Background: Individual values and beliefs vary according to cultural and social factors. To better understand clinical decision-making and inform future research, we undertook a survey of preferences in treatment goals for managing patients with acute ischemic stroke among medical professionals in China.
Methods: We designed a web-based survey through literature search, face-to-face interviews, pilot questionnaire development, and focus group meetings. Key outcomes explored were death, disability, quality of life, neurological impairments, cognitive dysfunction, and hemorrhagic transformation. Participants were asked to rate the importance of each outcome on a 5-point Likert scale to allow calculation of a weighted score of importance: higher scores indicating greater importance.
Results: During promotion among 2700 delegates at several major neurology conferences in 2018, 1189 participants (mean age 40 years, 53% female) completed the survey of whom 96% were clinicians, mainly from tertiary care hospitals located in 30 Provinces of China. For established therapies with bleeding risk (e.g. thrombolysis and thrombectomy), death was the most important outcome (weighted score 4.60), followed by disability (4.45), quality of life (4.45), neurological impairments (4.34), cognitive dysfunction (4.03), and hemorrhagic transformation (3.99). For other acute therapies without bleeding risk, quality of life ranked first (4.08), followed by disability (4.03), neurological impairment (3.92), death (3.79), cognitive dysfunction (3.78), and hemorrhagic transformation (3.51). Given a therapy with insufficient evidence of benefit, 845 (71%) participants thought it would be worth trying for potential to improve neurological recovery or quality of life.
Conclusions: From the perspective of Chinese medical staff, death is the most important outcome measure for patients with acute ischemic stroke. When reduction of death or disability were less likely to be achievable, the improvement in quality of life is an acceptable outcome measure. In contrast to the previously perceived high fear of bleeding in practice, hemorrhagic transformation was the least concerned even for therapies with a potential bleeding risk.