Palliative Care: A Crucial Role in Stroke Recovery

Palliative care plays a significant role in the recovery process after a stroke, increasing the chances of a better quality of life for patients and their families. Stroke, often perceived as an acute medical emergency, continues to pose long-term challenges for survivors. Palliative care is essential in supporting patients and their families through these challenges, helping them cope with difficult decisions and continuous care needs.

Understanding the Role of Palliative Care

A recent scientific statement from the American Heart Association (AHA) highlights the importance of palliative care in improving the quality of life for stroke survivors and their loved ones. According to AHA data, about 795,000 people experience a stroke each year in the United States. The Burden of Disease study estimates a 70% increase in stroke occurrences between 1990 and 2019. Projections for 2030 show that another 3.4 million adults will undergo a stroke, a 20.5% increase compared to 2012.

Long-Term Challenges After a Stroke

Most stroke survivors face long-term challenges, including loss of independence, functional deficiencies, cognitive impairment, and dementia. These problems can be exacerbated by individual comorbidities, lack of an adequate support system, changing living conditions, and racial and ethnic inequalities in healthcare. For instance, African American and Hispanic populations have a higher risk of stroke and are less likely to receive prompt treatment.

In the last decade, the concept of using palliative care has been outlined to help patients and their families manage the long-term effects of a stroke. A common misconception about palliative care is that it is intended only for patients at the end of life. In reality, it benefits patients at all stages of the disease, including after a stroke. The fact that a stroke tends to stay with people throughout their lives and changes their lives and quality is often overlooked. A stroke, and especially a severe stroke, is a chronic condition, says Claire J. Creutzfeldt, MD, president of the scientific statement of AHA on palliative care in stroke.

Importance of Communication Within Multidisciplinary Teams

Palliative care post-stroke involves a multidisciplinary team that communicates the goals of care and quality of life for patients, caregivers, and families, including aspects of care at the end of life, if necessary. Even if palliative care should be integrated at all stages of post-stroke care, there are several barriers to its implementation. Creutzfeldt mentions that there are only a few neurologists with double certification in vascular neurology and palliative care, but palliative care is a skill that a neurologist treating stroke should have.

Most palliative care needs can and need to be evaluated and managed by the patient’s neurologist, with additional training in palliative communication and care skills, Creutzfeldt adds.

Misconceptions About Palliative Care

In addition to the wrong conceptions of what is and what is not palliative care, there is also a general reluctance in society to discuss death and the end of life, which is another barrier in exploring these topics. Seth Krevat, MD, medical director at Medstar National Center for Human Factors in Healthcare, says any palliative care hospital can introduce this form of care in post-stroke, but there is no need for a specialist to provide palliative care on comfort and quality of life.

Moreover, AHA recognizes racial and ethnic inequalities in healthcare, mentioning that African and Hispanic populations have a higher risk of stroke, a higher risk of weaker functional results, and are less likely to receive prompt treatment for stroke. When we see African-American patients, because of their experiences or their community, they can be reluctant to engage in palliative care or accept it. Therefore, cultural sensitivity is extremely important in this area, says Krevat.

Additional Research Needed

Even though post-stroke palliative care is essential, research in this area remains limited. A systematic study of post-stroke palliative care interventions identified only seven studies published between 1990 and 2021. This underlines the need for further research to better understand how palliative care can be integrated and applied in this context. Creutzfeldt and Krevat agree that there is an urgent need to study new solutions to support patients and their long-term families after a stroke.

The research we propose would have a huge impact, improving how we forecast and communicate the forecasts, how we discuss the care goals after a severe stroke and how we support people in the long run, concludes Creutzfeldt.

Practical Applications and Case Studies

In the United States, palliative care programs have been implemented in various hospitals and healthcare settings to support stroke survivors. For example, the Mayo Clinic in Rochester, Minnesota, has integrated palliative care into its stroke rehabilitation program, providing comprehensive support to patients and their families. This includes regular check-ins with palliative care specialists, counseling services, and community support groups.

Another example is the University of California, San Francisco (UCSF) Medical Center, which has developed a specialized palliative care unit for stroke patients. This unit focuses on pain management, emotional support, and helping patients and families navigate the complexities of post-stroke care. The success of these programs highlights the importance of integrating palliative care into standard stroke treatment protocols.

Addressing Potential Counterarguments

Critics may argue that the integration of palliative care into stroke treatment adds an unnecessary layer of complexity and cost. However, studies have shown that early intervention with palliative care can reduce hospital readmissions, decrease healthcare costs, and improve patient outcomes. For instance, a study published in the Journal of Palliative Medicine found that patients who received palliative care after a stroke had lower rates of depression and anxiety, and better overall quality of life.

Conclusion

Palliative care is a vital component of stroke recovery, offering support and improving the quality of life for patients and their families. By addressing the long-term challenges and misconceptions surrounding palliative care, healthcare providers can better support stroke survivors. Further research and integration of palliative care into standard stroke treatment protocols are essential to enhance patient outcomes and reduce healthcare disparities.

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