Family Decision about the Treatment Options at the Sudden Change for a Patient with Serious Stroke Condition

Monday, 9 November 2015

Eri Kataoka, MSN, RN
Department of Nursing, Kawasaki Medical School Hospital, Kurashiki, Japan
Misae Ito, PhD, RN, RMW, MSN, PhD
Department of Nursing, Faculty of Haelth and Welfale, Kawasaki University of Medical Welfare, Kurashiki, Japan


When a patient has serious stroke, family will make a decision whether cardiopulmonary resuscitationis performed or not on admission. It is expected the family is unable to make a decision. The purpose of this study was to clarify how the family made a decision about the treatment options at the sudden change for a patient with serious stroke condition.


The families of a patient in this study were recruited with an introduction from the physician in charge of the patient who had stable conditions with serious stroke, were independent before admissions, and explained the treatment options including Do Not Attempt Resuscitation at the sudden change on admission. The participants were agreed with the study participation orally and in writing, and asked by interviewing the structured and semi-structured items made by the investigators originally after approving the ethical committees from Kawasaki University of Medical Welfare and the hospital where the investigators recruited the participants. The interviews were recorded by IC recorder with their agreements. Data were analyzed verbatim by the content analysis.


One-third patients told the families about a life prolonging remedy in advance orally, and one-third families desired all life prolonging remedies not complying with the instructions of the doctors. Thoughts of the families making decisions on the treatment options at the sudden change for the patients were categorized into the following five categories: ‘difficulty in understanding the life-prolonging treatment once’; ‘to think whether to do life-prolonging treatment by the patient condition’; ‘I cannot but entrust a doctor’; ‘To have no doubts how to make decision’; and ‘To recall the patient’s wishes.’


It’s necessary for nurses to understand how the family understand and feel the patient’s situations, and how they have the patient’s wishes when they are required the decision-making of the treatment options at the patient’s sudden change. Nurses also have to collaborate with a physician in an interprofessional team.