A study of the opinions of Swedish healthcare personnel regarding acceptable outcome following decompressive hemicraniectomy for ischaemic stroke

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Fältnamn	Indikatorer	Metadata
000		04030naa a2200397 4500
001		oai:DiVA.org:oru-62387
003		SwePub
008		180102s2018 \| \|\|\|\|\|\|\|\|\|\|\|000 \|\|eng\|
024	7	a https://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-623872 URI
024	7	a https://doi.org/10.1007/s00701-017-3358-y2 DOI
040		a (SwePub)oru
041		a engb eng
042		9 SwePub
072	7	a ref2 swepub-contenttype
072	7	a art2 swepub-publicationtype
100	1	a Olivecrona, Magnus,d 1959-u Örebro universitet,Institutionen för medicinska vetenskaper,Region Örebro län,Department of Anaesthesia and Intensive Care, Section for Neurosurgery, Örebro University Hospital, Örebro, Sweden4 aut0 (Swepub:oru)msoa
245	1 0	a A study of the opinions of Swedish healthcare personnel regarding acceptable outcome following decompressive hemicraniectomy for ischaemic stroke
264		c 2017-11-04
264	1	b Springer,c 2018
338		a print2 rdacarrier
520		a BACKGROUND: Decompressive hemicraniectomy (DC) is an established lifesaving treatment for malignant infarction of the middle cerebral artery (mMCAI). However, surgical decompression will not reverse the effects of the stroke and many survivors will be left severely disabled. The objective of this study was to assess what neurological outcome would be considered acceptable in these circumstances amongst Swedish healthcare workers.METHOD: Healthcare workers were invited to participate in a presentation that outlined the pathophysiology of mMCAI, the rationale behind DC and outcome data from randomised controlled trials that have investigated efficacy of the procedure. They were then asked which neurological outcome would they feel to be acceptable based on the modified Rankin Score (mRS) and the Aphasia Handicap Scale (AHS). Information regarding sex, age, marital status, relatives, religion, earlier experience of stroke and occupation was also collected.RESULTS: Six hundred and nine persons participated. The median accepted mRS was 3. An mRS of 4 or 5 was perceived to be acceptable by only 30.5% of participants. Therefore the most likely outcome, based on the results of the randomised controlled trials, would be unacceptable to most of the participants [OR 0.39 (CI, 0.22-0.69)]. The median accepted AHS was 3. A worst language outcome of restricted autonomy of verbal communication (AHS 3) or better would be accepted by 44.6%.CONCLUSIONS: This study has highlighted the ethical problems when obtaining consent for DC following mMCAI, because for many of the participants the most likely neurological outcome would be deemed unacceptable. These issues need to be considered prior to surgical intervention and the time may have come for a broader societal discussion regarding the value of a procedure that converts death into survival with severe disability given the attendant financial and healthcare resource implications.
650	7	a MEDICIN OCH HÄLSOVETENSKAPx Klinisk medicinx Kirurgi0 (SwePub)302122 hsv//swe
650	7	a MEDICAL AND HEALTH SCIENCESx Clinical Medicinex Surgery0 (SwePub)302122 hsv//eng
650	7	a MEDICIN OCH HÄLSOVETENSKAPx Klinisk medicinx Neurologi0 (SwePub)302072 hsv//swe
650	7	a MEDICAL AND HEALTH SCIENCESx Clinical Medicinex Neurology0 (SwePub)302072 hsv//eng
653		a Ethics
653		a Hemicraniectomy
653		a Malignant middle cerebral artery infarction
653		a Outcome
700	1	a Honeybul, Stephenu Departement of Neurosurgery, Sir Charles Gairdner Hospital, Perth, Australia4 aut
710	2	a Örebro universitetb Institutionen för medicinska vetenskaper4 org
773	0	t Acta Neurochirurgicad : Springerg 160:1, s. 95-101q 160:1<95-101x 0001-6268x 0942-0940
856	4	u https://doi.org/10.1007/s00701-017-3358-yy Fulltext
856	4	u https://link.springer.com/content/pdf/10.1007/s00701-017-3358-y.pdf
856	4 8	u https://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-62387
856	4 8	u https://doi.org/10.1007/s00701-017-3358-y

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