How would your doctor have any clue about how close you are to death with no objective information on the dead and damaged areas in stroke?
My doctor told me I had a massive stroke but that had to be pulled out of his ass, he had no concrete information to base that upon. Yeah, my left side didn't work at all but I could hold lucid conversations immediately. I'd have to say most of my damage probably occurred during the first week as the neuronal cascade of death killed off a huge chunk of my brain.
http://www.news-medical.net/news/20160414/Physicians-failing-to-talk-to-stroke-patients-about-end-of-life-treatment-preferences.aspx
By Lucy Piper
US research suggests that physician-patient
discussion about limitations on life-sustaining interventions following
ischaemic stroke is low, poorly documented and often left too late.
Among 198 patients, aged 80 years on average, who died within 30 days
of admission to hospital due to stroke, less than 40% had discussions
with their physicians about limitations on life-sustaining interventions
documented during the index hospitalisation.
Even among patients who died while in hospital or were discharged to
hospice, only 50% had documented discussions about end-of-life
treatment.
This was despite 47% of patients documenting at or within 48 hours of
admission their desire to forgo at least one life-sustaining
intervention.
"This suggests that there is an opportunity to improve
patient-physician communication, and thus the quality of palliative care
in stroke, in the early poststroke period", say lead researcher Maisha
Robinson (Mayo Clinic, Jacksonville, Florida, USA) and colleagues.
Indeed, their findings showed that for most patients discussions
occurred just 5 days before death and although unable to discern the
reasons for this lateness, the researchers propose it could be due to
worsening or lack of improvement of the patient's clinical condition or
due to episodes of poor quality of care leading to clinical
deterioration.
Physician communication was a significant 56% less likely to be
documented for patients with mild to severe stokes than for those with
very severe strokes, particularly regarding preferences for
cardiopulmonary resuscitation.
"It is plausible that physicians are more comfortable initiating
discussions about end-of-life care decisions in catastrophic situations
or that these discussions more often lead to documented decisions to
withhold life-sustaining interventions with severe strokes relative to
milder ones, or both", suggests the team in Neurology.
Ying
Xian (Duke University Medical Center, Durham, North Carolina, USA) and
Winston Chiong (University of California, San Francisco, USA) stress in a
related editorial
that the highly preference-sensitive nature of decisions on
life-sustaining therapy after acute ischaemic stroke and their ability
to "profoundly influence consequent mortality" make them "essential" to
ensure high-quality care.
They conclude: "As has been noted elsewhere, such failures to
incorporate patient preferences are themselves preventable medical
errors, and these errors are particularly consequential in the setting
of ischemic stroke."
"Future initiatives to improve safety and reduce preventable errors
in stroke care should include efforts to identify contributing factors
associated with the lack of communication, develop interventions to
promote healthy dialog among patients, their families, and the health
care team, and ultimately improve patient-centered care at the end of
life for stroke patients." (Nothing on objectively determining the damage, so guessing is involved.)
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