Expert consensus communication for acute stroke treatment

INTERVENTION: Participants watched a video simulation in which a neurologist informed an individual (actor) that their family member had experienced a stroke, and described tissue Plasminogen Activator (tPA) therapy as an option for treatment. The simulation lasted around 5 minutes, the approximate amount of time clinicians have available to convey stroke treatment information. The neurologist was provided with a hypothetical scenario which involved a stroke patient eligible for tPA. During the simulated consultation, the neurologist described the treatment options available to the patient using the essential communication strategies developed by an expert advisory group, which related to: 1) the environment in which the discussion takes place; 2) introduction and purpose of the discussion; 3) information provision; 4) risk communication; 5) addressing emotions and assessing understanding; 6) summarising the discussion. There was no wash‐out period between the viewing expert consensus and usual care communication. CONDITION: Stroke PRIMARY OUTCOME: Hypothetical treatment choice assessed via “Imagine that you were in the position of the patient discussed in the video, would you choose to have the clot busting treatment?” Response options ranged “Yes, definitely”, “Yes, probably” to “No, probably not”, “No, definitely not” (1 ‐ 4). Hypothetical treatment choice for a family member assessed via “Imagine that you were in the position of the person in the video and had to make a decision about treatment for a family member. Would you choose for your family member to have the clot busting treatment?” Response options ranged “Yes, definitely”, “Yes, probably” to “No, probably not”, “No, definitely not” (1 ‐ 4). Mean knowledge of stroke treatment score as assessed via the following 5 multiple choice items. Participants were asked to select the true statement. ; 1) Stroke is caused by: ; ‐ A blockage in the lung ; ‐ A blockage in blood flow to the heart ; ‐ A blockage in blood flow in the brain ; ; 2) tissue Plasminogen Activator (tPA) treatment works by: ; ‐ Thinning the blood to dissolve the clot ; ‐ Reducing inflammation around the clot ; ‐ Causing tissue damaged by the stroke to re‐grow ; ; 3) tPA treatment: ; ‐ Only has risks ; ‐ Has both risks and benefits ; ‐ Only has benefits ; ; 4) tPA treatment: ; ‐ Cannot not save lives ; ‐ Can reduce the amount of brain damage caused by stroke ; ‐ Cannot cause bleeding ; ; 5) Out of 50 people treated with the clot busting medicine, approximately how many would experience bleeding in the brain as a side effect of the treatment? ; ‐ 1 ; ‐ 15 ; ‐ 20 INCLUSION CRITERIA: Patients attending the out‐patient clinic for any type of condition, aged 18 years or older during the study period were eligible to participate. SECONDARY OUTCOME: Acceptability of the communication strategy and information provided in the video as assessed via 16 items using a 4‐point likert scale (1 = strongly agree; 4 = strongly disagree). Given the ratings were from the perspective of the family member, not the hypothetical stroke patient, items were derived from the Decisional Conflict Scale (DCS). The DSC measures personal perceptions of choice uncertainty, factors contributing to uncertainty, and effective decision making. Preferred communication method was identified by asking participants "If you had to make a decision about whether you wanted clot busting treatment to be given to a family member, which style of information giving would you prefer?". An additional 6 items regarding the reasons for their preference were assessed on a 4‐point likert scale (1= strongly agree; 4 = strongly disagree).