Stroke Survivors' Perspectives on Post–Acute Rehabilitation Options, Goals, Satisfaction, and Transition to Home

Abstract

Background and Purpose: Patients and caregivers have not typically been involved in the selection of a post-acute care (PAC) provider. In 2015, the Centers for Medicare and Medicaid Services (CMS) proposed the need to involve patients and their families during discharge planning. Engaging patients in rehabilitation decisions encourages shared decision-making among patients and their clinicians. The purpose of this study was to examine stroke survivors' perspectives on their involvement in selecting a post-acute care (PAC) provider and their goalsetting, and their satisfaction with the rehabilitation stay, and their discharge advice for stroke survivors, prior to 2015.Methods: This qualitative study utilized semi-structured interviews. Thematic content analysis was performed on 18 stroke survivors' interviews (mean age=68 years) on their involvement related to their inpatient rehabilitation facility (IRF) or skilled nursing facility (SNF) stay, goalsetting, and discharge needs.Results: More than half the participants were not involved in the selection of their PAC setting and believed that doctors made these decisions. Around two-fifths of stroke survivors reported they were not involved in rehabilitation goal-setting. Most patients were satisfied with their rehabilitation stay. When asked to recommend discharge topics for other stroke survivors,

Enablers and barriers in hospital‐to‐home transitional care for stroke survivors and caregivers: A systematic review

“…Due to shortened hospital stays, comprehensive discharge planning must begin early in the inpatient setting to enable preparation for transitioning to the community (Mountain et al, 2020;Olson, & Juengst, 2019). Barriers to a partnership approach during discharge planning include the readiness of survivors and caregivers to participate, the lack of organisational support for health professionals and inadequate person-centredness in goal setting (Busetto et al, 2020;Connolly, & Mahoney, 2018;Kable et al, 2019;Krishnan et al, 2019;Pereira et al, 2020). With mismatched care goals and priorities between health professionals and survivors/caregivers, an informed and well-planned transition is unlikely to be achieved, resulting in unmet care needs and negative impacts on the development of self-management capacities for long-term stroke management at home (Andrew et al, 2018;Hughes et al, 2019).…”

“…This organisational context of care constrains health professionals' commitment to optimise care services (Chen et al, 2020;O'Brien et al, 2014). Discrepancies in goals are reported to inhibit partnerships and collaborations between clinicians, stroke survivors and caregivers (Chen et al, 2020;Krishnan et al, 2019). Stroke survivors and caregivers feel alone and abandoned after discharge due to fragmented service provision (Lindblom et al, 2020;Miller et al, 2019).…”

“…Self-management capability refers to an individual's strategies, skills and confidence to manage their chronic conditions and take charge of their life (Barker et al, 2018). Factors contributing to inadequate engagement in discharge planning are multifactorial and include lack of collaboration amongst multidisciplinary teams and service providers, time constraints, a lack of beds and readiness of survivors/caregivers to participate (Krishnan et al, 2019;Olson, & Juengst, 2019;Waring et al, 2019). Poor engagement in the discharge planning process prevents stroke survivors and caregivers from building skills and confidence in the management of their condition and undertaking daily activities at home (Miller et al, 2019).…”

Perceptions about the Therapeutic Itinerary after stroke: a qualitative research

“…The delay postpones decision making for the application of thrombolytic drugs, while the recommended time for this procedure is, at most, four hours and thirty minutes after stroke (22)(23) . Literature reports perceptions of delays in seeking treatment after the first symptoms as well as doubts about the diagnosis and quality of care in different countries (9,12,21) .…”

“…Each choice is made according to the situations and explanations culturally accepted by the group (8) . In this regard, different studies have recommended the incorporation of surviving patients' perspectives, within each socio-cultural context, for the improvement of lines of care (9)(10) .…”