Stroke is a major cause of death and lifelong disability. Although stroke treatments have improved, many patients are left with life-changing deficits. Shared decision making and consent are fundamental to good medical practice. This is challenging because stroke often causes mental incapacity, prior views might not be known and prognosis early after stroke is often uncertain. There are no large trials of shared decision making after severe stroke, so we need to rely on observational data to inform practice. Core ethical principles of autonomy, beneficence, non-maleficence and justice must underpin our decision making. ‘Surrogate’ decision makers will need to be involved if a patient lacks capacity, and prior expressed views and values and beliefs need to be taken into account in decision making. Patients and surrogates often feel shocked at the sudden nature of stroke, and experience grief including anticipatory grief. Health care professionals need to acknowledge these feelings and provide support, be clear about what decisions need to be made and provide sufficient information about the stroke, and the risks and benefits of treatments being considered. Shared decision making can be emotionally difficult for health care professionals and so working in a supportive environment with compassionate leadership is important. Further research is needed to better understand the nature of grief and what sort of psychological support would be most helpful. Large randomised trials of shared decision making are also needed.

中文翻译：

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严重中风后老年人的共同决策

中风是死亡和终身残疾的主要原因。尽管中风治疗有所改善，但许多患者仍面临着改变生活的缺陷。共同决策和同意是良好医疗实践的基础。这是具有挑战性的，因为中风常常导致精神障碍，先前的观点可能不为人所知，并且中风后早期的预后通常是不确定的。目前还没有关于严重中风后共同决策的大型试验，因此我们需要依靠观察数据来指导实践。自主、仁慈、非恶意和正义等核心道德原则必须成为我们决策的基础。如果患者缺乏能力，则需要“代理”决策者参与，并且在决策时需要考虑之前表达的观点、价值观和信仰。患者和代理人经常对中风的突然性感到震惊，并经历悲伤，包括预期的悲伤。医疗保健专业人员需要承认这些感受并提供支持，明确需要做出哪些决定，并提供有关中风的充分信息，以及正在考虑的治疗的风险和益处。对于医疗保健专业人员来说，共同决策可能会在情感上变得困难，因此在富有同情心的领导力的支持性环境中工作非常重要。需要进一步的研究来更好地了解悲伤的本质以及什么样的心理支持最有帮助。还需要共同决策的大型随机试验。