title: Identifying palliative care issues in inpatients dying following stroke.
abstract: BACKGROUND
  Stroke leads to high mortality and morbidity but often there is a conflict between need for palliative care and avoidance of 'therapeutic nihilism'.
  
  
  OBJECTIVE
  We aimed to elicit the palliative care needs of stroke patients at the end of their lives in our unit with a low overall mortality rate (1 month: 8.8 %, inpatient: 12.9 %).
  
  
  METHODS
  We identified consecutive stroke patients who died over 2 years. Their clinical records were used for data collection.
  
  
  RESULTS
  Of 54 deaths, 33 (61.1 %) were females, mean (SD) age at death was 79.3 ± 12.9 years. 41 (75.9 %) died after first stroke, 9 (16.7 %) were inpatient strokes, 7 (13.0 %) thrombolysed and 7 (13.0 %) had strokes as treatment complication. There were clear statements recorded in 26 (48.1 %) that patients were dying and death was thought to be due primarily to extent of brain injury in 24 (44.4 %). Palliative needs identified included dyspnoea 21 (38.9 %), pain 17 (31.5 %), respiratory secretions 17 (31.5 %), agitation 14 (25.9 %) and psychological distress 1 (1.9 %). Symptoms were due to premorbid diseases in 6 (11.1 %). Palliative care expertise were sought in 13 (24.1 %) and continuous subcutaneous infusion was used in 18 (33.3 %) to control symptoms. 4 (7.4 %) subjects underwent cardiac arrest calls and 9 (16.7 %) deaths occurred in ICU/HDU. The median Stroke-Death interval was 20 days (range 0-389). Do Not Attempt Resuscitation (DNAR) orders were in place in 86.8 % of patients. The median DNAR-Death interval was 7 days (range 0-311) with 7-day DNAR-Death rate of 53.2 % and 30-day of 78.7 % of the total deaths.
  
  
  CONCLUSIONS
  Dyspnoea, pain and respiratory secretions were identified as the main palliative care needs.
authors: Acute Stroke Service, St James Hospital, Dublin 8, Ireland. damaze2002@yahoo.com.
authors: O
authors: O
authors: Ntlholang
authors: Acute Stroke Service, St James Hospital, Dublin 8, Ireland.
authors: S
authors: S
authors: Walsh
authors: Acute Stroke Service, St James Hospital, Dublin 8, Ireland.
authors: D
authors: D
authors: Bradley
authors: Acute Stroke Service, St James Hospital, Dublin 8, Ireland.|Department of Medical Gerontology, Trinity College Dublin, Dublin 2, Ireland.
authors: J
authors: J
authors: Harbison
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D059350:Chronic Pain / Q000517:prevention & control; D004417:Dyspnea / Q000628:therapy; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D010166:Palliative Care / Q000592:standards*; D012137:Respiratory System / Q000378:metabolism; D016414:Resuscitation Orders; D012189:Retrospective Studies; D020521:Stroke / Q000628:therapy*; D013727:Terminal Care / Q000592:standards*
keywords: End-of-life care; General palliative care; Specialist palliative care; Stroke