Application and research progress of shared decision-making tools in ultra-early vascular recanalization therapy for ischemic stroke_West China Medical Journal

Authors：

WEN Juan ¹ , LIU Simin ¹ , YANG Yujia ² , LUO Anling ² , ZHANG Zhao ² , YANG Qin ² , HE Li ² ,  ZHOU Muke ²

1. General Practice Medical Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

ZHOU Muke, Email: muke.zhou@scu.edu.cn

Keywords：

Acute ischemic stroke; vascular recanalization therapy; shared decision-making tools; shared decision-making

DOI：

10.7507/1002-0179.202411150

Video：

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This article explores the application and research progress of shared decision-making (SDM) tools in ultra-early vascular recanalization therapy for ischemic stroke, focusing on analyzing the functional characteristics and advantages and disadvantages of various tools. Based on functional goals, SDM tools can be divided into four categories: brief decision aids, risk communication tools, patient information tools, and prognosis assessment tools. These tools can assist patients and doctors in making informed treatment decisions quickly in time-sensitive situations, providing a reference for optimizing stroke revascularization treatment. Additionally, SDM tools can facilitate communication between doctors and patients, enabling patients to better understand the risks and benefits of treatment options, leading to choices more aligned with personal preferences and values. Through an in-depth study of these SDM tools, it is expected to improve the diagnostic and treatment efficiency for stroke patients, reduce decision conflicts, promote collaboration between doctors and patients, and provide new ideas and methods for stroke treatment and management.

