Skip to main content

Palliative Care and Stroke

  • Reference work entry
  • First Online:
Book cover Textbook of Palliative Care
  • 143 Accesses

Abstract

There have been significant advances in the prevention and management of stroke over the last few decades. Despite these important developments, stroke, both in the acute and chronic phases, remains a major cause of morbidity and mortality. The value of integrating palliative care principles and practices into stroke care management is being increasingly recognized across a range of domains including symptom management, assistance with complex decision-making, discharge planning, and end-of-life care. This chapter will explore the logistics, benefits, complexities, and challenges associated with the evolving relationship between stroke and palliative care services.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 819.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 1,099.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  • Addington-Hall J, Lay M, Altmann D, McCarthy M. Symptom control, communication with health professionals, and hospital care of stroke patients in the last year of life as reported by surviving family, friends, and officials. Stroke. 1995;26(12):2242–8.

    Article  CAS  PubMed  Google Scholar 

  • Alonso A, Ebert AD, Dörr D, Buchheidt D, Hennerici MG, Szabo K. End-of-life decisions in acute stroke patients: an observational cohort study. BMC Palliat Care. 2016;15(1):1.

    Article  Google Scholar 

  • Andersen KK, Olsen TS, Dehlendorff C, Kammersgaard LP. Hemorrhagic and ischemic strokes compared stroke severity, mortality, and risk factors. Stroke. 2009;40(6):2068–72.

    Article  PubMed  Google Scholar 

  • Blacquiere DP, Gubitz GJ, Dupere D, McLeod D, Phillips S. Evaluating an organized palliative care approach in patients with severe stroke. Can J Neurol Sci. 2009;36(06):731–4.

    Article  PubMed  Google Scholar 

  • Blacquiere D, Bhimji K, Meggison H, Sinclair J, Sharma M. Satisfaction with palliative care after stroke. A prospective cohort study. Stroke. 2013;44:2617–9.

    Article  PubMed  Google Scholar 

  • Burton CR, Payne S. Integrating palliative care within acute stroke services: developing a programme theory of patient and family needs, preferences and staff perspectives. BMC Palliat Care. 2012;11(1):1.

    Article  Google Scholar 

  • Burton CR, Payne S, Addington-Hall J, Jones A. The palliative care needs of acute stroke patients: a prospective study of hospital admissions. Age Ageing. 2010;39(5):554–9.

    Article  PubMed  Google Scholar 

  • Campbell BC, Mitchell PJ, Kleinig TJ, Dewey HM, Churilov L, Yassi N, et al. Endovascular therapy for ischemic stroke with perfusion-imaging selection. N Engl J Med. 2015;372(11):1009–18.

    Article  CAS  PubMed  Google Scholar 

  • Carod-Artal FJ, Egido JA. Quality of life after stroke: the importance of a good recovery. Cerebrovasc Dis. 2009;27(Suppl 1):204–14.

    Article  PubMed  Google Scholar 

  • Carod-Artal J, Egido JA, Gonzalez JL, de Seijas EV. Quality of life among stroke survivors evaluated 1 year after stroke. Stroke. 2000;12:2995–3000.

    Article  Google Scholar 

  • Casaubon LK, Boulanger J-M, Glasser E, Blacquiere D, Boucher S, Brown K, et al. Canadian stroke best practice recommendations: acute inpatient stroke care guidelines, update 2015. Int J Stroke. 2016;11(2):239–52.

    Article  PubMed  Google Scholar 

  • Choi-Kwon S, Choi JM, Kwon SU, Kang DW, Kim JS. Factors that affect the quality of life at 3 years post-stroke. J Clin Neurol. 2006;2:34–41.

    Article  PubMed  PubMed Central  Google Scholar 

  • Cowey E, Smith LN, Stott DJ, McAlpine CH, Mead GE, Barber M, et al. Impact of a clinical pathway on end-of-life care following stroke: a mixed methods study. Palliat Med. 2015;29(3):249–59.

    Article  PubMed  Google Scholar 

  • Creutzfeldt CJ, Holloway RG, Walker M. Symptomatic and palliative care for stroke survivors. J Gen Intern Med. 2012;27:853–60.

