Background Despite advances in managing stroke, death and severe disability are common outcomes. Many patients unfortunately have profound irreversible damage on a background of multiple co-morbidities. However there is also a group of patients where the extent of irreversibility is unclear and the likelihood of survival may be longer, which leads to complex issues around capacity and decision making, whether clinically assisted nutrition and hydration is appropriate and ongoing symptom management. Difficulties can arise in recognising dying when the trajectory of the disease is not easily predicted.
Method Since May 2016 a member of the palliative care team has attended the board round on the acute stroke ward on a weekly basis to provide direct advice or take referrals while discussing all ward patients.
Results Over 12 months the palliative care team was involved in the care of 37 patients. The average Karnofsky Performance Score (KPS) of patients seen was 20. 57% referrals were related to managing patients in the last few days of life with 76% needing advice regarding symptom management. Nearly a third of referrals involved supporting the team in appropriate decision making around escalation of care in particular use of artificial feeding in patients who lack capacity.
Conclusions Stroke patients do have palliative care needs. The acute stroke team valued having regular input from the specialist palliative care team in particular with regard to recognising and managing the last few days of life and help in decision making around long term feeding in patients with an uncertain prognosis who lacked capacity. Funding has been approved to develop this work further with a pilot project enabling a palliative care CNS to have designated time to work on the general stroke wards from 2018.
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