Abstract
Purpose: Severe stroke poses vast challenges. Appropriate goals of care according to individual preferences and values have to be developed under time restrictions—often impeded by limited ability to communicate and the need for decisions by surrogates. The aim of our study was to explore the decision-making process and the involvement of specialist palliative care in the acute phase of severe stroke.Methods: Twenty patients suffering from severe ischemic stroke treated in an Austrian acute inpatient stroke unit were included in a prospective study. Their families were interviewed with a questionnaire (FS-ICU 24), which covered satisfaction with care and decision-making. With a second questionnaire, decision-making processes within the stroke team were investigated.Results: A palliative approach and early integration of specialist palliative care in severe ischemic stroke results in individualized therapeutic goals, including withholding therapeutic or life-sustaining measures, especially in patients with pre-existing illness.Conclusions: Family members benefit from understandable and consistent information, emotional support, and a professional team identifying their needs. Stroke unit professionals need skills as well as knowledge and strategies in order to make decisions and provide treatment at the end-of-life, when there may be ethical or legal issues. Close cooperation with specialist palliative care services supports both treatment teams and families with communication and decision-making for patients with severe ischemic stroke.
Highlights
Stroke is a leading cause of death and disability worldwide
The aim of our study was to assess whether the approach of having early and close cooperation with specialist palliative care (SPC) services has an impact on stroke patient’s families sense of satisfaction
A total of 427 patients with ischemic stroke were treated in this stroke unit in 2019
Summary
Stroke is a leading cause of death and disability worldwide. Despite a decline in incidence and mortality in recent years, the prevalence of stroke increases due to a growing and aging population. Stroke will remain a major concern globally [1]. American and Canadian professional societies recommend palliative care as an integrated part of stroke care [2, 3]. Families are confronted with an acute onset and the victim’s devastating decline in function and cognition— often accompanied by loss of verbal communication skills. Anxiety and depression among stroke patient’s family members are common [4] and the related emotional burden is measurable 1 year after the incident [5]
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