Study Of Thrombolytic Decision Delay In Acute Ischemic Stroke Under A Shared Decision-Making Perspective

ObjectiveAcute ischemic stroke is a disease with high morbidity,high disability rate and high mortality rate.Intravenous thrombolysis in the time window is the most important treatment mode for acute ischemic stroke.Delayed thrombolysis decision-making is one of the reasons that hinder thrombolytic therapy.This study will study the present situation of intravenous thrombolysis decision delay of acute ischemic stroke from the perspective of common decision,and analyze the influencing factors of thrombolysis decision delay in acute ischemic stroke,provide theoretical basis for doctor-patient communication of intravenous thrombolysis,help to shorten the decision time of intravenous thrombolysis in acute ischemic stroke,improve decision quality and efficiency,and improve the thrombolysis rate and thrombolysis effect in the time window.MethodsThis study involves two research forms,quantitative research and qualitative research.1.Quantitative study: Through retrospective analysis of 149 patients of acute ischemic stroke patients admitted to a senior stroke center in Zhaoqing city from July 2021 to January 2023,the relationship between DNT delay and thrombolysis decision time and the related factors of thrombolysis decision delay were found.2.Quality research: in April 2021-October 2022,under the perspective of common decision,through thrombolysis decision agent for 19 ischemic stroke,10 medical staff,eight patients with semi-structured interview,using Colaizz seven step analysis of interview data analysis,extract the causes of thrombolysis decision delay in acute ischemic stroke patients.Two research methods were combined to explore the influencing factors and causes of thrombolysis decision delay in acute ischemic stroke patients under the common decision perspective.Results1.Quantitative study results:(1)Between thrombolysis decision time and DNT time in 149 patients with acute ischemic stroke who had completed thrombolysis,the decision delay rate in the DNT delay group(42.53%)was significantly higher than the decision non-delay rate(16.13%),P<0.05.(2)for 149 patients of thrombolysis of acute ischemic stroke into decision delay and decision delay group,the thrombolysis decision time and related factors for t test and one-way variance analysis,the results show that at high risk of stroke number of 3 or more,talk doctor title for intermediate and below the acute ischemic stroke patients decision delay rate is highest(P<0.05).There was no statistical difference in the decision time of thrombolysis in acute ischemic stroke patients with different gender,age,residence,marital status,medical insurance status,work status,previous stroke history,high-risk disease of stroke,and hospital arrival(P> 0.05).2.Qualitative study results: A total of 19 ischemic stroke thrombolysis decision agents,10 medical staff,8 patients were interviewed in this study,A total of 3 themes and 10sub-themes were extracted: the theme is the decision-making power under the influence of multiple parties,Including four sub-themes: family-centered joint decision-making power,child-centered decision-making power,decision-making power under monetary influence,and patients with weakened decision-making power,The second theme is the contradictory decision influence,Including four sub-themes: decision under the influence of familiarity and strangeness,decision under the influence of trust and doubt,decision under the influence of responsibility and obligation,and decision under the influence of positive and negative emotions,The theme three is the decision-making communication seeking change,It includes two sub-themes: decision communication to improve cognition through multiple channels and decision communication oriented by health benefits.Conclusion1.The results of retrospective statistical analysis showed that the decision delay rate was significantly higher than the decision non-delay rate.The higher the number of diseases with high risk of stroke,the intermediate and below are the factors leading to the delay of thrombolysis decision.2.In the qualitative research,it is found that from the perspective of common decision making,the delay of thrombolysis decision is affected by many factors.The main causes of thrombolysis decision delay include decision power under the influence of multiple parties,contradictory decision influence,and decision communication seeking changes.Medical staff can by understanding the related factors leading to acute ischemic stroke bolt decision delay,in decision subject,individual rights,the improvement of the hospital process,strengthen medical care and policy escort four aspects of the process,improve thrombolysis decision improve decision experience,reduce thrombolysis decision dilemma,reduce decision delay,improve the rate of intravenous thrombolysis in patients with acute ischemic stroke in the time window.