The last days of dying stroke patients referred to a palliative care consult team in an acute hospital.
OBJECTIVE
Needs of patients dying from stroke are poorly investigated. We aim to assess symptoms of these patients referred to a palliative care consult team, and to review their treatment strategies.


METHODS
All charts of patients dying from stroke in a tertiary hospital, and referred consecutively to a palliative care consultant team from 2000 to 2005, were reviewed retrospectively. Symptoms, ability to communicate, treatments, circumstances and causes of death were collected.


RESULTS
Forty-two patients were identified. Median NIH Stroke Scale on admission was 21. The most prevalent symptoms were dyspnoea (81%), and pain (69%). Difficulties or inability to communicate because of aphasia or altered level of consciousness were present in 93% of patients. Pharmacological respiratory treatments consisted of anti-muscarinic drugs (52%), and opioids (33%). Pain was mainly treated by opioids (69%). During the last 48 h of life, 81% of patients were free of pain and 48% of respiratory distress. The main causes of death were neurological complications in 38% of patients, multiple medical complications in 36%, and specific medical causes in 26%.


CONCLUSIONS
Patients dying from stroke and referred to a palliative care consult team have multiple symptoms, mainly dyspnoea and pain. Studies are warranted to develop specific symptoms assessment tools in non-verbal stroke patients, to accurately assess patients' needs, and to measure effectiveness of palliative treatments.
Mazzocato
C
C
Palliative Care Service, Department of Internal Medicine, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Switzerland.
Michel-Nemitz
J
J
Anwar
D
D
Michel
P
P
D000208:Acute Disease / Q000401:mortality / Q000628:therapy; D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000627:therapeutic use; D001037:Aphasia / Q000453:epidemiology; D001293:Attitude to Death; D002423:Cause of Death / Q000639:trends; D002648:Child; D015897:Comorbidity; D003244:Consciousness Disorders / Q000453:epidemiology; D004185:Disability Evaluation; D004417:Dyspnea / Q000453:epidemiology / Q000628:therapy; D006761:Hospitals / Q000706:statistics & numerical data* / Q000639:trends; D006801:Humans; D007223:Infant; D018727:Muscarinic Antagonists / Q000627:therapeutic use; D020380:Needs Assessment; D017063:Outcome Assessment, Health Care / Q000379:methods; D010146:Pain / Q000453:epidemiology; D059408:Pain Management; D010147:Pain Measurement; D010166:Palliative Care / Q000379:methods* / Q000706:statistics & numerical data; D010347:Patient Care Planning; D011787:Quality of Health Care / Q000706:statistics & numerical data / Q000639:trends; D012189:Retrospective Studies; D012720:Severity of Illness Index; D020521:Stroke / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy*; D013727:Terminal Care; D016896:Treatment Outcome
D000701:Analgesics, Opioid; D018727:Muscarinic Antagonists