Attitudes of Neurologists and Nurses towards Prognosis and Quality of Life after Decompressive Hemicraniectomy after Space-Occupying MCA Infarction (P07.002)

Abstract

Objective: We assessed attitudes of neurologists and nurses towards decompressive hemicraniectomy (DH) after space-occupying MCA infarction. Background While DH reduces mortality after space-occupying MCA infarction, quality of life in survivors is discussed controversially. Design/Methods: A questionnaire on attitudes regarding prognosis and quality of life after DH sent to tertiary care centers throughout Germany was returned by 280 neurologists and 160 nurses with professional contact to this patient group. Results: In both groups of experts, estimates of the probability of survival after DH and the resulting degree of disability were consistent with results of clinical studies. Only 9% of the nurses and 33% of the physicians assumed that the majority of survivors achieve an acceptable quality of life. 58% of physicians and 32% of nurses would suggest DH to their nearest relative. Assuming an uncertain outcome, 61% of physicians and 22% of nurses would agree to DH. In both professional groups, agreement for surgery increased when scenarios with a more favorable outcome were proposed (modified Rankin Scale (mRS) 2-5)). If an outcome of a mRS of 4 was proposed, indicating moderately severe disability, only a minority favored surgery (25% of doctors, nurses 8%). We found no relevant associations between agreeing to surgery and respondents9 age, sex, religion, living situation, or health status. Conclusions: Despite realistic assessments of patients9 prognoses after DH, the majority of respondents estimated quality of life of survivors as not satisfactory. Nurses had a more pessimistic stance towards DH. The majority of respondents considered an outcome with a mRS of 4 as not acceptable. Our results indicate a discrepancy between guidelines advocating DH as a life-saving treatment option and the attitude of many doctors and nurses who treat these patients in daily practice and who consider quality of life in surviving patients to be not acceptable. Disclosure: Dr. Schwarz has nothing to disclose. Dr. Kuehner has nothing to disclose.