Practical palliative care after stroke

Dr Ruth England is a Consultant in Palliative Medicine at Royal Derby Hospital. She tweets @DrRuthEngland. She will be speaking at the upcoming BGS event Living and Dying Well with Frailty on 6 March in London. Please note this event has now SOLD OUT.

Palliative care is an active, holistic approach to those facing life-threatening illness. Good palliative care allows us ‘to live as well as possible for as long as possible’; and includes support for those approaching the end of their life.

In the UK, someone suffers a stroke every 5 minutes. Although there has been a decline in stroke mortality, it remains a leading cause of death in those aged over 65.  There a high risk of dying immediately after an event, and 40% of those affected by stroke die within a year. Long term survivors are likely to be burdened with ongoing physical, psychological and social issues.

There are international, detailed guidelines for the management of stroke, but these tend to focus on the acute phase and rehabilitation process. The benefit of palliative care for stroke patients and their families is recognised, but guidelines often only briefly mention palliation for those who will not recover. Evidence for palliative care for patients within a stroke context is scant: recommendations often rely on studies from an oncological setting. Our session on 6^th March does not claim to offer new research in this group, but rather raises practical considerations from the perspective of an interested palliative medicine consultant.

The potential for recovery after an acute stroke is often unclear, making treatment decisions exquisitely difficult. We will reflect on limitations of prognostic tools available and the difficulties this can cause for practicing clinicians; and consider ways to keep the patient and their loved ones at the centre of decision making.

Stroke can cause a range of problems that may have a profound impact on quality of life, for example, respiratory secretions, agitation, dry mouth, pain, depression, and anxiety. We will address symptom management both of the actively dying stroke patient and the person living with chronic stroke.

Good communication is essential in palliative care. A stroke may render the patient unable to express themselves – and thus their mental capacity may be called into question. We will review practical considerations when communicating with patients after stroke, both in the immediate phase and in the longer term.

We look forward to an interactive audience – willing to share experiences – working with each other during this session, to further our appreciation of palliative care issues facing patients and those important to them after stroke.