Decision-making delays in endovascular treatment for acute ischemic stroke: A qualitative study of perspectives from family surrogates, physicians, and nurses.

Abstract

To explore the reasons for decision-making delays in endovascular treatment (EVT) for acute ischemic stroke (AIS), from the perspectives of surrogate decision-makers, physicians, and nurses. This descriptive qualitative study included semi-structured interviews conducted with surrogate decision-makers for patients undergoing endovascular thrombectomy for AIS, as well as the attending physicians and nurses. Participants were recruited using purposive sampling to ensure a diverse representation of perspectives. The data were analysed applying thematic analysis. Our analysis revealed three main themes and seven subthemes: (1) Theme 1, Dynamic decision-making influenced by multiple factors. Family-centered collaborative decision-making; The unique position of surrogate decision-makers; Economic pressure in decision-making. (2) Theme 2, Limited support. Unfamiliar illness and environment; The marginalized role of patients in decision-making processes. (3) Theme 3, Building "bridges" of trust. The importance of doctors; Be patient. Decision-making delays in EVT stem from intertwined cultural, informational, and support-related factors influencing surrogate judgment in time-critical stroke care. Targeted improvements in rapid communication, role clarification, and decision support are essential to reduce treatment delays. These findings offer practical direction for designing strategies and policies to optimize surrogate decision-making and improve access to timely EVT. Healthcare providers should target specific causes of surrogate decision-making delays including family-centered collaborative processes, insufficient support for surrogate decision-makers and trust gaps with medical staff when designing interventions. This study provides targeted references for clinical practices to shorten surrogate decision-making time. It also offers a reference basis for formulating policies to address key barriers in surrogate decision-making delays such as economic pressure and unclear decision-making roles.