Situationally-sensitive knowledge translation and relational decision making in hyperacute stroke: a qualitative study.
Stroke is a leading cause of disability. Early treatment of acute ischaemic stroke with rtPA reduces the risk of longer term dependency but carries an increased risk of causing immediate bleeding complications. To understand the challenges of knowledge translation and decision making about treatment...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2012-01-01
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| Series: | PLoS ONE |
| Online Access: | http://europepmc.org/articles/PMC3365903?pdf=render |
| _version_ | 1818892642654617600 |
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| author | Madeleine J Murtagh Duika L Burges Watson K Neil Jenkings Mabel L S Lie Joan E Mackintosh Gary A Ford Richard G Thomson |
| author_facet | Madeleine J Murtagh Duika L Burges Watson K Neil Jenkings Mabel L S Lie Joan E Mackintosh Gary A Ford Richard G Thomson |
| author_sort | Madeleine J Murtagh |
| collection | DOAJ |
| description | Stroke is a leading cause of disability. Early treatment of acute ischaemic stroke with rtPA reduces the risk of longer term dependency but carries an increased risk of causing immediate bleeding complications. To understand the challenges of knowledge translation and decision making about treatment with rtPA in hyperacute stroke and hence to inform development of appropriate decision support we interviewed patients, their family and health professionals. The emergency setting and the symptomatic effects of hyper-acute stroke shaped the form, content and manner of knowledge translation to support decision making. Decision making about rtPA in hyperacute stroke presented three conundrums for patients, family and clinicians. 1) How to allow time for reflection in a severely time-limited setting. 2) How to facilitate knowledge translation regarding important treatment risks and benefits when patient and family capacity is blunted by the effects and shock of stroke. 3) How to ensure patient and family views are taken into account when the situation produces reliance on the expertise of clinicians. Strategies adopted to meet these conundrums were fourfold: face to face communication; shaping decisions; incremental provision of information; and communication tailored to the individual patient. Relational forms of interaction were understood to engender trust and allay anxiety. Shaping decisions with patients was understood as an expression of confidence by clinicians that helped alleviate anxiety and offered hope and reassurance to patients and their family experiencing the shock of the stroke event. Neutral presentations of information and treatment options promoted uncertainty and contributed to anxiety. 'Drip feeding' information created moments for reflection: clinicians literally made time. Tailoring information to the particular patient and family situation allowed clinicians to account for social and emotional contexts. The principal responses to the challenges of decision making about rtPA in hyperacute stroke were relational decision support and situationally-sensitive knowledge translation. |
| first_indexed | 2024-12-19T17:59:57Z |
| format | Article |
| id | doaj.art-d95d74674ba9434abc5d2e6c30e5b56e |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-12-19T17:59:57Z |
| publishDate | 2012-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-d95d74674ba9434abc5d2e6c30e5b56e2022-12-21T20:11:42ZengPublic Library of Science (PLoS)PLoS ONE1932-62032012-01-0176e3706610.1371/journal.pone.0037066Situationally-sensitive knowledge translation and relational decision making in hyperacute stroke: a qualitative study.Madeleine J MurtaghDuika L Burges WatsonK Neil JenkingsMabel L S LieJoan E MackintoshGary A FordRichard G ThomsonStroke is a leading cause of disability. Early treatment of acute ischaemic stroke with rtPA reduces the risk of longer term dependency but carries an increased risk of causing immediate bleeding complications. To understand the challenges of knowledge translation and decision making about treatment with rtPA in hyperacute stroke and hence to inform development of appropriate decision support we interviewed patients, their family and health professionals. The emergency setting and the symptomatic effects of hyper-acute stroke shaped the form, content and manner of knowledge translation to support decision making. Decision making about rtPA in hyperacute stroke presented three conundrums for patients, family and clinicians. 1) How to allow time for reflection in a severely time-limited setting. 2) How to facilitate knowledge translation regarding important treatment risks and benefits when patient and family capacity is blunted by the effects and shock of stroke. 3) How to ensure patient and family views are taken into account when the situation produces reliance on the expertise of clinicians. Strategies adopted to meet these conundrums were fourfold: face to face communication; shaping decisions; incremental provision of information; and communication tailored to the individual patient. Relational forms of interaction were understood to engender trust and allay anxiety. Shaping decisions with patients was understood as an expression of confidence by clinicians that helped alleviate anxiety and offered hope and reassurance to patients and their family experiencing the shock of the stroke event. Neutral presentations of information and treatment options promoted uncertainty and contributed to anxiety. 'Drip feeding' information created moments for reflection: clinicians literally made time. Tailoring information to the particular patient and family situation allowed clinicians to account for social and emotional contexts. The principal responses to the challenges of decision making about rtPA in hyperacute stroke were relational decision support and situationally-sensitive knowledge translation.http://europepmc.org/articles/PMC3365903?pdf=render |
| spellingShingle | Madeleine J Murtagh Duika L Burges Watson K Neil Jenkings Mabel L S Lie Joan E Mackintosh Gary A Ford Richard G Thomson Situationally-sensitive knowledge translation and relational decision making in hyperacute stroke: a qualitative study. PLoS ONE |
| title | Situationally-sensitive knowledge translation and relational decision making in hyperacute stroke: a qualitative study. |
| title_full | Situationally-sensitive knowledge translation and relational decision making in hyperacute stroke: a qualitative study. |
| title_fullStr | Situationally-sensitive knowledge translation and relational decision making in hyperacute stroke: a qualitative study. |
| title_full_unstemmed | Situationally-sensitive knowledge translation and relational decision making in hyperacute stroke: a qualitative study. |
| title_short | Situationally-sensitive knowledge translation and relational decision making in hyperacute stroke: a qualitative study. |
| title_sort | situationally sensitive knowledge translation and relational decision making in hyperacute stroke a qualitative study |
| url | http://europepmc.org/articles/PMC3365903?pdf=render |
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