Advance care planning in stroke: influence of time on engagement in the process.
OBJECTIVE
Individuals who experience stroke have a higher likelihood of subsequent stroke events, making it imperative to plan for future medical care. In the event of a further serious health event, engaging in the process of advanced care planning (ACP) can help family members and health care professionals (HCPs) make medical decisions for individuals who have lost the capacity to do so. Few studies have explored the views and experiences of patients with stroke about discussing their wishes and preferences for future medical events, and the extent to which stroke HCPs engage in conversations around planning for such events. In this study, we sought to understand how the process of ACP unfolded between HCPs and patients post-stroke.


METHODS
Using grounded theory (GT) methodology, we engaged in direct observation of HCP and patient interactions on an acute stroke unit and two stroke rehabilitation units. Using semi-structured interviews, 14 patients and four HCPs were interviewed directly about the ACP process.


RESULTS
We found that open and continual ACP conversations were not taking place, patients experienced an apparent lack of urgency to engage in ACP, and HCPs were uncomfortable initiating ACP conversations due to the sensitive nature of the topic.


CONCLUSIONS
In this study, we identified lack of engagement in ACP post-stroke, attributable to patient and HCP factors. This encourages us to look further into the process of ACP in order to develop open communication between the patient with stroke, their families, and stroke HCPs.
Faculty of Nursing, University of Calgary, Calgary, AB, Canada.
Theresa
T
Green
Health Sciences, McMaster University, Hamilton, ON, Canada.
Shreyas
S
Gandhi
Faculty of Nursing, University of Calgary, Calgary, AB, Canada.
Tessa
T
Kleissen
Faculty of Nursing, University of Calgary, Calgary, AB, Canada ; Department of Medicine, University of Calgary, Calgary, AB, Canada.
Jessica
J
Simon
Faculty of Nursing, University of Calgary, Calgary, AB, Canada.
Shelley
S
Raffin-Bouchal
Calgary Stroke Program, Alberta Health Services, Calgary, AB, Canada.
Karla
K
Ryckborst
engagement; health care providers; palliative; qualitative