1
|
Comer AR, Williams LS, Bartlett S, D'Cruz L, Endris K, Marchand M, Zepeda I, Toor S, Waite C, Jawed A, Holloway R, Creutzfeldt CJ, Slaven JE, Torke AM. Palliative and End-of-Life Care After Severe Stroke. J Pain Symptom Manage 2022; 63:721-728. [PMID: 34995684 PMCID: PMC9018507 DOI: 10.1016/j.jpainsymman.2021.12.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 12/28/2021] [Accepted: 12/30/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND OBJECTIVES The distinct illness trajectory after acute ischemic stroke demands a better understanding of the utilization of palliative care consultations (PCC) for this patient cohort. This study sought to determine the prevalence, predictors, and outcomes associated with PCC for patients hospitalized with severe ischemic stroke. METHODS This multicenter cohort study was conducted at four hospitals (2 comprehensive and 2 primary stroke centers) between January, 2016 and December, 2019. We included all patients with a discharge diagnosis of ischemic stroke and an initial National Institutes of Health Stroke Scale (NIHSS) of 10 or greater. We compared patient sociodemographic, clinical and care characteristics as well as hospital outcomes between patients who did and did not receive PCC. RESULTS The study included 1297 patients hospitalized with severe ischemic stroke. PCC occurred for 20% of all patients and this proportion varied across institutions from 11.9% to 43%. Less than half (43%) of patients who died in the hospital. In multivaraible analysis, PCC was less likely in female patients (OR .76, 95% CI .59, .99, P=0.04) but more likely in patients with higher NIHSS (OR1.95, 95% CI 1,13, 3.37, P=0.02). Patients with PCC had higher rates of moving to a plan focused on comfort measures (CMO) (P<0.01) and removal of artificial nutrition as part of a move to CMO (P<0.01). In a sub analysis of patients who died in the hospital and received PCC, patients who died on or before hospital day 3 were less likely to receive PCC than patients who died on or after hospital day 4 (24% v. 51%) (P=<0.01). CONCLUSIONS Most patients with severe stroke do not receive PCC, even among those who experience in-hospital death. The results of this study indicate there are missed opportunities for PCC to help reduce suffering after severe stroke.
Collapse
Affiliation(s)
- Amber R Comer
- Indiana University School of Health and Human Sciences (A.R.C), Indianapolis, Indiana.
| | - Linda S Williams
- Richard L. Roudebush Veterans Affairs Medical Hospital (L.S.W), Indiana University School of Medicine, Regenstrief Institute, Inc, Indianapolis, Indiana, USA
| | - Stephanie Bartlett
- Indiana University School of Health and Human Sciences (S.B., L.D., K.E., M.M., I.Z., C.W.), Indianapolis, Indiana, USA
| | - Lynn D'Cruz
- Indiana University School of Health and Human Sciences (S.B., L.D., K.E., M.M., I.Z., C.W.), Indianapolis, Indiana, USA
| | - Katlyn Endris
- Indiana University School of Health and Human Sciences (S.B., L.D., K.E., M.M., I.Z., C.W.), Indianapolis, Indiana, USA
| | - McKenzie Marchand
- Indiana University School of Health and Human Sciences (S.B., L.D., K.E., M.M., I.Z., C.W.), Indianapolis, Indiana, USA
| | - Isabel Zepeda
- Indiana University School of Health and Human Sciences (S.B., L.D., K.E., M.M., I.Z., C.W.), Indianapolis, Indiana, USA
| | - Sumeet Toor
- Indiana University School of Medicine (S.T., J.E.S.), Indianapolis, Indiana, USA
| | - Carly Waite
- Indiana University School of Health and Human Sciences (S.B., L.D., K.E., M.M., I.Z., C.W.), Indianapolis, Indiana, USA
| | - Areeba Jawed
- University Of Michigan (A.J.), Ann Arbor, Michigan, USA
| | | | | | - James E Slaven
- Indiana University School of Medicine (S.T., J.E.S.), Indianapolis, Indiana, USA
| | - Alexia M Torke
- Indiana University School of Medicine, Indiana University Center for Aging Research, Regenstrief Institute (A.M.T.), Daniel F. Evans Center for Spiritual and Religious Values in Healthcare, Indianapolis, Indiana, USA
| |
Collapse
|