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End-of-Life Care for Stroke
Stroke is a leading cause of disability and the third leading cause of death in Canada, according to the Heart and Stroke Association. Despite a high mortality rate, the experience of dying from a stroke has received limited attention from a palliative point of view. When attempting to make inferences from other specialties that have well researched methods of palliation, there was an obvious gap when considering the stroke population. Palliative stroke patients, at the Royal University Hospital, rarely have access to a bed on a specialized palliative care unit.
Source: Journal of Pain and Symptom Management - November 30, 2018 Category: Palliative Care Authors: Shelley Jolly, Ruth Whelan, Kimberly Davy Source Type: research

Palliative Care and Stroke: An Integrative Review of the Literature (S740)
Stroke survivors and their family members face unique needs related to life-altering functional and cognitive changes and burdensome symptoms, which negatively impact quality of life (QOL). Guidelines recommend that primary palliative care (PC) be offered to all stroke patients; however, gaps exist in understanding how PC is perceived and implemented within stroke.
Source: Journal of Pain and Symptom Management - February 1, 2018 Category: Palliative Care Authors: Kristen Overbaugh, Stephanie Molidor, Carole White, Deborah James Source Type: research

This Stroke Changed My Life and I Need Help: Social Media Resources for Bilingual Caregivers of Stroke Victims (S753)
Stroke remains a leading cause of long-term disability and burdened quality of life not only for stroke survivors with remaining disability (SSRDs) but also for the informal caregivers (ICGs) who care for them. Approximately 50% of SSRDs will require ICG hands-on support, precluding them from leaving home. With current technology, social media might be the only way for ICG to gain training/access support. What resources are available out there for ICGs of SSRDs?
Source: Journal of Pain and Symptom Management - January 25, 2020 Category: Palliative Care Authors: Sandra Sanchez-Reilly, Laura Reilly-Sanchez, Valeria Restrepo, Marcos Restrepo, Jeanette Ross, Michael Mader Source Type: research

Changes in the Use of Intensive and Supportive Procedures for Patients with Stroke in Taiwan in the Last Month of Life between 2000 and 2010
Stroke is the second leading cause of death and the primary cause of disability worldwide. It is uncertain what care patients with stroke receive in their end of life care and what trends in care are in recent years.
Source: Journal of Pain and Symptom Management - November 27, 2017 Category: Palliative Care Authors: Pei-Yi Wang, Yen-Ni Hung, Robert Smith, Chia-Chin Lin Source Type: research

Palliative and End-of-Life Care After Severe Stroke
This study sought to determine the prevalence, predictors, and outcomes associated with PCC for patients hospitalized with severe ischemic stroke.
Source: Journal of Pain and Symptom Management - January 4, 2022 Category: Palliative Care Authors: Amber R. Comer, Linda S. Williams, Stephanie Bartlett, Lynn D'Cruz, Katlyn Endris, McKenzie Marchand, Isabel Zepeda, Sumeet Toor, Carly Waite, Areeba Jawed, Robert Holloway, Claire J. Creutzfeldt, James E. Slaven, Alexia M. Torke Tags: Original Article Source Type: research

OnabotulinumtoxinA Improves Pain in Patients with Post-Stroke Spasticity: Findings from a Randomized, Double-Blind, Placebo-Controlled Trial
Patients with post-stroke spasticity (PSS) commonly experience pain in affected limbs, which may impact quality of life.
Source: Journal of Pain and Symptom Management - March 28, 2016 Category: Palliative Care Authors: Jörg Wissel, Vaidyanathan Ganapathy, Anthony B. Ward, Jörgen Borg, Per Ertzgaard, Christoph Herrmann, Anders Haggstrom, Mohamed Sakel, Julia Ma, Rozalina Dimitrova, Antony Fulford-Smith, Patrick Gillard Source Type: research

OnabotulinumtoxinA Improves Pain in Patients With Post-Stroke Spasticity: Findings From a Randomized, Double-Blind, Placebo-Controlled Trial
Patients with post-stroke spasticity (PSS) commonly experience pain in affected limbs, which may impact quality of life.
Source: Journal of Pain and Symptom Management - March 28, 2016 Category: Palliative Care Authors: J örg Wissel, Vaidyanathan Ganapathy, Anthony B. Ward, Jörgen Borg, Per Ertzgaard, Christoph Herrmann, Anders Haggstrom, Mohamed Sakel, Julia Ma, Rozalina Dimitrova, Antony Fulford-Smith, Patrick Gillard Tags: Original Article Source Type: research

Establishing Goals of Care for Patients with Stroke and Feeding Problems: An Interdisciplinary Trigger-Based Continuous Quality Improvement Project
Few patients with dysphagia due to stroke receive early palliative care to align treatment goals with their values, as called for by practice guidelines, particularly before enteral access procedures for artificial nutrition.
Source: Journal of Pain and Symptom Management - June 25, 2018 Category: Palliative Care Authors: Franchesca Hwang, Christine Boardingham, Susanne Walther, Molly Jacob, Andrea Hidalgo, Chirag D. Gandhi, Anne C. Mosenthal, Sangeeta Lamba, Ana Berlin Source Type: research

