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Evaluating an Organized Palliative Care Approach in Patients with Severe Stroke

Published online by Cambridge University Press:  02 December 2014

Dylan P. V. Blacquiere
Affiliation:
Division of Neurology, The Ottawa Hospital, Ottawa, Ontario
Gord J. Gubitz
Affiliation:
Division of Neurology, QEII Health Sciences Centre, Halifax, Nova Scotia, Canada
David Dupere
Affiliation:
Division of Palliative Care, QEII Health Sciences Centre, Halifax, Nova Scotia, Canada
Deborah McLeod
Affiliation:
Cancer Care Program, QEII Health Sciences Centre, Halifax, Nova Scotia, Canada
Stephen Phillips
Affiliation:
Division of Neurology, QEII Health Sciences Centre, Halifax, Nova Scotia, Canada
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Abstract

Background:

A recent survey found few guidelines on the provision of palliative care following stroke; none examined the efficacy or results of any such process. The role of the patient's family in decision making and in conflicts with staff has not been evaluated. We sought to formally evaluate the use of locally-developed palliative care guidelines on our Acute Stroke Unit (ASU).

Methods:

We retrospectively examined records of 104 patients who died on our ASU over a two-year period to determine if our existing palliative guidelines were reflected in clinical practice, and to identify conflicts that arose. Data on medical and nursing care, palliative decisions, and medication use were compared to the ASU's existing palliative care guidelines. Family concerns about the palliative process were also reviewed.

Results:

Of patients admitted to the stroke unit, 104 (16% of total admissions) died. Ninety-four (90.4%) of these were palliated; all received routine nursing and comfort care prior to death. Median time from admission to palliation was 3.6 days; median time from admission to death was 8.5 days. Most had vital signs (98.9%), investigations (100%) and non-palliative medications (95.7%) stopped, and had nasogastric feeding (96.8%) and intravenous fluids (87.2%) withdrawn or never begun. Most were treated with morphine (93.6%) and scopolamine (81.9%). Concerns raised by family members centered around hydration and feeding (45.7%), doubts about palliative care (27.8%) and patient comfort (18.2%).

Conclusions:

A formal approach to palliation results in timely decisions regarding end of life care with relatively few conflicts. Further work to address the specific concerns of families is needed.

Type
Other
Copyright
Copyright © The Canadian Journal of Neurological 2009

References

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