"Two per cent isn't a lot, but when it comes to death it seems quite a lot anyway'': patients' perception of risk and willingness to accept risks associated with thrombolytic drug treatment for acute stroke
"Two per cent isn't a lot, but when it comes to death it seems quite a lot anyway'': patients' perception of risk and willingness to accept risks associated with thrombolytic drug treatment for acute stroke
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DOI：
10.1136/jme.2007.023192
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发表时间：
2009-01-01
影响因子：
4.1
通讯作者：
Wyller, T. B.
中科院分区：
文献类型：
--
作者：
Mangset, M.;Berge, E.;Wyller, T. B.
背景：治疗急性缺血性中风的溶栓药物可降低死亡或严重残疾的风险。然而，这种治疗也与潜在致命性颅内出血的风险增加有关。这使患者面临着是否要冒严重副作用的风险以增加获得有利结果的可能性的两难境地。目的：探讨急性脑卒中患者对溶栓药物治疗相关风险的认知和接受风险的意愿。设计：11名已被告知溶栓药物治疗并已决定是否参加溶栓药物试验的患者接受了反复的定性、半结构化访谈。结果：许多患者对风险的认知有限。与溶栓药物治疗有关。有些人认为这种风险与他们无关，并且不愿意接受治疗可能造成伤害。其他人似乎意识到治疗意味着暴露在风险之中。患者承担风险的意愿也存在很大差异。一些声明揭示了参与治疗决定的含糊性和混乱性。患者对风险的推理被纳入他们与健康相关的经历和生活史的背景中。一些患者希望医生对决策负责。结论：急性中风患者在感知和处理有关风险的信息方面存在困难，可能会降低他们参与涉及风险的临床决策的能力。
Background: Thrombolytic drugs to treat an acute ischaemic stroke reduce the risk of death or major disability. The treatment is, however, also associated with an increased risk of potentially fatal intracranial bleeding. This confronts the patient with the dilemma of whether or not to take a risk of a serious side effect in order to increase the likelihood of a favourable outcome.Objective: To explore acute stroke patients' perception of risk and willingness to accept risks associated with thrombolytic drug treatment.Design: Eleven patients who had been informed about thrombolytic drug treatment and had been through the process of deciding whether or not to participate in a thrombolytic drug trial went through repeated qualitative, semistructured interviews.Results: Many patients showed a limited perception of the risks connected with thrombolytic drug treatment. Some perceived the risk as not relevant to them and were reluctant to accept that treatment could cause harm. Others seemed to be aware that treatment would mean exposure to risk. The patients' willingness to take a risk also varied substantially. Several statements revealed ambiguity and confusion about being involved in a decision about treatment. The patients' reasoning about risk was put into the context of their health-related experiences and life histories. Several patients wanted the doctor to be responsible for the decisions.Conclusion: Acute stroke patients' difficulties in perceiving and processing information about risk may reduce their ability to be involved in clinical decisions where risks are involved.