ORACLE Stroke Study: Opinion Regarding Acceptable Outcome Following Decompressive Hemicraniectomy for XXXX .

@entity1 @entity3517 @entity385
BACKGROUND: There continues to be considerable interest in the use of decompressive hemicraniectomy in the management of @entity385 ; however, concerns remain about long-term outcome. OBJECTIVE: To assess opinion on consent and acceptable outcome among a wide range of healthcare workers. METHODS: Seven hundred seventy-three healthcare workers at the 2 major public neurosurgical centers in Western Australia participated. @entity1 were asked to record their opinion on consent and acceptable outcome based on the @entity3517 ( @entity3517 ). The evidence for clinical efficacy of the procedure was presented, and @entity1 were then asked to reconsider their initial responses. RESULTS: Of the 773 @entity1 included in the study, 407 (52.7%) initially felt that they would provide consent for a decompressive craniectomy as a lifesaving procedure, but only a minority of them considered an @entity3517 score of 4 or 5 an acceptable outcome (for @entity3517 score  <=4, n = 67, 8.7%; for @entity3517 score = 4, n = 57, 7.4%). After the introduction of the concept of the disability paradox and the evidence for the clinical efficacy of decompressive craniectomy, more @entity1 were unwilling to accept decompressive craniectomy (18.1% vs 37.8%), but at the same time, more were willing to accept an @entity3517 score  <=4 as an acceptable outcome (for @entity3517 score  <=4, n = 92, 11.9%; for @entity3517 score = 4, n = 79, 10.2%). CONCLUSION: Most @entity1 felt survival with dependency to be unacceptable. However, many would be willing to provide consent for surgery in the hopes that they may survive with some degree of independence. ABBREVIATIONS: DESTINY, Decompressive Surgery for the Treatment of Malignant Infarction of the Middle Cerebral ArterymRS, modified Rankin Scale.
