Recent findings from a scientific report emphasize the advantages of implementing palliative care for stroke survivors and their families, particularly following their discharge from hospitals. This type of care aims to alleviate pain and manage symptoms but is significantly underused, especially in communities of Black, Hispanic, and Asian patients, according to a new article published by the American Heart Association in their journal, “Stroke.”
Released on Monday, the report advocates for the incorporation of palliative care across all phases of post-stroke treatment. This includes addressing psychological well-being, navigating complicated healthcare systems, and preparing for end-of-life decisions when necessary. “A stroke is frequently perceived as a brief incident, but that perception is misleading,” stated Dr. Claire J. Creutzfeldt, who spearheaded the report. Dr. Creutzfeldt serves as an associate professor of neurology at the University of Washington in Seattle. “While most strokes may not pose an immediate threat to life, each stroke is indeed life-changing and demands top-notch, individualized care. The infusion of palliative care principles in stroke treatment is essential at all ensuing stages.”
Strokes affect nearly 800,000 individuals in the United States annually. They occur when a blood vessel supplying the brain becomes obstructed or ruptured, disrupting blood flow and resulting in the death of brain cells. Stroke stands as a primary cause of long-term disabilities and is the fifth leading cause of death nationwide, resulting in approximately 160,000 fatalities each year. Although advancements in medical treatments enable stroke survivors to live longer, many confront persistent challenges, including physical and cognitive difficulties, as well as psychosocial complications. The burden of care often falls heavily on family members, who may struggle with their responsibilities.
The newly released report stresses the necessity of incorporating palliative care strategies that enhance communication regarding prognosis and care objectives, simplify navigation through complex healthcare systems, and address the psychosocial needs of patients and families coping with loss. Additionally, it underscores the importance of preparing for end-of-life care as necessary while highlighting the need to address disparities in care related to sociodemographic factors and regional variations.
This holistic approach to palliative care extends beyond merely managing physical symptoms and pain. It encompasses emotional and spiritual needs while carefully considering the expectations, values, and goals of families. The report affirms that emotional, spiritual, and psychosocial support is crucial for delivering high-quality stroke care to both survivors and their caregivers. The outline includes stages following a severe stroke, alongside a checklist for palliative care and screening tools aimed at identifying and addressing the needs of patients and families effectively.
“Recognizing how illness and disability affect a person’s quality of life is vital,” Creutzfeldt expressed. “Treatment options should differ from patient to patient, reflecting their values, beliefs, and cultural contexts.” She pointed out that the support required by survivors and their family members may evolve over time based on various factors, including symptoms, function changes, and illness progression.
The report notes a research gap surrounding palliative care for stroke survivors, which has led to considerable differences in the types of care they receive. Symptoms such as pain frequently go untreated, with research indicating that post-stroke pain peaks between four to six months and two years post-stroke, yet remains underdiagnosed. Alarmingly, almost 45% of stroke survivors leave hospitals without plans for additional services, such as home-based care or hospice support. Additionally, referrals for palliative care often surface only at the end-of-life stage.
Black and Hispanic individuals, who experience higher rates of stroke and poorer outcomes, are less likely to receive immediate treatments like intravenous therapy or surgical options for blood clots. Furthermore, they are considerably less prone to establishing “do not resuscitate” orders or advance directives compared to white patients, with reduced likelihood of being discharged to hospice care.
While some factors influencing these disparities might stem from cultural variations, the report indicates that the specific hospital where care is provided also plays a crucial role in determining access to palliative care, pointing to systemic inequities within healthcare structures. A 2023 scientific report by the American Heart Association addressing racial and ethnic disparities in stroke treatment underlines the necessity to better comprehend how clinicians and healthcare systems affect treatment patterns and seek potential solutions to these issues.