A new statement from the American Heart Association (AHA) recommends that people recovering from a severe stroke receive tailored and coordinated care that optimizes quality of life and minimizes suffering. The statement – which was published today in the journal Stroke – represents the first attempt to establish a fundamental set of recommendations that can help guide physicians, patients, and their families through the difficult decisions that arise from this condition.
“The majority of stroke patients require access to some form of palliative care,” said Robert Holloway, M.D., M.P.H., the chair of the Department of Neurology at the University of Rochester School of Medicine and Dentistry. “Accomplishing this requires that a hospital’s system of stroke care and its team of providers place the patient and their family at the center of the decision-making process and build a plan of care that is based on their values and informed by effective and constant communication.”
Holloway is the lead author of the AHA statement which was crafted by a panel of 12 providers, including Robert McCann, M.D., chief of Medicine at UR Medicine’s Highland Hospital.
Care for patients who have suffered from a severe or life-threatening stroke is influenced by complex medical choices that must be made by caregivers, the patient, and family members. As many as 30 percent of stroke patients face a life of severe disability and family members must often grapple with a series of complex and emotional decisions about treatment and recovery. In many instances these decisions must be made without the direct input of the patient.
The new AHA recommendations – which were based on an exhaustive and systematic review of the current state of stroke care – stress that effective palliative care for stroke requires close collaboration and communication between patients, families, and the team of providers that comprise the stroke care team, including neurologists, neurosurgeons, primary care providers, nurses, and therapists.
Specifically, stroke patients and their families should expect that caregivers will:
- Talk to them about the preferences, needs, and values that will help guide medical decisions;
- Provide them with an understanding of the prognosis, including how to grapple with difficult and serious issues such as the mental or physical losses caused by stroke, including death;
- Understand what aspects of recovery are most important to the patient and family;
- Help them understand the pros and cons of life-sustaining treatment options;
- Guide them through the best treatment options to manage post-stroke symptoms, including pain;
- Help coordinate care, including referral to a palliative care specialists or hospice if necessary;
- Help preserve dignity and maximize comfort through the course of care, including if the patient is in the process of dying or nearing death.
“Stroke is a devastating disease that has so far received little attention in the area of palliative care,” said Holloway. “By addressing the palliative care needs throughout the course of the illness, we can improve quality of life of patients and their families.”