Appraisal of Health States Worse than Death in Patients with Acute Stroke (S714)
Goals of care discussions are frequently indicated after acute stroke. Many of these conversations happen without direct patient participation secondary to aphasia or encephalopathy.
Source: Journal of Pain and Symptom Management - January 25, 2020 Category: Palliative Care Authors: Elyse Everett, William Everett, Matthew Brier, Patrick White Source Type: research

Electro-acupuncture for post-stroke spasticity: results of a pilot pragmatic randomized controlled trial
People with spasticity which occurred between 30 days and one year after stroke onset with a baseline Modified Ashworth Scale (MAS) ≥ 1.
Source: Journal of Pain and Symptom Management - August 4, 2020 Category: Palliative Care Authors: Yiyi Cai, Claire Shuiqing Zhang, Anthony Lin Zhang, Cliff Da Costa, Charlie Changli Xue, Zehuai Wen Tags: Original Article Source Type: research

Mobility Goals of Care Conversations with Hospitalized Patients Suffering Severe Stroke (Sci239)
1. Using the WHO Functional classification, attendants will understand a mobility goals-of-care conversation, its prevalence, associated predictors, interventions, and outcomes.2. The attendant will be able to note similarities and differences between the large stroke population and the propensity-matched groups.
Source: Journal of Pain and Symptom Management - April 14, 2023 Category: Palliative Care Authors: Stephanie L. Bartlett, Kristine Miller, James Slaven, Veronica R. Kassab, Aubrey Odgers, Xochitl G. Rivera-Cordova, Amber R. Comer Source Type: research

Improving Access to Specialist Palliative Care for Patients with Catastrophic Strokes: A Quality Improvement Project to Trigger Inpatient Palliative Care Consultations (QI730)
The American Stroke Association strongly recommends palliative care for patients hospitalized with catastrophic strokes to improve shared decision-making and relieve suffering. An automatic trigger to consider a consult for these patients may improve access to palliative care. The National Institutes of Health Stroke Scale (NIHSS) is a good predictor of short- and long-term outcomes and high scores (>= 20) are associated with poorer prognosis.
Source: Journal of Pain and Symptom Management - February 23, 2021 Category: Palliative Care Authors: Vandana Nagpal, Marcey Osgood, Jennifer Reidy Source Type: research

Subcutaneous Use of Baclofen
Painful spasticity is an often debilitating symptom that occurs mostly in patients with neurologic diseases such as multiple sclerosis or stroke. Treatment approaches include pharmacologic and nonpharmacologic interventions. Baclofen is one of the drugs commonly used to decrease elevated muscle tone. This GABAB agonist acts primarily by limiting the release of excitatory neurotransmitters on the spinal level, thereby decreasing spastic muscle tone. Baclofen is licensed for oral and intrathecal use in spasticity. The abrupt cessation of baclofen therapy can lead to withdrawal syndromes including epileptic seizures. Here, we...
Source: Journal of Pain and Symptom Management - May 30, 2014 Category: Palliative Care Authors: Constanze Rémi, Elisabeth Albrecht Tags: Letters Source Type: research

Hospice and Palliative Medicine Clinician Views of Deactivation of Ventricular Assist Devices at End of Life
Left ventricular assist devices (LVADs) provide circulatory support to patients with advanced heart failure. These devices are used as a temporary bridge to recovery, bridge to cardiac transplantation, or as destination therapy (DT)—where the patient will have the device in situ for the remainder of his/her life. Compared to medical management alone, LVAD-DT often improves survival and quality of life for patients with severe heart failure.1 However, patients with LVADs may experience a host of challenges including a catastrophic event (e.g., stroke, hemorrhage, infection), a concurrent slow decline in health (e.g., righ...
Source: Journal of Pain and Symptom Management - May 26, 2015 Category: Palliative Care Authors: Keith M. Swetz, Sara E. Wordingham, Matthew H. Armstrong, Katlyn E. Koepp, Abigale L. Ottenberg Source Type: research

Hospice and Palliative Medicine Clinician Views of Deactivation of Ventricular Assist Devices at the End of Life
Left ventricular assist devices (LVADs) provide circulatory support to patients with advanced heart failure. These devices are used as a temporary bridge to recovery, bridge to cardiac transplantation, or as destination therapy (DT)—where the patient will have the device in situ for the remainder of his/her life. Compared to medical management alone, LVAD-DT often improves survival and quality of life for patients with severe heart failure.1 However, patients with LVADs may experience a host of challenges including a catastrophic event (e.g., stroke, hemorrhage, infection), a concurrent slow decline in health (e.g., righ...
Source: Journal of Pain and Symptom Management - May 26, 2015 Category: Palliative Care Authors: Keith M. Swetz, Sara E. Wordingham, Matthew H. Armstrong, Katlyn E. Koepp, Abigale L. Ottenberg Tags: Letter Source Type: research

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