End-of-life decisions in acute stroke patients

• Verfasst von: Alonso, Angelika [VerfasserIn]
• Verfasst von: Ebert, Anne [VerfasserIn]
• Verfasst von: Dörr, Dorothee [VerfasserIn]
• Verfasst von: Buchheidt, Dieter [VerfasserIn]
• Verfasst von: Hennerici, Michael G. [VerfasserIn]
• Verfasst von: Szabo, Kristina [VerfasserIn]
• Titel: End-of-life decisions in acute stroke patients
• Titelzusatz: an observational cohort study
• Verf.angabe: Angelika Alonso, Anne D. Ebert, Dorothee Dörr, Dieter Buchheidt, Michael G. Hennerici and Kristina Szabo
• E-Jahr: 2016
• Jahr: 05 April 2016
• Umfang: 9 S.
• Fussnoten: Gesehen am 28.03.2019
• Titel Quelle: Enthalten in: BMC palliative care
• Ort Quelle: London : BioMed Central, 2002
• Jahr Quelle: 2016
• Band/Heft Quelle: 15(2016), Artikel-ID 38, Seite 1-9
• ISSN Quelle: 1472-684X
• DOI: doi:10.1186/s12904-016-0113-8
• Datenträger: Online-Ressource
• Sprache: eng
• K10plus-PPN: 1662518110

Abstract

Background: Crucial issues of modern stroke care include best practice end-of-life-decision (EOLD)-making procedures and the provision of high-quality palliative care for dying stroke patients. Methods: We retrospectively analyzed records of those patients who died over a 4-year period (2011-2014) on our Stroke Unit concerning EOLD, focusing on the factors that most probably guided decisions to induce limitation of life-sustaining therapy and subsequently end-of-life-care procedures thereafter. Results: Of all patients treated at our Stroke Unit, 120 (2.71 %) died. In 101 (86.3 %), a do-not-resuscitate-order (DNRO) was made during early treatment. A decision to withdraw/withhold further life supportive therapy was made in 40 patients (34.2 %) after a mean of 5.0 days (range 0-29). Overall patient death occurred after a mean time of 7.0 days (range 1-30) and 2.6 days after therapy restrictions. Disturbance of consciousness at presentation, dysphagia on day 1 and large supratentorial stroke were possible indicators of decisions to therapeutic withdrawing/withholding. Proceedings of EOL care in these patients were heterogeneous; in most cases monitoring (95 %), medical procedures (90 %), oral medication (88 %), parenteral nutrition (98 %) and antibiotic therapy (86 %) were either not ordered or withdrawn, however IV fluids were continued in all patients. Conclusions: A high percentage of stroke patients were rated as terminally ill and died in the course of caregiving. Disturbance of consciousness at presentation, dysphagia on day 1 and large supratentorial stroke facilitated decisions to change therapeutic goals thus initiating end-of-life-care. However, there is further need to foster research on this field in order to ameliorate outcome prognostication, to understand the dynamics of EOLD-making procedures and to educate staff to provide high-quality patient-centred palliative care in stroke medicine.