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Abstract T MP87: Information Framing And Decision-making After Malignant Middle Cerebral Artery Stroke


 Background and Objective:
 In patients with malignant infarction of the middle cerebral artery (MCA), decompressive hemicraniectomy (DHC) reduces mortality and improves outcome but leaves many survivors severely disabled. In deciding whether to undergo this surgery, patients and surrogates look to providers for relevant prognostic information to help make treatment decisions based on their personal values. The goal of this study is to explore whether the way treatment information is framed influences decision-making regarding DHC.
 
 
 Methods:
 Ambulatory patients and their family members in hospital outpatient waiting rooms were recruited for this voluntary survey. Subjects were randomized to 1 of 5 different videos of a physician discussing treatment options for their loved one with a hypothetical acute malignant MCA ischemic stroke, each video with a different presentation format (positive or negative framing, reporting results in absolute or relative proportions, graphical display). Subjects were then asked to indicate their treatment decisions and to provide basic demographic data.
 
 
 Results:
 Fifty-three subjects were enrolled in the study, the majority of whom were insured (47; 88.7%), white (40; 78.4%) and independent (33; 64.7%). Half were 51 years or older (27; 50.9%) and had an income less than $50,000 annually (50.9%). Randomization arms did not differ according to age (p=0.5), functional status (p=0.3), income (p=0.9), insurance type (p=0.4) or race (p=0.8). Marital status differed slightly between arms (p=0.06). Controlling for marital status, subjects were most likely to choose surgery for their loved one (OR 6.9, 95% CI: 0.6, 77.8) after viewing video B (positive framing, relative risk reduction) and least likely (OR 0.8, 95% CI: 0.1-5.5) after viewing video C (negative framing, relative risk reduction) compared to those in the graphical group.
 
 
 Conclusions:
 Information framing may influence surrogate decision-making for DHC after malignant MCA ischemic stroke. Clinicians should consider this influence when counseling patients; formal decision aids or other methods to present results in a more standardized fashion may help mitigate these effects.
