Who Obtains Informed Consent for Endovascular Thrombectomy in Acute Stroke? A Survey of Clinicians.
Abstract Body: Introduction: Informed consent (IC) plays a central role in medical care and research. Practices for endovascular thrombectomy (EVT) in acute stroke are not well elucidated. We investigated the clinical roles and medical specialties of individuals who obtain IC for EVT, aiming to provide insights for enhancing the process in contemporary stroke care.
Methods: We conducted a survey from July to December 2023 among clinicians involved in acute stroke care. Utilizing Qualtrics, we disseminated a structured questionnaire through various national and international platforms including the American Academy of Neurology and StrokeNet. This analysis summarizes findings pertaining to the characteristics of those who obtain EVT IC at the respondents’ institution.
Results: Among 168 participants, 71% were staff physicians, 70% practiced in the United States (US), and 70% were based at academic centers. The most common medical specialties obtaining EVT IC were neurology (77%), followed by neurosurgery (41%), radiology (30%) and emergency medicine (10%) (Table 1). Staff physician (61%) was the most common clinical role involved, followed by fellows (43%), residents (48%), and advanced practice providers (APP, 36%) (Table 2). Non-US institutions were more likely to utilize a provider from neurology alone (50% vs. 31%, p=0.016) and staff physicians (76% vs. 54%, p=0.008), while US institutions were more likely to utilize providers from neurosurgery (51% vs. 18%, p<0.001), APPs (43 vs. 18%, p=0.002) and residents (56% vs. 28%, p=0.001). Non-academic institutions more frequently used emergency medicine providers (25% vs. 5%, p<0.001) and APPs (50% vs. 31%, p=0.031), while academic institutions commonly utilized neurosurgery providers (48% vs. 18%, p=0.001), residents (59% vs. 13%, p<0.001) and fellows (52% vs. 18%, p<0.001).
Conclusion: This study highlights the diverse medical specialties and clinical roles of persons obtaining IC for EVT, with neurologists and staff physicians being the most frequently utilized. These variations likely reflect availability and capacity of certain providers in different settings. Future efforts to optimize the IC process should be multi-disciplinary, with standardized content that addresses issues such as ischemic core volume, outcome expectations and diversity.
Mbonde, Amir
( Medical College of Georgia
, Scottsdale
, Arizona
, United States
)
Patel, Aman
( Massachusetts General Hospital
, Boston
, Massachusetts
, United States
)
Young, Michael
( Massachusetts General Hospital
, Boston
, Massachusetts
, United States
)
Regenhardt, Robert
( Massachusetts General Hospital
, Watertown
, Massachusetts
, United States
)
Alsarah, Ali
( Massachusetts General Hospital
, Boston
, Massachusetts
, United States
)
Demaerschalk, Bart
( Mayo Clinic College of Medicine
, Scottsdale
, Arizona
, United States
)
Dmytriw, Adam
( Massachusetts General Hospital
, Boston
, Massachusetts
, United States
)
Moyer, Quentin
( Massachusetts General Hospital
, Boston
, Massachusetts
, United States
)
Hirsch, Joshua
( MGH
, Boston
, Massachusetts
, United States
)
Singhal, Aneesh
( Massachusetts General Hospital
, Boston
, Massachusetts
, United States
)
Leslie-mazwi, Thabele
( University of Washington
, Seattle
, Washington
, United States
)
Rost, Natalia
( MASSACHUSETTS GENERAL HOSPITAL
, Winchester
, United States Minor Outlying Islands
)
Author Disclosures:
Amir Mbonde:DO NOT have relevant financial relationships
| Aman Patel:DO have relevant financial relationships
;
Consultant:microvention :Active (exists now)
; Consultant:medtronic:Active (exists now)
; Consultant:Stryker:Active (exists now)
| Michael Young:No Answer
| Robert Regenhardt:DO have relevant financial relationships
;
Other (please indicate in the box next to the company name):Rapid Medical (DSMB):Active (exists now)
; Research Funding (PI or named investigator):SVIN:Past (completed)
; Research Funding (PI or named investigator):Heitman Foundation for Stroke:Active (exists now)
; Research Funding (PI or named investigator):NINDS:Past (completed)
| Ali Alsarah:No Answer
| Bart Demaerschalk:DO NOT have relevant financial relationships
| Adam Dmytriw:DO NOT have relevant financial relationships
| Quentin Moyer:No Answer
| Joshua Hirsch:DO have relevant financial relationships
;
Consultant:Medtronic:Active (exists now)
; Consultant:Viz AI:Active (exists now)
; Consultant:Sanofi:Active (exists now)
; Consultant:Rapid Medical:Active (exists now)
; Consultant:Cerenovus:Active (exists now)
; Consultant:Relievant:Active (exists now)
| Aneesh Singhal:DO have relevant financial relationships
;
Royalties/Patent Beneficiary:UptoDate Mecicine:Active (exists now)
; Consultant:Medical Expert Witness:Active (exists now)
; Research Funding (PI or named investigator):NIH-NINDS:Active (exists now)
; Other (please indicate in the box next to the company name):Medlink, Inc (honoraria):Active (exists now)
| Thabele Leslie-Mazwi:DO NOT have relevant financial relationships
| Natalia Rost:DO NOT have relevant financial relationships