A new Scottish study suggests that physicians of severe stroke patients need to take into account their patients’ mental health needs and better prepare their families for the possibility that their loved one may not recover.
The study, conducted by researchers from the universities of Edinburgh and Glasgow, reveals that many stroke patients and their families experience debilitating feelings of loss and uncertainty following a major stroke which can significantly impact their quality of life.
A stroke occurs when the blood supply to part of the brain is interrupted or reduced, typically by a blocked artery, or a blood vessel leaking or bursting, depriving brain tissue of oxygen and nutrients. Stroke accounts for more than 6 million deaths per year worldwide.
For the study, the researchers followed patients in Scotland over the course of a year following a severe form of stroke. They also interviewed health care staff and family caregivers. The series of interviews conducted over a period of six months suggest that healthcare professionals should not shy away from sensitive discussions about death.
“Stroke occurs suddenly and patients may face death or survival with major disability,” said Professor Gillian Mead of the Centre for Clinical Brain Sciences at the University of Edinburgh.
“Staff must have sensitive conversations with patients and family to find out their views and agree on which treatments are appropriate. This is an important education and training topic for everyone in the stroke team.”
More than half of the patients in the study died within six months of admission to hospital. Families reported that despite the high risk of death, care was overly focused on physical recovery with little attention to emotional needs or preparation for death.
“If they had told us the magnitude of the stroke as far back as the first hospital visit we would have done things differently, rather than pushing for something that was never going to happen,” said one of the study caregivers whose father died from a severe stroke.
Since so many major-stroke patients die within six months, the study researchers suggest that care should reflect the possibility of death and disability. They also say that rehabilitation should incorporate principles of palliative care to address the emotional, social and spiritual— as well as the physical — needs of patients.
“It is a sad fact that many people with a severe stroke die, despite excellent and speedy medical care. Whilst we hope for a good recovery, relatives and patients also should be supported in preparing for the worst to help them to focus on quality of life,” said study leader Professor Scott Murray of the University of Edinburgh’s Usher Institute of Population Health Science and Informatics.
The new study appears in the Canadian Medical Association Journal and was funded by Chief Scientist Office, part of the Scottish Government Health Directorates.
Source: University of Edinburgh