No abstract

Introduction: The AHA 2014 statement on palliative and end-of-life (EOL) care in stroke recommended patient- and family-centered care and goals of care discussions. Despite a recurrent stroke risk of up to 39% at 10 years, stroke survivors have low advance directive completion rates. We conducted a survey characterizing the advance care planning (ACP) attitudes in our population of stroke clinic patients. Methods: We developed a survey based on validated surveys assessing ACP behaviors and engagement. The survey was provided to all TIA, ischemic and hemorrhagic stroke patients in our clinic between February and August 2021. Non-English-speaking patients and those unable to express preferences were excluded. Results: Surveys were provided to 88 stroke survivors with a 68.2% response rate (N=60). Patient characteristics reported in Table 1. Patients were racially and ethnically diverse and 54.2% had greater than high school education. Patients were also fairly independent, most living at home (96.7%) and ambulatory (63.3%). Most patients completed the survey a median of 43 days after their first stroke (63.3%). Less than half (48.3%) of patients had designated a medical decision maker but many (63.3%) had had conversations with family/decision makers about preferences for future medical care if they were to become very sick or near the EOL. However, only 46.7% felt ready to talk with a doctor about these preferences. More than half (53.3%) of patients indicated that they would like their stroke doctor’s participation if/when they were to have such a conversation. Conclusions: In our study group of diverse, younger and more independent stroke survivors, we found that many had had ACP conversations with surrogate decision makers and more than half wanted their stroke doctor to participate in future discussions. More work is needed to assess the generalizability of our findings and how ACP can be improved for stroke survivors who are at high risk for recurrent events.