AUTHOR=Riesinger Renate , Altmann Klaus , Lorenzl Stefan 

TITLE=Involvement of Specialist Palliative Care in a Stroke Unit in Austria—Challenges for Families and Stroke Teams

JOURNAL=Frontiers in Neurology

VOLUME=Volume 12 - 2021

YEAR=2021

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2021.683624

DOI=10.3389/fneur.2021.683624

ISSN=1664-2295

ABSTRACT=Abstract
Purpose: Severe stroke poses vast challenges. Appropriate goals of care according to individual preferences and values have to be developed under time restrictions – often impeded by limited ability to communicate and the need for decisions by surrogates. 
The aim of our study was to explore the decision-making process and the involvement of specialist palliative care in the acute phase of severe stroke.
Methods: Twenty patients suffering from severe ischemic stroke treated in an Austrian acute inpatient stroke unit were included in a prospective study. Their families were interviewed with a questionnaire (FS-ICU 24), which covered satisfaction with care and decision-making. With a second questionnaire, decision-making processes within the stroke team were investigated.
Results: A palliative approach and early integration of specialist palliative care in severe ischemic stroke results in individualized therapeutic goals, including withholding therapeutic or life-sustaining measures, especially in patients with pre-existing illness.
Conclusions: Family members benefit from understandable and consistent information, emotional support and a professional team identifying their needs. Stroke unit professionals need skills as well as knowledge and strategies in order to make decisions and provide treatment at the end-of-life, when there may be ethical or legal issues.
Close cooperation with specialist palliative care services supports both treatment teams and families with communication and decision-making for patients with severe ischemic stroke.