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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
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Palliative and End-of-Life Care After Severe Stroke
Amber R Comer1, Linda S Williams2, Stephanie Bartlett3
1Indiana University School of Health and Human Sciences (A.R.C), Indianapolis, Indiana.
Journal of Pain and Symptom Management
|January 7, 2022
Summary
Most severe ischemic stroke patients do not receive palliative care consultations (PCC), missing opportunities to reduce suffering. PCC is less common in females but more likely with higher stroke severity, influencing care plans and comfort measures.
Area of Science:
- Neurology
- Palliative Care Medicine
- Health Services Research
Background:
- Severe ischemic stroke has a distinct illness trajectory requiring better understanding of palliative care consultations (PCC).
- Palliative care consultations are crucial for managing complex patient needs and improving end-of-life care in stroke patients.
Purpose of the Study:
- To determine the prevalence, predictors, and outcomes of palliative care consultations for hospitalized severe ischemic stroke patients.
- To identify factors influencing the utilization of PCC in this patient population.
Main Methods:
- A multicenter cohort study involving 1297 patients with severe ischemic stroke (NIHSS ≥ 10) across four hospitals.
- Comparison of sociodemographic, clinical, and care characteristics, along with hospital outcomes, between patients who received PCC and those who did not.
Main Results:
- Palliative care consultations were utilized by 20% of patients, with significant institutional variation (11.9%–43%).
- PCC was less likely in female patients but more likely with higher NIHSS scores.
- Patients receiving PCC showed increased rates of transitioning to comfort measures, including artificial nutrition removal.
Conclusions:
- A majority of severe ischemic stroke patients do not receive PCC, indicating missed opportunities for improved care and suffering reduction.
- PCC is underutilized, particularly for patients who die in the hospital, highlighting a need for earlier integration.
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