Symptom Control, Communication With Health Professionals, and Hospital Care of Stroke Patients in the Last Year of Life as Reported by Surviving Family, Friends, and Officials

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Abstract
Background and Purpose The needs of and appropriate service provision for patients dying from stroke have received little attention. The quality of care in the last year of life received by a population-based sample of stroke patients is described here, focusing on symptom control, communication with health professionals, and hospital care. Methods Secondary analysis was made of data from the Regional Study of Care for the Dying, a retrospective interview survey in 20 nationally representative English health districts. Subjects were 237 persons who died from stroke in 1990. Of informants, 20% were spouses, 48% relatives, 11% friends or neighbors, and 20% officials. Results More than half the patients were reported to have experienced pain (65%), mental confusion (51%), low mood (57%), and urinary incontinence (56%) in the last year of life. Pain control was inadequate: 51% of those treated for pain by hospital doctors and 45% of those treated by general practitioners were reported to have received treatment that relieved pain partially if at all. One third of respondents thought that hospital doctors had been too rushed (37%), and 25% thought that the patient had had insufficient choice about treatment. Two fifths had been unable to get all the information they had wanted about the patient’s condition. Conclusions Improvements in symptom control and psychosocial support for patients who die from stroke are needed, as is better communication between health professionals and patients and their families. Education of doctors and nurses working with stroke patients in the principles of palliative care may help ensure that all dying stroke patients receive high-quality care.