Evidence map›Paper›PMID 25009137›Full record

ArticleBMJ open2014

Understanding clinicians' decisions to offer intravenous thrombolytic treatment to patients with acute ischaemic stroke: a protocol for a discrete choice experiment.

Aoife De Brún, Darren Flynn, Kerry Joyce, Laura Ternent, Christopher Price, Helen Rodgers, Gary A Ford, Emily Lancsar, Matthew Rudd, Richard G Thomson

Open access · goldAbstract read
In one paragraph

Article in BMJ open, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
3.4field-weighted citation impact, top 6% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed, 11 citations in OpenAlex.

  1. Article
  2. Article
  3. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors at 4 institutions in 2 countries.

Aoife De BrúnInstitute of Health & Society, Newcastle University, Newcastle upon Tyne, UK.
Darren FlynnInstitute of Health & Society, Newcastle University, Newcastle upon Tyne, UK.
Kerry JoyceInstitute of Health & Society, Newcastle University, Newcastle upon Tyne, UK.
Laura TernentInstitute of Health & Society, Newcastle University, Newcastle upon Tyne, UK.
Christopher PriceNorthumbria Healthcare NHS Foundation Trust, Ashington, UK.
Helen RodgersInstitute for Ageing and Health (Stroke Research Group), Newcastle University, Newcastle upon Tyne, UK.
Gary A FordOxford University Hospitals NHS Trust, Oxford, UK.
Emily LancsarCentre for Health Economics, Monash University, Clayton, Melbourne, Victoria, Australia.
Matthew RuddNorthumbria Healthcare NHS Foundation Trust, Ashington, UK.
Richard G ThomsonInstitute of Health & Society, Newcastle University, Newcastle upon Tyne, UK.
Newcastle University · GBNorthumbria Healthcare NHS Foundation Trust · GBMonash University · AUOxford University Hospitals NHS Trust · GB

Funding

Department of Health 12/5001/45Department of Health RP-PG-0606-1241Medical Research Council MR/K02325X/1
6 · The paper itself

Abstract

backgroundIntravenous thrombolysis is an effective emergency treatment for acute ischaemic stroke for patients meeting specific criteria. Approximately 12% of eligible patients in England, Wales and Northern Ireland received thrombolysis in the first quarter of 2013, yet as many as 15% are eligible to receive treatment. Suboptimal use of thrombolysis may have been largely attributable to structural factors; however, with the widespread implementation of 24/7 hyper acute stroke services, continuing variation is likely to reflect differences in clinical decision-making, in particular the influence of ambiguous areas within the guidelines, licensing criteria and research evidence. Clinicians' perceptions about thrombolysis may now exert a greater influence on treatment rates than structural/service factors. This research seeks to elucidate factors influencing thrombolysis decision-making by using patient vignettes to identify (1) patient-related and clinician-related factors that may help to explain variation in treatment and (2) associated trade-offs in decision-making based on the interplay of critical factors. METHODS/ANALYSIS: A discrete choice experiment (DCE) will be conducted to better understand how clinicians make decisions about whether or not to offer thrombolysis to patients with acute ischaemic stroke. To inform the design, exploratory work will be undertaken to ensure that (1) all potentially influential factors are considered for inclusion; and (2) to gain insights into the 'grey areas' of patient factors. A fractional factorial design will be used to combine levels of patient factors in vignettes, which will be presented to clinicians to allow estimation of the variable effects on decisions to offer thrombolysis. ETHICS AND DISSEMINATION: Ethical approval for this study was obtained from the Newcastle University Research Ethics Committee. The results will be disseminated in peer review publications and at national conferences. Findings will be translated into continuing professional development activities and will support implementation of a computerised decision aid for thrombolysis (COMPASS) in acute stroke care.

Indexed as

Administration, IntravenousBrain IschemiaClinical Decision-MakingFibrinolytic AgentsHumansResearch DesignStrokeFibrinolytic Agentsdecision-makingdiscrete choice experimentthrombolysis

Identifiers

PMID25009137
PMCPMC4091456
OpenAlexW2145172183

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.