The emerging partnership between palliative care and stroke

Holloway, Robert G.; Bernat, James L.

doi:10.1212/cpj.0000000000000361

Cited by 3 publications

(1 citation statement)

References 8 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…11,12 Time limited trials of therapy may allow surrogates to process emotions and clinicians to provide more accurate predictions regarding long-term outcomes. 13,14 However, conventional outcomes such as mortality and functional scores are unlikely to reflect the potential value in MOLST reversal. For example, death after acute intervention does not necessarily indicate an incorrect decision for MOLST reversal if the emergent procedure was in concordance with patient goals at the time the decision was made.…”

Section: Discussionmentioning

confidence: 99%

Reversal of Advanced Directives in Neurologic Emergencies

McHugh

George

Bender

et al. 2022

The Neurohospitalist

Self Cite

View full text Add to dashboard Cite

Objective Patients with advanced directives or Medical Orders for Life-Sustaining Treatment (MOLST), including “Do Not Resuscitate” (DNR) and/or “Do Not Intubate” (DNI), may be candidates for procedural interventions when presenting with acute neurologic emergencies. Such interventions may limit morbidity and mortality, but typically they require MOLST reversal. We investigated outcomes of patients with MOLST reversal for treatment of neurologic emergencies. Methods We conducted a retrospective chart review from July 1, 2019 to April 30, 2021 of patients with MOLST reversal treated in our NeuroMedicine Intensive Care Unit. Variables collected include neurologic disease, MOLST reversal decision maker, procedural interventions, and outcomes. Results Twenty-seven patients (18 female, median age 78 years (IQR 73-85 years), median baseline modified Rankin score 1 [IQR 0-2.5] were identified with MOLST reversal. The most common pre-procedural MOLST was DNR/DNI (n=22, 81%), and 93% (n=25) pre-procedural MOLSTs were completed by the patient. MOLSTs were reversed by surrogates in n=23 cases (85%). The median time from MOLST completion to MOLST reversal was 603 days (IQR 45 days to 4 years). The most common neurologic emergency was ischemic stroke (n=14, 52%). Most patients died (n=14, 52%), 26% (n=7) were discharged to skilled nursing, and 22% (n=6) returned to home or assisted living. Conclusions In neurologic emergencies, urgent shared decision making is needed to ensure goal-concordant care, which may result in reversal of existing advanced directives. Outcomes of patients with MOLST reversal were heterogeneous, emphasizing the importance of deliberate patient-centered care weighing the risks and benefits of each intervention.

show abstract

Section: Discussionmentioning

confidence: 99%