1.	王族, 宋海庆. 急性缺血性卒中血管内治疗研究进展. 中国脑血管病杂志, 2021, 18(1): 65-67.
2.	Saver JL, Goyal M, Bonafe A, et al. Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. N Engl J Med, 2015, 372(24): 2285-2295.
3.	Masthoff M, Krähling H, Akkurt BH, et al. Evaluation of effectiveness and safety of the multizone NeVa^TM stent retriever for mechanical thrombectomy in ischemic stroke. Neuroradiology, 2023, 65(12): 1777-1785.
4.	Grøan M, Ospel J, Ajmi S, et al. Time-based decision making for reperfusion in acute ischemic stroke. Front Neurol, 2021, 12: 728012.
5.	Armstrong MJ. Shared decision-making in stroke: an evolving approach to improved patient care. Stroke Vasc Neurol, 2017, 2(2): 84-87.
6.	Hawley ST, Morris AM. Cultural challenges to engaging patients in shared decision making. Patient Educ Couns, 2017, 100(1): 18-24.
7.	Guo Z, Zeng S, Ling K, et al. Experiences and needs of older patients with stroke in China involved in rehabilitation decision-making: a qualitative study. BMC Med Inform Decis Mak, 2024, 24(1): 330.
8.	Tan N, Maki KG, López-olivo MA, et al. Cultural influences on shared decision-making among Asian Americans: a systematic review and meta-synthesis of qualitative studies. Patient Educ Couns, 2023, 106: 17-30.
9.	Herpich F, Rincon F. Management of acute ischemic stroke. Crit Care Med, 2020, 48(11): 1654-1663.
10.	Krishnamurthi RV, Ikeda T, Feigin VL. Global, regional and country-specific burden of ischaemic stroke, intracerebral haemorrhage and subarachnoid haemorrhage: a systematic analysis of the Global Burden of Disease Study 2017. Neuroepidemiology, 2020, 54(2): 171-179.
11.	何肖君, 戴雅玲, 李钻芳, 等. 不同溶栓时间窗 rt-PA 治疗急性缺血性脑卒中后神经血管功能的变化特征. 中国老年学杂志, 2023, 43(6): 1436-1441.
12.	Powers WJ, Rabinstein AA, Ackerson T, et al. 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 2018, 49(3): e46-e110.
13.	Hua X, Liu M, Wu S. Definition, prediction, prevention and management of patients with severe ischemic stroke and large infarction. Chin Med J (Engl), 2023, 136(24): 2912-2922.
14.	Zakharov VV, Vakhnina NV, Gogoleva AG. The criteria for effectiveness of reperfusion therapy and neuroprotective therapy in ischemic stroke. Zh Nevrol Psikhiatr Im S S Korsakova, 2021, 121(4): 86-92.
15.	Dhand S, O’Connor P, Hughes C, et al. Acute ischemic stroke: acute management and selection for endovascular therapy. Semin Intervent Radiol, 2020, 37(2): 109-118.
16.	Wardlaw JM, Murray V, Berge E, et al. Recombinant tissue plasminogen activator for acute ischaemic stroke: an updated systematic review and meta-analysis. Lancet, 2012, 379(9834): 2364-2372.
17.	Mendelson SJ, Prabhakaran S. Diagnosis and management of transient ischemic attack and acute ischemic stroke: a review. JAMA, 2021, 325(11): 1088-1098.
18.	Charles C, Gafni A, Whelan T. Shared decision-making in the medical encounter: what does it mean? (Or it takes at least two to tango). Soc Sci Med, 1997, 44(5): 681-692.
19.	史润泽, 弓宸, 康晓凤. 心血管领域患者决策辅助工具临床应用研究的系统评价. 中华现代护理杂志, 2019, 25(7): 832-837.
20.	刘宇丹, 张彩云, 刘彦秋, 等. 血液肿瘤患者共享决策研究进展. 中国医药导报, 2024, 21(22): 81-85.
21.	段玉霞, 李珍, 张斯齐, 等. 结直肠癌诊疗中患者决策辅助工具应用效果的系统评价. 中国全科医学, 2023, 26(25): 3194-3201.
22.	Légaré F, Witteman HO. Shared decision making: examining key elements and barriers to adoption into routine clinical practice. Health Aff (Millwood), 2013, 32(2): 276-284.
23.	Yaşa ME, Aydoğan Arslan S, Yıldırım Şahan T, et al. Validity and reliability of the Turkish version of the Ottawa Sitting Scale in patients with acute stroke. Disabil Rehabil, 2024, 46(17): 3992-3997.
24.	黄榕翀, 徐鸣悦, 郭宏洲. 中国医患共同决策现状与挑战. 中华医学杂志, 2020, 100(30): 2346-2350.
25.	Bajenaru L, Sorici A, Mocanu IG, et al. Shared decision-making to improve health-related outcomes for adults with stroke disease. Healthcare (Basel), 2023, 11(12): 1803.
26.	Shapiro J, Bessette M, Levine SR, et al. HandiStroke: a handheld tool for the emergent evaluation of acute stroke patients. Acad Emerg Med, 2003, 10(12): 1325-1328.
27.	Kent DM, Selker HP, Ruthazer R, et al. The stroke-thrombolytic predictive instrument: a predictive instrument for intravenous thrombolysis in acute ischemic stroke. Stroke, 2006, 37(12): 2957-2962.
28.	Zhang YQ, Liu AF, Man FY, et al. MRI radiomic features-based machine learning approach to classify ischemic stroke onset time. J Neurol, 2022, 269(1): 350-360.
29.	Saposnik G, Goyal M, Majoie C, et al. Visual aid tool to improve decision making in acute stroke care. Int J Stroke, 2016, 11(8): 868-873.
30.	Martins SC, Pontes-Neto O, Carbonera LA, et al. Implementation of a telestroke program based on a smartphone application. Stroke, 2020, 51(Suppl_1): WMP1.
31.	Gadhia J, Starkman S, Ovbiagele B, et al. Assessment and improvement of figures to visually convey benefit and risk of stroke thrombolysis. Stroke, 2010, 41(2): 300-306.
32.	Cunningham VL. The outcome wheel: a potential tool for shared decision-making in ischemic stroke thrombolysis. CJEM, 2008, 10(6): 545-551.
33.	Flynn D, Nesbitt DJ, Ford GA, et al. Development of a computerised decision aid for thrombolysis in acute stroke care. BMC Med Inform Decis Mak, 2015, 15: 6.
34.	Martins S, Weiss G, Almeida AG, et al. Validation of a smartphone application in the evaluation and treatment of acute stroke in a comprehensive stroke center. Stroke, 2020, 51(1): 240-246.
35.	McMeekin P, Flynn D, Ford GA, et al. Development of a decision analytic model to support decision making and risk communication about thrombolytic treatment. BMC Med Inform Decis Mak, 2015, 15: 90.
36.	Knapp P, Wanklyn P, Raynor DK, et al. Developing and testing a patient information booklet for thrombolysis used in acute stroke. Int J Pharm Pract, 2010, 18(6): 362-369.
37.	Chung CC, Bamodu OA, Hong CT, et al. Application of machine learning-based models to boost the predictive power of the SPAN index. Int J Neurosci, 2023, 133(1): 26-36.
38.	Ali SF, Viswanathan A, Singhal AB, et al. The TeleStroke mimic (TM)-score: a prediction rule for identifying stroke mimics evaluated in a Telestroke Network. J Am Heart Assoc, 2014, 3(3): e000838.
39.	Visvanathan A, Dennis M, Mead G, et al. Shared decision making after severe stroke-How can we improve patient and family involvement in treatment decisions?. Int J Stroke, 2017, 12(9): 920-922.

