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This manuscript presents a retrospective analysis examining the integration of palliative care into the care of stroke patients admitted to a regional stroke center. The study is important because despite the high morbidity and mortality associated with stroke, there is often a delay in initiating palliative care for these patients until death appears imminent. Early integration of palliative care has been shown to improve quality of life and symptom management in other serious illnesses like cancer.

Key findings and take-away messages:

  • Only 28.8% of stroke patients who died in the hospital received a palliative medicine consultation (PMC), with a median time to consultation of 6 days from admission. This highlights missed opportunities for early palliative care integration.
  • Factors associated with a higher likelihood of receiving PMC included older age, female gender, absence of stroke diagnosis on admission, ischemic stroke type, and comorbidities of cancer or dementia. Admission from another acute care hospital and lower Glasgow Coma Scale scores (indicating coma) were associated with a lower likelihood of PMC.
  • In multivariate analysis, only coma was significantly associated with a higher incidence of death, while no factors remained significantly associated with receiving PMC.

In summary, the results demonstrate an underutilization and delay in palliative care consultation for patients with severe strokes, even among those with the highest risk of death. The authors conclude that prospective studies in various stroke care settings are needed to better understand barriers and optimize the integration of palliative care into the management of acute stroke patients

Read the full paper.

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