Palliative and End-of-Life Care After Severe Stroke

Comer, Amber; Williams, Linda S.; Bartlett, Stephanie; D’Cruz, Lynn; Endris, Katlyn; Marchand, McKenzie; Zepeda, Isabel; Waite, Carly; Jawed, Areeba; Holloway, Robert G.; Creutzfeldt, Claire J.; Slaven, James E.; Torke, Alexia M.

doi:10.1016/j.jpainsymman.2021.12.032

Cited by 15 publications

(9 citation statements)

References 29 publications

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“…For hospitalized stroke patients, this leads to various problems: firstly, patients are not placed in contact with a collaborating palliative care team at an early stage in the hospital. For example, data from a multicenter study including four major United States hospitals show that palliative consultants became involved for stroke patients with severe disease a median of 2-9 days before the patients' deaths (37). Only 19.7% of the affected patients received a consultation from the palliative care service.…”

Section: Barriers To Hospice Transfermentioning

confidence: 99%

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Frequency of discharge of hospitalized patients with stroke to free-standing hospice facilities—a register study from Germany

Dasch¹,

Berger²,

Lenz³

et al. 2022

Ann Palliat Med

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Background: Due to a lack of data, it is unknown if and how frequently in-patients with severe stroke are discharged to free-standing hospice facilities in Germany.Methods: Patients aged 18 or over who had been hospitalized for ischemic stroke (IS) (International Statistical Classification of Diseases, ICD-10: I63), intracerebral bleeding (ICB) (ICD-10: I61), or subarachnoid bleeding (SAB) (ICD-10: I60) were investigated. The analysis was based on data from the Northwest-German Stroke Registry from 2017 to 2020. The aim was to determine the frequency (crude/ age-standardized) of hospital discharges to hospices. In addition, factors influencing the primary outcome, hospital discharge to a free-standing hospice, were assessed using multivariate logistic regression.Results: A total of 339,513 cases of hospitalized patients diagnosed with stroke were recorded, comprising 308,067 (90.7%) with IS, 26,957 (7.9%) with ICB, and 4,489 (1.3%) with SAB. Their mean age was 73.1±13.1 years, and 52.6% were men. During hospitalization, 26,037 patients died (7.7%), including

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Section: Barriers To Hospice Transfermentioning

confidence: 99%

“…Numerous studies have emphasized the need for palliative care and the importance of including palliative care expertise in the treatment of stroke patients with severe disease courses (24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37). Respect for the patient's dignity represents an essential aspect of palliative care here.…”

Section: Introductionmentioning

confidence: 99%

Frequency of discharge of hospitalized patients with stroke to free-standing hospice facilities—a register study from Germany

Dasch¹,

Berger²,

Lenz³

et al. 2022

Ann Palliat Med

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Section: Introductionmentioning

confidence: 99%

“…7 A recent published study highlights missed opportunities with only 1 in 5 individuals admitted with severe stroke receiving PC consultation and stresses the need for further work in this area. 8 Use of electronic medical record (EMR) for reminding and guiding providers to standardized approaches of care of diseases has been shown to be helpful for a variety of medical needs. 9 Triggers utilized to notify a provider when a patient with atrial fibrillation is not anticoagulated in an effort to stimulate more conversations about starting anticoagulation have proven to be beneficial.…”

Section: Introductionmentioning

confidence: 99%

Improving Access to Specialist Palliative Care for Patients With Catastrophic Strokes Using Best Practice Advisory- a Feasibility Study

Nagpal

Osgood

Reidy

et al. 2023

The Neurohospitalist

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Background and Purpose The American Heart Association and American Stroke Association (AHA/ASA) strongly recommend specialty palliative care (PC) for all patients hospitalized with life-threatening or life-altering strokes to provide expert symptom management, improve communication, promote shared decision-making and relieve suffering. We piloted an intervention to remind physicians about high PC needs of their patients admitted with catastrophic stroke. Methods We worked with colleagues from medical informatics to create a “Best Practice Advisory” (BPA) to recommend a goals-of-care conversation and PC consultation for patients with a National Institutes of Health Stroke Scale (NIHSS) score of 20 or more in our electronic medical record (Epic). We evaluated the impact of this BPA, after implementation, on the number and timing of PC consults and reviewed barriers to this system change. Results The BPA was operational in Jan 2019. Data analysis showed that it fired for all patients with an entered NIHSS score of ≥20. Though a large portion of the BPAs (more than 90%) were acknowledged without documented reason (after selecting “do not order”), PC consultations per 100 patients with triggered BPA increased from the first year of implementation (11.7 in 2019) to the next 2 years (20.7 in 2020, 15.6 in 2021). Also, the providers learned to manage BPA alerts better resulting in more than 30% reduction in the number of BPA alerts fired for each patient encounter in 2020-2021 compared to 2019.

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“…Despite the recognition that PC services after acute stroke are valuable, gaps exist in the identification of appropriate short- and long-term PC services for acute stroke patients as well as in the utilization of PC services throughout the illness trajectory 3 . The issue remains that patients with acute stroke do not consistently receive PC consultation (PCC) 11,12 . Williams and colleagues reviewed patients with acute stroke who received or did not receive PCC.…”

mentioning

confidence: 99%

Evaluating the FRAIL Questionnaire as a Trigger for Palliative Care Consultation After Acute Stroke

Keiser

Buterakos

Stutzky

et al. 2023

J Hosp Palliat Nurs

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The American Heart Association and the American Stroke Association jointly released guidelines stating that all patients with a new diagnosis of stroke should receive palliative care consultation starting in the acute phase of care. The purpose of this project was to increase palliative care consultation rates for patients after an acute stroke by using a frailty score to trigger a palliative care consult. Provider education on palliative care and a 5-question fatigue, resistance, ambulation, illnesses, and loss of weight (FRAIL) questionnaire was delivered by a presentation, handouts, and a follow-up email using previously developed content. Patients included adults admitted to the neuroscience critical care unit of a Midwestern comprehensive stroke center with an admission diagnosis of acute stroke (n = 120). The charge nurse completed the FRAIL questionnaire as a screening tool to trigger a palliative care consult. A survey was also distributed to providers (n = 54) to understand their knowledge, thoughts, and feelings toward palliative care. There was an increase in patients who received palliative care consultation from 14.9% to 21.7% after implementation of the FRAIL questionnaire. Also, providers felt better able to provide symptom management to patients after acute stroke. Further research is necessary to determine if the FRAIL survey is an adequate trigger for palliative care consultation.

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Palliative and End-of-Life Care After Severe Stroke

Cited by 15 publications

References 29 publications

Frequency of discharge of hospitalized patients with stroke to free-standing hospice facilities—a register study from Germany

Frequency of discharge of hospitalized patients with stroke to free-standing hospice facilities—a register study from Germany

Improving Access to Specialist Palliative Care for Patients With Catastrophic Strokes Using Best Practice Advisory- a Feasibility Study

Evaluating the FRAIL Questionnaire as a Trigger for Palliative Care Consultation After Acute Stroke

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