The palliative care needs of acute stroke patients: a prospective study of hospital admissions

Burton, Christopher R., Payne, Sheila, Addington-Hall, Julia and Jones, Amanda (2010) The palliative care needs of acute stroke patients: a prospective study of hospital admissions. Age and Ageing, 39 (5), 554-559. (doi:10.1093/ageing/afq077).

Abstract

Background: despite a mortality rate of approximately 30% in acute stroke, little is known about the palliative care needs of this group of patients.

Design: prospective study of 191 acute stroke patients admitted to hospital in England. Biographical, medical and stroke-related data were collected. Participants completed the Sheffield Profile for Assessment and Referral to Care (SPARC), a screening tool for referral to specialist palliative care.

Findings: over 50% reported moderate to significant fatigue-related problems. Approximately 50% reported symptom-related problems (e.g. pain) or psychological distress (e.g. anxiety). Approximately 25% had concerns about death or dying, and 66% had concerns about dependence and disability. Over 50% were worried about the impact of stroke on family members. There were significant main effects of dependence (Barthel Index) (F1,123 = 12.640 P = 0.001) and age (F4,123 = 3.022 P = 0.020), and a significant three-factor interaction between dependence, age and co-morbidities (F9,123 = 2.199 P = 0.026) in predicting total SPARC scores.

Conclusions: acute stroke patients have a high prevalence of palliative care needs. Acute stroke services should use the SPARC for needs assessment. Priority for assessment should be given to patients with a score of <15/20 on the Barthel Index, a tool already used in most stroke services.

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