    Article  PubMed  PubMed Central  Google Scholar 

  • Creutzfeldt CJ, Holloway RG, Curtis JR, Palliative Care A. Core competency for stroke neurologists. Stroke. 2015;46(9):2714–9.

    Article  PubMed  PubMed Central  Google Scholar 

  • de Boer ME, Depla M, Wojtkowiak J, Visser MC, Widdershoven GA, Francke AL, et al. Life-and-death decision-making in the acute phase after a severe stroke: interviews with relatives. Palliat Med. 2015;29(5):451–7.

    Article  PubMed  Google Scholar 

  • De Ryck A, Fransen E, Brouns R, Geurden M, Peij D, Marien P, et al. Post-stroke depression and its multifactorial nature: results from a prospective longitudinal study. J Neurol Sci. 2014;347:159–66.

    Article  PubMed  Google Scholar 

  • duPreez AE, Smith MA, Liou JI, Frytak JR, Finch MD, Cleary JF, et al. Predictors of hospice utilization among acute stroke patients who died within thirty days. J Palliat Med. 2008;11(9):1249–57.

    Article  PubMed  PubMed Central  Google Scholar 

  • Eastman P, McCarthy G, Brand CA, Weir L, Gorelik A, Le B. Who, why and when: stroke care unit patients seen by a palliative care service within a large metropolitan teaching hospital. BMJ Support Palliat Care. 2013;3(1):77–83.

    Article  PubMed  Google Scholar 

  • Eriksson H, Milberg A, Hjelm K, Friedrichsen M. End of life care for patients dying of stroke: a comparative registry study of stroke and cancer. PLoS One. 2016;11(2):e0147694.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  • Feigin VL, Forouzanfar MH, Krishnamurthi R, Mensah GA, Connor M, Bennett DA, et al. Global and regional burden of stroke during 1990–2010: findings from the global burden of disease study 2010. Lancet. 2014;383(9913):245–55.

    Article  PubMed  PubMed Central  Google Scholar 

  • Frese A, Husstedt IW, Ringelstein EB, Evers S. Pharmacologic treatment of central post-stroke pain. Clin J Pain. 2006;22:252–60.

    Article  CAS  PubMed  Google Scholar 

  • Frontera JA, Curtis JR, Nelson JE, Campbell M, Gabriel M, Mosenthal AC, et al. Integrating palliative care into the care of neurocritically ill patients: a report from the improving palliative care in the ICU project advisory board and the center to advance palliative care. Crit Care Med. 2015;43(9):1964–77.

    Article  PubMed  PubMed Central  Google Scholar 

  • Gardiner C, Harrison M, Ryan T, Jones A. Provision of palliative and end-of-life care in stroke units: a qualitative study. Palliat Med. 2013;27(9):855–60.

    Article  PubMed  Google Scholar 

  • Goyal M, Demchuk AM, Menon BK, Eesa M, Rempel JL, Thornton J, et al. Randomized assessment of rapid endovascular treatment of ischemic stroke. NEJM. 2015;372(11):1019–30.

    Article  CAS  PubMed  Google Scholar 

  • Hackett ML, Pickles K. Part I: frequency of depression after stroke: an updated systematic review and meta-analysis of observational studies. Int J Stroke. 2014;9(8):1017–25.

    Article  PubMed  Google Scholar 

  • Hackett ML, Anderson CS, House A, Xia J. Interventions for treating depression after stroke. Cochrane Database Syst Rev. 2008;(4):CD003437. https://doi.org/10.1002/14651858.CD003437.pub3.

  • Hankey GJ, Jamrozik K, Broadhurst RJ, Forbes S, Anderson CS. Long term disability after first-ever stroke and related prognostic factors in the Perth community stroke study 1989-1990. Stroke. 2002;33:1034–40.

    Article  PubMed  Google Scholar 

  • Hemphill JC, Greenberg SM, Anderson CS, Becker K, Bendok BR, Cushman M, et al. Guidelines for the management of spontaneous intracerebral hemorrhage a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2015;46(7):2032–60.

