AHA/ASA Guideline on Palliative Care in Stroke

March 28, 2014

The American Heart Association/American Stroke Association has issued a scientific statement on palliative care for stroke patients, emphasizing the importance of a well-coordinated medical team to personalize care, optimize quality of life, and minimize suffering.

The statement, published online in Stroke on March 27, is the first in the United States to outline fundamental palliative care — defined as patient- and family-centered care that improves life by anticipating, preventing, and treating suffering — for stroke patients.

Needs Are "Enormous"

The statement describes the palliative care needs of patients with serious or life-threatening stroke and their families as "enormous," including complex decision-making, aligning treatment with goals, and symptom control. "Primary palliative care should be available to all patients with serious or life-threatening stroke and their families throughout the entire course of illness," it states.

"Palliative care should be a collaboration between patients, families, a stroke team and various providers, including neurologists, neurosurgeons, primary care providers, nurses and therapists," said lead author of the statement, Robert Holloway, MD, chairman of the Neurology Department at the University of Rochester, New York.

"The stroke team and its members can manage many of the palliative care problems themselves. It encourages patient independence and informed choices," he added.

The statement points out that stroke care is dominated by clinically challenging, emotionally intense, and ethically complex medical choices, and that most patients when acutely ill or dying want relief of suffering, help in minimizing the burden on families, closer relationships with loved ones, and a sense of control.

It adds that palliative care has much to offer in the provision of stroke care. It should be viewed not as an alternative to offering life-sustaining therapies or other evidence-based stroke treatments but as an important supplement that can enhance care delivery for patients, families, and providers alike.

The statement notes that palliative care should be customized to stroke patients and their families, and should include the following:

  • Talking about patient preferences, needs, and values as a guide to medical decisions;

  • Discussing what aspects of recovery are most important to the patient/family;

  • Having effective, sensitive discussions about the prognosis of the patient, how to deal with physical or mental losses from a stroke, and, if necessary, of dying, among other serious topics;

  • Offering guidance through choices about life-sustaining treatment options, addressing pros and cons of cardiopulmonary resuscitation, ventilators, feeding tubes, surgery, do-not-resuscitate orders, do-not-intubate orders, and natural feeding;

  • Knowing the best treatment options for common post-stroke symptoms, including pain, other physical symptoms, and psychological problems, such as depression and anxiety;

  • Engaging a palliative care specialist if complex issues arise; and

  • Helping preserve dignity and maximizing comfort throughout the course of a stroke, including during the dying process and when nearing death.

Stroke. Published online March 27, 2014. Abstract

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