A new scientific statement from the American Heart Association (AHA), published in Stroke, provides updated insight on how the integration of palliative care can improve overall quality of life for both survivors of a stroke and their caregivers.
The co-authored statement accompanies a scientific statement on palliative and end-of-life care in Stroke that was released by the AHA in 2014, which discussed core palliative care competencies and skills for health care professionals. The updated statement covers the significant updates that have emerged over the past decade, including the importance of palliative care principles to all levels of care for a stroke.
“Even though the majority of strokes are not immediately life-threatening, every stroke is life-altering, and every stroke requires high-quality, person-centered care,” said Claire J. Creutzfeldt, MD, chair of the writing group that authored the new statement and associate professor of neurology at the University of Washington in Seattle, in a press release. “Integrating palliative care principles into stroke care is fundamental for all patients at every stage after a stroke.”
As treatment for strokes has advanced over the last decade, the number of survivors has increased. Despite this increase, survivors often experience long-term physical and cognitive challenges in the weeks, months, and years after experiencing a stroke. The press release also outlines the effect of the complicated recovery process on family members and caregivers, who experience challenges of their own in helping loved ones recover or navigating end-of-life care options.
The updated scientific statement highlights improved communication strategies for goals of care, how the different needs of patients and their caregivers can be better met by health care professionals, and how caregivers can navigate the complexity of end-of-life care when necessary. It also highlights the inequities that exist in palliative care for survivors of stroke.
The Spectrum of Support Needs in Palliative Care
According to the AHA statement, the most successful post-stroke care interventions are those that emphasize the importance of supporting patients and their caregivers through the emotional, psychosocial, spiritual, and existential needs that arise during palliative care. The authors encourage multidimensional, proactive, and holistic assessments for patients and their caregivers, focusing on goals of care and care expectations.
“An individualized and culturally sensitive approach to assessment and management is always best. Additionally, the palliative care needs of patients and their families or care partners after a stroke fluctuate over the course of their illness based on events, symptoms, changes in function and stage of the illness,” said Creutzfeldt in the press release.
How Systematic Inequities Affect Patient Outcomes After a Stroke
Other factors outlined by the scientific statement that influence patient outcomes in palliative care are the systemic disparities and inequities in stroke health care, which have the most far-reaching impact on Black, Hispanic, and Asian patients. These patient populations have a “higher stroke incidence, worse functional outcomes, and less frequent use of acute treatments, such as intravenous therapy or surgical procedures to treat blood clots.”
Some of the differences in stroke care for minority patient populations include being less likely than White patients to have “do not resuscitate” orders and advance directives and being less likely to be discharged to hospice care than White patients. The new statement also provides suggestions on combatting systemic inequities through tailored care strategies, many of which were previously covered in the AHA 2023 scientific statement, Strategies to Reduce Racial and Ethnic Inequities in Stroke Preparedness, Care, Recovery, and Risk Factor Control.
In the press release, Creutzfeldt stressed that “it’s essential to recognize the impact of illness and disability on someone’s quality of life and understand that treatment decisions will vary from patient to patient, based on their values, their beliefs, and their culture.”
Expanding Knowledge of Post–Acute Care for Survivors of Stroke
The statement underscores another area of limited research in palliative care for patients and their caregivers after a stroke, the post–acute phase after discharge from the hospital. In two recent studies referenced by the statement authors, 34% to 45% of survivors of a stroke were discharged from the hospital without additional home health care or hospice services. Moreover, 30% to 42% of patients were discharged to inpatient post–acute care facilities.
The authors note that regardless of where patients were discharged, referrals to palliative care options were infrequent. In addition, a recent review article of post-stroke palliative care that was referenced in the statement illustrated that only 0.4% to 8.9% of referrals to such services were made for care after a stroke and most of those referrals were made near the end of life for patients.
End-of-Life Care Versus Palliative Care After Stroke
Although survival after experiencing a stroke is increasing, so is the percentage of patients who die at home after a stroke. Palliative care is available for patients at all treatment stages after an illness, but hospice or end-of-life care, provided only when a patient’s life expectancy is six months or less, is an important resource and can improve quality of life for both patients and their caregivers.
The statement highlights that unlike palliative care, hospice care should focus on managing end-of-life symptoms such as pain and dyspnea, as well as counseling family and caregivers on what to expect during the dying process. The statement underscores that “patients and their family members benefit from receiving intensive comfort measures and emotional support.” And for those patients who don’t qualify for hospice care due to a longer life expectancy, palliative care can also provide care that relieves pain and improves quality of life.
The AHA statement demonstrates that by integrating all principles of palliative care, from immediate survival and recovery after a stroke to end-of-life care when necessary, health care professionals can help with navigation of the complex recovery landscape via strategies that address managing long-term challenges, improving communication for goals of care, combatting care inequities, and addressing the wide spectrum of support needs for patients and their caregivers.
Source: American Heart Association
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