    Article  PubMed  Google Scholar 

  • Holloway RG, Ladwig S, Robb J, Kelly A, Nielsen E, Quill TE. Palliative care consultations in hospitalized stroke patients. J Palliat Med. 2010;13(4):407–12.

    Article  PubMed  PubMed Central  Google Scholar 

  • Holloway RG, Arnold RM, Creutzfeldt CJ, Lewis EF, Lutz BJ, McCann RM, et al. Palliative and end-of-life care in stroke a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2014;45(6):1887–916.

    Article  PubMed  Google Scholar 

  • Intercollegiate Stroke Working Group. National clinical guideline for stroke 5th edition [Online]. London: Royal College of Physicians; 2016. Available: www.strokeaudit.org/SupportFiles/Documents/Guidelines/2016-National-Clinical-Guideline-for-Stroke-5t-(1).aspx.

  • Jack C, Jones L, Jack BA, Gambles M, Murphy D, Ellershaw JE. Towards a good death: the impact of the care of the dying pathway in an acute stroke unit. Age Ageing. 2004;33(6):625–6.

    Article  CAS  PubMed  Google Scholar 

  • Kalra L, Evans A, Perez I, Melbourn A, Pateal A, Knapp M, et al. Training carers of stroke patients: randomized controlled trial. BMJ. 2004;328:1099.

    Article  PubMed  PubMed Central  Google Scholar 

  • Kelly AG, Hoskins KD, Holloway RG. Early stroke mortality, patient preferences, and the withdrawal of care bias. Neurology. 2012;79(9):941–4.

    Article  PubMed  PubMed Central  Google Scholar 

  • Kim JS, Bashford G, Murphy TK, Martin A, Dror V, Cheung R. Safety and efficacy of pregabalin in patients with central post-stroke pain. Pain. 2011;152(5):1018–23.

    Article  CAS  PubMed  Google Scholar 

  • Langhorne P, Fearon P, Ronning OM, Kaste M, Palomaki H, Vemmos K, et al. Stroke unit care benefits patients with intracerebral hemorrhage systematic review and meta-analysis. Stroke. 2013;44(11):3044–9.

    Article  PubMed  Google Scholar 

  • Leigon G, Boivie J. Central post-stroke pain: a controlled trial of amitriptyline and carbamazepine. Pain. 1989;36:27–36.

    Article  Google Scholar 

  • Maldonado NJ, Kazmi SO, Suarez JI. Update in the management of acute ischemic stroke. Crit Care Clin. 2014;30(4):673–97.

    Article  PubMed  Google Scholar 

  • Mazzocato C, Michel-Nemitz J, Anwar D, Michel P. The last days of dying stroke patients referred to a palliative care consult team in an acute hospital. Eur J Neurol. 2010;17(1):73–7.

    Article  CAS  PubMed  Google Scholar 

  • Mozaffarian D, Benjamin SJ, Go AS, Arnett DK, Blaha MJ, Cushman M, et al. Heart disease and stroke Statistics-2015 update: a report from the American Heart Association. Circulation. 2015;131:e29–e322.

    PubMed  Google Scholar 

  • Murthy SB, Moradiya Y, Hanley DF, Ziai WC. Palliative care utilization in nontraumatic intracerebral hemorrhage in the United States. Crit Care Med. 2016;44:575–82.

    Article  PubMed  Google Scholar 

  • National Stroke Foundation. Clinical guidelines for stroke management. Melbourne; 2010.

    Google Scholar 

  • Neuberger J, Guthrie C, Aaronovitch D. More care, less pathway: a review of the Liverpool care pathway. London: Department of Health; 2013.

    Google Scholar 

  • Ntlholang O, Walsh S, Bradley D, Harbison J. Identifying palliative care issues in inpatients dying following stroke. Ir J Med Sci. 2016;185:741–4.

    Article  CAS  PubMed  Google Scholar 

  • Parry-Jones AR, Paley L, Bray BD, Hoffman AM, James M, Cloud GC, et al. Care-limiting decisions in acute stroke and association with survival: analyses of UK national quality register data. Int J Stroke. 2016;11(3):321–31.

