Palliative care underutilized in stroke patients

A review of patients with ischemic stroke found that palliative care is not utilized in a majority of cases, according to research presented at the American Academy of Neurology annual meeting.

Toby Gropen, MD, professor at University of Alabama at Birmingham, and colleagues urged physicians to consider palliative care, which can lessen suffering.

"Despite the potential benefits of [palliative care], a recent AHA scientific statement found that [palliative care] use in stroke was understudied and poorly understood," the researchers wrote in their abstract.

Gropen and colleagues conducted a retrospective review of 776 patients with ischemic stroke who visited the comprehensive stroke center at University of Alabama at Birmingham. They analyzed clinical and demographic data and compared the number of patients who received an inpatient palliative care consult with the number of patients with a had a discharge modified Rankin scale (mRS) score of 4-6, which indicated the need for assistance with bodily needs and walking.

Results showed that 6% of patients received a palliative care consult. In the 254 patients who had an mRS score of 4-6 and were discharged, 16% received a palliative care consult. Consults occurred, on average, 3.5 days after admission.

The researchers found that patients who received a palliative care consult had more inpatient complications (56.5% vs. 21.8%; P < .001), had more severe strokes (median NIHSS score 17 vs. 5; P < .001) and were older (median age 75 vs. 65; P < .001).

In addition, following the palliative care consult, the percentage of patients who had do not resuscitate/do not intubate orders and comfort care orders increased (78.3% to 95.7% and 30.4% to 58.7%, respectively).

“Our observations suggest that [palliative care] may be underutilized in ischemic stroke patients, particularly in those who may benefit from it the most,” Gropen and colleagues concluded. “[Palliative care] has great potential to diminish suffering through physical and psychological symptom management. Providers should at least consider [palliative care] consults for hospitalized stroke patients.”– by Chelsea Frajerman Pardes

Reference:

Gropen T, et al. Palliative care is underutilized in ischemic stroke patients with poor functional outcome. Presented at: American Academy of Neurology Annual Meeting; April 15-21, 2016; Vancouver, British Columbia.

Disclosures: Gropen reports no relevant financial disclosures. Please see the full abstract for a complete list of all other authors' relevant financial disclosures.