Palliative Care for Stroke Patients and Their Families: Barriers for Implementation

Abstract

Stroke is a leading cause of death, disability and is a symptom burden worldwide. It impacts patients and their families in various ways, including physical, emotional, social, and spiritual aspects. As stroke is potentially lethal and causes severe symptom burden, a palliative care (PC) approach is indicated in accordance with the definition of PC published by the WHO in 2002. Stroke patients can benefit from a structured approach to palliative care needs (PCN) and the amelioration of symptom burden. Stroke outcome is uncertain and outlook may change rapidly. Regarding these challenges, core competencies of PC include the critical appraisal of various treatment options, and openly and respectfully discussing therapeutic goals with patients, families, and caregivers. Nevertheless, PC in stroke has to date mainly been restricted to short care periods for dying patients after life-limiting complications. There is currently no integrated concept for PC in stroke care addressing the appropriate moment to initiate PC for stroke patients, and the question of how to screen for symptoms remains unanswered. Therefore, PC for stroke patients is often perceived as a stopgap in cases of unfavorable prognosis and very short survival times. In contrast, PC can provide much more for stroke patients and support a holistic approach, improve quality of life and ensure treatment according to the patient's wishes and values. In this short review we identify key aspects of PC in stroke care and current barriers to implementation. Additionally, we provide insights into our approach to PC in stroke care.

Knowledge, attitude, confidence, and educational needs of palliative care in nurses caring for non-cancer patients: a cross-sectional, descriptive study

“…For example, patients with cancer usually face steady progression and a short-term terminal phase; while patients with chronic diseases, such as organ failure, gradually decline with intermittent deterioration and recovery episodes [ 14 ]. Moreover, lack of palliative care experience could be associated with lower palliative care knowledge levels for non-cancer patients because there is not yet an integrated concept regarding the appropriate moment for transition from acute or critical care to palliative care in non-cancer patients [ 42 ]. Hence, doctors and nurses caring for non-cancer patients should be trained to understand the diverse needs and develop competency in providing timely palliative care [ 42 ].…”

“…Moreover, lack of palliative care experience could be associated with lower palliative care knowledge levels for non-cancer patients because there is not yet an integrated concept regarding the appropriate moment for transition from acute or critical care to palliative care in non-cancer patients [ 42 ]. Hence, doctors and nurses caring for non-cancer patients should be trained to understand the diverse needs and develop competency in providing timely palliative care [ 42 ]. Further research on developing education programs for nurses caring for non-cancer patients should be conducted.…”

Mortality prognostication scores do not predict long-term, health-related quality of life after burn: A burn model system national database study

“…[ 10 ] Therefore, it is important that we develop support tools for these discussions and activities. Such tools have been used in the hours and days after other emergency conditions, such as non-burn injury, traumatic brain injury, respiratory failure, stroke and sepsis [ [11] , [12] , [13] , [14] ]. Over the last two decades, reports have described long-term quality of life after burn injury derived from patient-reported outcome measures.…”

The Attitudes of Physicians and the General Public toward Prognostic Disclosure of Different Serious Illnesses: a Korean Nationwide Study

“…Many previous studies have explored, for a range of serious illnesses, the barriers associated with the provision of palliative care to patients. 12 13 14 Their findings showed that one of the main challenges in this regard is a lack of discussion regarding prognosis and life expectancy. 15 16 17 18 A realistic sense of prognosis can help patients plan and make informed care-related decisions as they approach the end of their lives.…”