options for AIS education in the ED. Ninety five percent (19/20) of patients did not recall receiving any visual material used in education of risks and benefits. Most patients (18/20) reported understanding that a stroke was caused by a clot in the brain, however only 30% (6/20) recalled having heard of rt-PA prior to coming to the hospital. Forty-five percent (9/20) of the subjects perceived the descriptions of rt-PA with its risks and benefits as being completely clear whereas 20% (4/20) reported they were not at all clear.
Conclusions: Preliminary findings showed that less than half of the patients and CG felt the education was clear. However additional interviews are planned. Preliminary insights suggest an opportunity to use an individualized risk and benefit decision tool to inform and engage patients and CG regarding treatment decisions. We believe this can be accomplished without increasing the door to needle time in administration of rt-PA.
Author Disclosures: D. Summers: E. Honoraria; Significant; Genentech. E. Chhatriwalla: None. E. Gialde: None. J. Spertus: B. Research Grant; Significant; Genentech. C. Decker: None.
This research has received full or partial funding support from the American Heart Association, National Center.
- © 2014 by American Heart Association, Inc.