A study on factors influencing decision - making conflicts of proxies of thrombolytic patients with acute ischemic stroke: a network analysis

Abstract Background In China, the informed consent for thrombolysis in patients with AIS tends to be primarily signed by proxy decision-makers, generally for the family members of patients. The decision-making process is considerably influenced by various factors, including environmental conditions, individual characteristics, and clinical contexts, all of which exhibit substantial effects on the quality and efficiency of the decision-making process. Objective To conduct an in-depth analysis of the core and bridging factors that influence the decision-making processes of proxy decision-makers, aimed at establishing a foundation for the development of targeted decision support interventions. Methods A cross-sectional study was conducted from January 2024 to December 2024, involving the recruitment of volunteers from the Emergency Department of a tertiary hospital. The Cognitive Appraisal Orientation Test (CAOT), State-Trait Anxiety Inventory (STAI), Chinese version of the Decisional Conflict Scale (C-DCS), Wake Forest Physician Trust Scale (WFPTS), and Perceived Social Support Scale (SSS) were employed to evaluate the effects of the individual and environmental factors. Additionally, network analysis was applied in the visualization of the interrelationships among these variables, alongside the analysis of the pertinent indicators of the network structure. Results 855 valid questionnaires were obtained for subsequent analysis. Within the network structure, the value clarity dimension of C-DCS (C-DCS-val) (rs = 17.313, rc = 0.095) exhibited the highest strength and closeness centrality. Specifically, C-DCS-val from the C-DCS, the benevolent dimension of WFPTS (WFPTS-love) (rs = 11.421, rc = 0.088) from the WFPTS, and the positive dimension of CAOT (CAOT-pos) (rs = 8.312, rc = 0.067) from the CAOT were identified to exhibit the greatest strength centrality within their respective clusters. Additionally, WFPTS-love could function as a bridging factor between the multiple clusters within the network structure. Conclusion C-DCS-val serves as the central determinant, while WFPTS-love functions as the bridge that influences the decision-making process. This study highlights the critical role of healthcare professionals in aiding proxy decision-makers to clarify value preferences, alongside the enhancement of the effectiveness of their communication strategies.