Something to think about.
Insufficient knowledge of stroke patient’s last hours of life
Caregivers are displaying insufficient knowledge of how
things are for stroke patients the week before they die – for example,
staff have difficulties stating whether the patients had someone with
them at their death, or if they were experiencing pain. Care for stroke
patients therefore risks becoming worse compared to patients who die
from cancer.
Nearly 20 percent of those who suffer a stroke die within one month,
and 40 percent die within a year. With death so close, the care the
patients get at the end of their lives is enormously significant.
But general palliative care for stroke patients has deficiencies, as new research from Linköping University shows.
“There seems to be ignorance among those caring for stroke patients
about how things are for the patients the week before they die. For
example, it’s not known whether the person dies alone, or if they are in
pain. This is remarkable; we don’t see the same tendencies in cancer
care,” says Heléne Eriksson, who worked as a nurse for 25 years and is
now a PhD student.
Four researchers from Linköping University compared palliative care
for stroke patients with that for cancer patients. The comparison was
made using the Swedish palliative care register, to which caregivers
report in the event of a death. What researchers reacted to was the
remarkable differences in what the caregivers know about their patients
in the last week of their lives. Caregivers for stroke patients know to a
much lesser extent how things are for their patients before they die.
Registry data also shows that stroke patients, to a lesser extent
than cancer patients, are stated as suffering from pain, from feeling
sick, from confusion and anxiety, and from dyspnea (breathing
difficulties) in their last week of life; on the other hand, they suffer
more from rattling breath. Stroke patients seeming to suffer from fewer
symptoms compared to cancer patients, however, need not tally with
reality; it may be a result of the deficient insight of staff into how
things were for the patient.
Death not talked about
The study also shows that care for stroke patients at the end of
their lives is worse as regards information. The ‘turning point’
conversation – where people are told that a cure is not possible and
that care will instead enter a palliative stage – is rarely held with
stroke patients. Researchers do not know if this is due to the
conversation not being prioritised or if the patient’s condition is too
poor for it. Nor, after the patient has died, do those close to the
stroke patient get a follow-up conversation to the same extent as those
close to the cancer patient – something that could be important for them
when the course of the illness can go quickly.
“Being given good care in the last hours of life is important for all
people, even for those who don’t die of cancer. They should have as
peaceful a death as possible, and avoid an emergency care environment
where care staff and family members are running in and out to care for
other patients in the same room,” Ms Eriksson says.
She argues that care for stroke patients at the end of their lives
has the potential to be improved, and is looking for more training and
routines that function, regardless of diagnosis.
The study, which is a part of a doctoral thesis, has been published
in PLOS One. The authors are PhD student Heléne Eriksson, Professor
Katarina Hjelm, reader Anna Milberg and reader Maria Friedrichsen, all
of Linköping University.
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0147694#sec008
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