    Article  PubMed  Google Scholar 

  • Payne S, Burton C, Addington-Hall J, Jones A. End-of-life issues in acute stroke care: a qualitative study of the experiences and preferences of patients and families. Palliat Med. 2010;24(2):146–53.

    Article  PubMed  Google Scholar 

  • Raffaeli W, Minella CE, Magnani F, Sarti D. Population-based study of central post-stroke pain in Rimini District, Italy. J Pain Res. 2013;6:705–11.

    PubMed  PubMed Central  Google Scholar 

  • Robinson RG, Jorge RE. Post-stroke depression: a review. Am J Psychiatry. 2016;173(3):221–31.

    Article  PubMed  Google Scholar 

  • Rogers A, Addington-Hall J. Care of the dying stroke patients in the acute setting. J Res Nurs. 2005;10(2):153–67.

    Article  Google Scholar 

  • Saposnik G, Hill MD, O’Donnell M, Fang J, Hachinski V, Kapral MK. Variables associated with 7-day, 30-day, and 1-year fatality after ischemic stroke. Stroke. 2008;39(8):2318–24.

    Article  PubMed  Google Scholar 

  • Simmons BB, Parks SM. Intracerebral hemorrhage for the palliative care provider: what you need to know. J Palliat Med. 2008;11(10):1336–9.

    Article  PubMed  Google Scholar 

  • Smith EE, Hassan KA, Fang J, Selchen D, Kapral MK, Saposnik G, Investigators of the Registry of the Canadian Stroke Network, Stroke Outcome Research Canada (SORCan) Working Group. Do all ischemic stroke subtypes benefit from organized inpatient stroke care? Neurology. 2010a;75(5):456–62.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Smith EE, Shobha N, Dai D, Olson DM, Reeves MJ, Saver JL, et al. Risk score for in-hospital ischemic stroke mortality derived and validated within the get with the guidelines–stroke program. Circulation. 2010b;122(15):1496–504.

    Article  PubMed  Google Scholar 

  • Stevens T, Payne SA, Burton C, Addington-Hall J, Jones A. Palliative care in stroke: a critical review of the literature. Palliat Med. 2007;21(4):323–31.

    Article  CAS  PubMed  Google Scholar 

  • van Heugten C, Visser-Meily A, Post M, Lindeman E. Care for carers of stroke patients: evidence-based clinical practice guidelines. J Rehabil Med. 2006;38(3):153–8.

    Article  PubMed  Google Scholar 

  • Vartiainen N, Perchet C, Magnin M, Creac’h C, Convers P, Nighoghossian N, et al. Thalamic pain: anatomical and physiological indices of prediction. Brain. 2016;139(3):708–22.

    Article  PubMed  Google Scholar 

  • Wendler D, Rid A. Systematic review: the effect on surrogates of making treatment decisions for others. Ann Intern Med. 2011;154(5):336–46.

    Article  PubMed  Google Scholar 

  • World Health Organisation. The top 10 causes of death. 2014. http://www.who.int/mediacentre/factsheets/fs310/en/. Accessed 18 Nov 2016.

  • Young AJ, Rogers A, Dent L, Addington-Hall JM. Experiences of hospital care reported by bereaved relatives of patients after a stroke: a retrospective survey using the VOICES questionnaire. J Adv Nurs. 2009;65(10):2161–74.

    Article  PubMed  Google Scholar 

  • Zahuranec DB, Brown DL, Lisabeth LD, Gonzales NR, Longwell PJ, Smith MA, et al. Early care limitations independently predict mortality after intracerebral hemorrhage. Neurology. 2007;68(20):1651–7.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Peter Eastman .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this entry

Check for updates. Verify currency and authenticity via CrossMark

Cite this entry

Eastman, P., Le, B. (2019). Palliative Care and Stroke. In: MacLeod, R., Van den Block, L. (eds) Textbook of Palliative Care. Springer, Cham. https://doi.org/10.1007/978-3-319-77740-5_59

Download citation

Publish with us

Policies and ethics