Challenges in Obtaining Informed Consent for Endovascular Thrombectomy in Acute Stroke: A Survey of Providers
Ali Alsarah1, Amir Mbonde2, Adam Dmytriw3, Joshua Hirshch4, Aneesh Singhal3, Thabele Leslie-Mazwi5, Anna Bonkhoff4, Natalia Rost3, Aman Patel6, Michael Young7, Robert Regenhardt3
1Department of Neurology, MGB- Harvard Medical School, 2Mayo Clinic Arizona, 3Massachusetts General Hospital, 4Mass General Brigham, 5UW, 6MGB, 7Massachusetts General Hospital, Brigham, Harvard
Objective:
To identify challenges that providers face when obtaining informed consent (IC) for endovascular thrombectomy (EVT).
Background:
IC is viewed as integral to medical practice and clinical research, particularly when procedures are involved. However, the process can be fraught with significant challenges, especially for time sensitive emergency treatments such as EVT.
Design/Methods:
Healthcare providers involved in acute stroke care were surveyed from July to December 2023. The questionnaire was created using Qualtrics and distributed via institutional networks, professional societies including the American Academy of Neurology and StrokeNet, and social media.
Results:
Among 391 total respondents, 74% were staff physicians, predominantly from the United States (70%) and employed at academic medical centers (76%). The mean duration in clinical practice was 13.1 ±10.6 years. When asked how often there was uncertainty regarding the optimal approach to IC for EVT, responses stated: "never" (35%), "sometimes" (52%), "often" (9%), and "always" (4%). Respondents answered “no” (21%), “yes” (56%), or “unsure” (23%), when asked if their institutions had policies around IC for EVT. Furthermore, 83% stated they never received training at their institutions on the topic. In free-text responses about perceived challenges to IC for EVT, several key themes emerged: time constraints in emergency settings (40%), lack of patient capacity (20%), availability of surrogates/family (15%), communication barriers (10%), institutional practices/policies (10%), and legal/ethical considerations (5%). Respondents stated: “time is brain,” “seems excessive like consent for CPR,” “overly ambitious to provide EVT even outside of guidelines,” “wildly different physician opinions,” and “patients are unusually incapacitated.”
Conclusions:
This study underscores the provider uncertainty, lack of specific training, and challenges associated with obtaining IC for EVT in acute stroke care. To address these specific challenges, there is a critical need for standardized training, protocols, and guidelines that can be applied across varied geographical regions and multidisciplinary environments.
Disclaimer: Abstracts were not reviewed by Neurology® and do not reflect the views of Neurology® editors or staff.