1. 王族, 宋海庆. 急性缺血性卒中血管内治疗研究进展. 中国脑血管病杂志, 2021, 18(1): 65-67.
2. Saver JL, Goyal M, Bonafe A, et al. Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. N Engl J Med, 2015, 372(24): 2285-2295.
3. Masthoff M, Krähling H, Akkurt BH, et al. Evaluation of effectiveness and safety of the multizone NeVa^TM stent retriever for mechanical thrombectomy in ischemic stroke. Neuroradiology, 2023, 65(12): 1777-1785.
4. Grøan M, Ospel J, Ajmi S, et al. Time-based decision making for reperfusion in acute ischemic stroke. Front Neurol, 2021, 12: 728012.
5. Armstrong MJ. Shared decision-making in stroke: an evolving approach to improved patient care. Stroke Vasc Neurol, 2017, 2(2): 84-87.
6. Hawley ST, Morris AM. Cultural challenges to engaging patients in shared decision making. Patient Educ Couns, 2017, 100(1): 18-24.
7. Guo Z, Zeng S, Ling K, et al. Experiences and needs of older patients with stroke in China involved in rehabilitation decision-making: a qualitative study. BMC Med Inform Decis Mak, 2024, 24(1): 330.
8. Tan N, Maki KG, López-olivo MA, et al. Cultural influences on shared decision-making among Asian Americans: a systematic review and meta-synthesis of qualitative studies. Patient Educ Couns, 2023, 106: 17-30.
9. Herpich F, Rincon F. Management of acute ischemic stroke. Crit Care Med, 2020, 48(11): 1654-1663.
10. Krishnamurthi RV, Ikeda T, Feigin VL. Global, regional and country-specific burden of ischaemic stroke, intracerebral haemorrhage and subarachnoid haemorrhage: a systematic analysis of the Global Burden of Disease Study 2017. Neuroepidemiology, 2020, 54(2): 171-179.
11. 何肖君, 戴雅玲, 李钻芳, 等. 不同溶栓时间窗 rt-PA 治疗急性缺血性脑卒中后神经血管功能的变化特征. 中国老年学杂志, 2023, 43(6): 1436-1441.
12. Powers WJ, Rabinstein AA, Ackerson T, et al. 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 2018, 49(3): e46-e110.
13. Hua X, Liu M, Wu S. Definition, prediction, prevention and management of patients with severe ischemic stroke and large infarction. Chin Med J (Engl), 2023, 136(24): 2912-2922.
14. Zakharov VV, Vakhnina NV, Gogoleva AG. The criteria for effectiveness of reperfusion therapy and neuroprotective therapy in ischemic stroke. Zh Nevrol Psikhiatr Im S S Korsakova, 2021, 121(4): 86-92.
15. Dhand S, O’Connor P, Hughes C, et al. Acute ischemic stroke: acute management and selection for endovascular therapy. Semin Intervent Radiol, 2020, 37(2): 109-118.
16. Wardlaw JM, Murray V, Berge E, et al. Recombinant tissue plasminogen activator for acute ischaemic stroke: an updated systematic review and meta-analysis. Lancet, 2012, 379(9834): 2364-2372.
17. Mendelson SJ, Prabhakaran S. Diagnosis and management of transient ischemic attack and acute ischemic stroke: a review. JAMA, 2021, 325(11): 1088-1098.
18. Charles C, Gafni A, Whelan T. Shared decision-making in the medical encounter: what does it mean? (Or it takes at least two to tango). Soc Sci Med, 1997, 44(5): 681-692.
19. 史润泽, 弓宸, 康晓凤. 心血管领域患者决策辅助工具临床应用研究的系统评价. 中华现代护理杂志, 2019, 25(7): 832-837.
20. 刘宇丹, 张彩云, 刘彦秋, 等. 血液肿瘤患者共享决策研究进展. 中国医药导报, 2024, 21(22): 81-85.
21. 段玉霞, 李珍, 张斯齐, 等. 结直肠癌诊疗中患者决策辅助工具应用效果的系统评价. 中国全科医学, 2023, 26(25): 3194-3201.
22. Légaré F, Witteman HO. Shared decision making: examining key elements and barriers to adoption into routine clinical practice. Health Aff (Millwood), 2013, 32(2): 276-284.
