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J Med Ethics 2009;35:42-46 doi:10.1136/jme.2007.023192
  • Clinical ethics

“Two per cent isn’t a lot, but when it comes to death it seems quite a lot anyway”: patients’ perception of risk and willingness to accept risks associated with thrombolytic drug treatment for acute stroke

  1. M Mangset1,
  2. E Berge2,
  3. R Førde3,
  4. J Nessa4,
  5. T B Wyller1
  1. 1
    University of Oslo, Department of Geriatric Medicine, Ullevaal University Hospital, Oslo, Norway
  2. 2
    Department of Internal Medicine, Ullevaal University Hospital, Oslo, Norway
  3. 3
    University of Oslo, Centre for Medical Ethics, Oslo, Norway
  4. 4
    University of Bergen, Department of Public Health and Primary Health Care, Bergen, Norway
  1. Margrete Mangset, University of Oslo, Department of Geriatric Medicine, Ullevaal University Hospital, NO-0407 Oslo, Norway; margrete.mangset{at}medisin.uio.no
  • Received 20 September 2007
  • Revised 29 April 2008
  • Accepted 9 May 2008

Abstract

Background: Thrombolytic drugs to treat an acute ischaemic stroke reduce the risk of death or major disability. The treatment is, however, also associated with an increased risk of potentially fatal intracranial bleeding. This confronts the patient with the dilemma of whether or not to take a risk of a serious side effect in order to increase the likelihood of a favourable outcome.

Objective: To explore acute stroke patients’ perception of risk and willingness to accept risks associated with thrombolytic drug treatment.

Design: Eleven patients who had been informed about thrombolytic drug treatment and had been through the process of deciding whether or not to participate in a thrombolytic drug trial went through repeated qualitative, semistructured interviews.

Results: Many patients showed a limited perception of the risks connected with thrombolytic drug treatment. Some perceived the risk as not relevant to them and were reluctant to accept that treatment could cause harm. Others seemed to be aware that treatment would mean exposure to risk. The patients’ willingness to take a risk also varied substantially. Several statements revealed ambiguity and confusion about being involved in a decision about treatment. The patients’ reasoning about risk was put into the context of their health-related experiences and life histories. Several patients wanted the doctor to be responsible for the decisions.

Conclusion: Acute stroke patients’ difficulties in perceiving and processing information about risk may reduce their ability to be involved in clinical decisions where risks are involved.

Footnotes

  • A paper based on a previous version of the study was presented as a poster at the 17th Nordic Congress of Gerontology in Stockholm in 2004 and at the 18th World Congress of Gerontology in Rio de Janeiro in 2005.

  • Funding: Research scholarship from the Nursing Research Section at Ullevaal University Hospital, and support from the interdisciplinary Ethics Programme at the University of Oslo. The authors’ work is independent of this funding.

  • Competing interests: None.

  • Ethics approval: Approval number 279-03124 granted by the Regional Committee for Medical Research Ethics in the Eastern Health Region, Norway.

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