Abstract NS19: Exploring Clinician Perspectives of Treating Acute Stroke with Thrombolytic Therapy: Results of a Multi-Center Qualitative Research Study
Study Objectives: Multiple guidelines endorse recombinant tissue plasminogen activator (rt-PA) in eligible patients with acute ischemic stroke (AIS), but only 4-6% of patients are treated. Clinician doubts about treatment benefits or operational barriers may be among the reasons for not treating potentially eligible patients. Through qualitative interviews, we sought to better understand the issues and perspectives for AIS treatment from Emergency Medicine Physicians (EMP) and Neurology and Emergency based Advanced Practice Nurses (APN) looking for similarities and differences.
Methods: A multidisciplinary research team conducted in-depth interviews of 23 EMPs from 11 sites, and 20 APNs from 18 sites across the US. An interview guide was designed to elicit their current experience using rt-PA in AIS, approach to discussing rt-PA with patients and families, and cultural attitudes.
Results: EMPs (male = 74%; 12 average years of experience) and APNs (male = 5%; 9.4 average years of experience) described two themes as shared perspectives: Timely Presentation and Neurology Presence were both thought to be important facilitators to receive rt-PA. However, differing perspectives emerged in four themes: Knowledge of Long-term Outcomes; Impression of Data; Communication of Risk and Benefit; and Use of Written/Educational Material (Table). The themes and representative quotes are presented by subject number and years in practice.
Conclusions: While common perspectives were described, mainly contrasting beliefs emerged, most of which provide an opportunity to develop future strategies to improve guideline adherence for rt-PA use in AIS for each discipline.
Author Disclosures: E. Gialde: None. J. Spertus: Research Grant; Modest; NHLBI, Gilead, ACCF. Research Grant; Significant; NIH, Genentech. Other Research Support; Modest; OHPR. Ownership Interest; Significant; Health Outcomes Sciences. Consultant/Advisory Board; Modest; Genentech. E. Chhatriwalla: None. B. Garavalia: None. D. Summers: Speakers' Bureau; Modest; Genentech. M. Rymer: Research Grant; Modest; Genentech. Speakers' Bureau; Modest; Covidien. Consultant/Advisory Board; Modest; Medtronic. C. Decker: None.
This research has received full or partial funding support from the American Heart Association, National Center.
- © 2014 by American Heart Association, Inc.