23. Yaşa ME, Aydoğan Arslan S, Yıldırım Şahan T, et al. Validity and reliability of the Turkish version of the Ottawa Sitting Scale in patients with acute stroke. Disabil Rehabil, 2024, 46(17): 3992-3997.
24. 黄榕翀, 徐鸣悦, 郭宏洲. 中国医患共同决策现状与挑战. 中华医学杂志, 2020, 100(30): 2346-2350.
25. Bajenaru L, Sorici A, Mocanu IG, et al. Shared decision-making to improve health-related outcomes for adults with stroke disease. Healthcare (Basel), 2023, 11(12): 1803.
26. Shapiro J, Bessette M, Levine SR, et al. HandiStroke: a handheld tool for the emergent evaluation of acute stroke patients. Acad Emerg Med, 2003, 10(12): 1325-1328.
27. Kent DM, Selker HP, Ruthazer R, et al. The stroke-thrombolytic predictive instrument: a predictive instrument for intravenous thrombolysis in acute ischemic stroke. Stroke, 2006, 37(12): 2957-2962.
28. Zhang YQ, Liu AF, Man FY, et al. MRI radiomic features-based machine learning approach to classify ischemic stroke onset time. J Neurol, 2022, 269(1): 350-360.
29. Saposnik G, Goyal M, Majoie C, et al. Visual aid tool to improve decision making in acute stroke care. Int J Stroke, 2016, 11(8): 868-873.
30. Martins SC, Pontes-Neto O, Carbonera LA, et al. Implementation of a telestroke program based on a smartphone application. Stroke, 2020, 51(Suppl_1): WMP1.
31. Gadhia J, Starkman S, Ovbiagele B, et al. Assessment and improvement of figures to visually convey benefit and risk of stroke thrombolysis. Stroke, 2010, 41(2): 300-306.
32. Cunningham VL. The outcome wheel: a potential tool for shared decision-making in ischemic stroke thrombolysis. CJEM, 2008, 10(6): 545-551.
33. Flynn D, Nesbitt DJ, Ford GA, et al. Development of a computerised decision aid for thrombolysis in acute stroke care. BMC Med Inform Decis Mak, 2015, 15: 6.
34. Martins S, Weiss G, Almeida AG, et al. Validation of a smartphone application in the evaluation and treatment of acute stroke in a comprehensive stroke center. Stroke, 2020, 51(1): 240-246.
35. McMeekin P, Flynn D, Ford GA, et al. Development of a decision analytic model to support decision making and risk communication about thrombolytic treatment. BMC Med Inform Decis Mak, 2015, 15: 90.
36. Knapp P, Wanklyn P, Raynor DK, et al. Developing and testing a patient information booklet for thrombolysis used in acute stroke. Int J Pharm Pract, 2010, 18(6): 362-369.
37. Chung CC, Bamodu OA, Hong CT, et al. Application of machine learning-based models to boost the predictive power of the SPAN index. Int J Neurosci, 2023, 133(1): 26-36.
38. Ali SF, Viswanathan A, Singhal AB, et al. The TeleStroke mimic (TM)-score: a prediction rule for identifying stroke mimics evaluated in a Telestroke Network. J Am Heart Assoc, 2014, 3(3): e000838.
39. Visvanathan A, Dennis M, Mead G, et al. Shared decision making after severe stroke-How can we improve patient and family involvement in treatment decisions?. Int J Stroke, 2017, 12(9): 920-922.

West China Medical Journal

Latest ArticlesApplication and research progress of shared decision-making tools in ultra-early vascular recanalization therapy for ischemic stroke

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