Abstract
BackgroundCrucial issues of modern stroke care include best practice end-of-life-decision (EOLD)-making procedures and the provision of high-quality palliative care for dying stroke patients.MethodsWe retrospectively analyzed records of those patients who died over a 4-year period (2011–2014) on our Stroke Unit concerning EOLD, focusing on the factors that most probably guided decisions to induce limitation of life-sustaining therapy and subsequently end-of-life-care procedures thereafter.ResultsOf all patients treated at our Stroke Unit, 120 (2.71 %) died. In 101 (86.3 %), a do-not-resuscitate-order (DNRO) was made during early treatment. A decision to withdraw/withhold further life supportive therapy was made in 40 patients (34.2 %) after a mean of 5.0 days (range 0–29). Overall patient death occurred after a mean time of 7.0 days (range 1–30) and 2.6 days after therapy restrictions. Disturbance of consciousness at presentation, dysphagia on day 1 and large supratentorial stroke were possible indicators of decisions to therapeutic withdrawing/withholding. Proceedings of EOL care in these patients were heterogeneous; in most cases monitoring (95 %), medical procedures (90 %), oral medication (88 %), parenteral nutrition (98 %) and antibiotic therapy (86 %) were either not ordered or withdrawn, however IV fluids were continued in all patients.ConclusionsA high percentage of stroke patients were rated as terminally ill and died in the course of caregiving. Disturbance of consciousness at presentation, dysphagia on day 1 and large supratentorial stroke facilitated decisions to change therapeutic goals thus initiating end-of-life-care. However, there is further need to foster research on this field in order to ameliorate outcome prognostication, to understand the dynamics of EOLD-making procedures and to educate staff to provide high-quality patient-centred palliative care in stroke medicine.Electronic supplementary materialThe online version of this article (doi:10.1186/s12904-016-0113-8) contains supplementary material, which is available to authorized users.
Highlights
Crucial issues of modern stroke care include best practice end-of-life-decision (EOLD)-making procedures and the provision of high-quality palliative care for dying stroke patients
Whereas end-oflife care is well established in diseases such as cancer or advanced heart disease, research on end-of-life care has been relatively neglected in stroke populations and evaluation of end-of-life care processes in stroke has to date been very limited [16,17,18]
Our study aimed to describe and analyze EOLD of dying stroke patients who died during the in-hospital phase on the Stroke Unit, focusing on possible factors that could indicate the decision for a transition from life-sustaining therapy to withdrawal or withholding of defined diagnostic or therapeutic measures, and the impact of this decision on the proceedings thereafter
Summary
Crucial issues of modern stroke care include best practice end-of-life-decision (EOLD)-making procedures and the provision of high-quality palliative care for dying stroke patients. Despite considerable advances in acute stroke therapy and a decline of the relative rate of stroke deaths [1], stroke remains the third to fourth most common cause of death in the United States and Europe [1,2,3]. Despite elaborate recommendations addressing stroke system care and provider teams, standard operating procedures regarding diagnostic and therapeutic management of dying stroke patients are lacking, possibly due to the complexity of end-of-life issues
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