Background and purpose: End of life decision making is becoming an ever increasing focus for stroke patients and their care-givers. The American Heart Association recognized the importance of this process and the need for study in this area in a 2014 scientific statement. This remains a difficult discussion for many providers to engage in given the often difficult prognostication involved in this population. We hypothesize that including the stroke coordinator in end of life discussions will facilitate a consistent message for both families and providers, allowing less opportunity for the passage of conflicting information.
Methods and Results: The stroke coordinator cross trained and joined the palliative care committee, and the palliative care nurse joined the stroke team, to ensure ease of communication and collaboration. Additionally, the stroke team coordinator now participates in family care conferences in which end of life options are being discussed. The stroke team coordinator convenes with all providers prior to the family care conference to evaluate co-morbidities as well as stroke severity, thus allowing a holistic discussion with the family.
Outcomes: The stroke team coordinator brings a unique perspective to end of life conversations. While physicians provide clinical data around stroke severity and co-morbidities the stroke coordinator discusses outcomes and quality of life. By exploring with families what a loved one would consider an acceptable quality of life we are able to more fully assist the family to make difficult decisions. Expertise in palliative care assists in those conversations and allows family to feel comfortable understanding the options available. Most importantly, a frank discussion around feeding issues is essential to assure families that withholding tube feedings will not cause the patient distress.
Conclusion: The stroke team coordinator is in a unique position to provide leadership and guidance through often difficult and murky end of life discussions proving to be a valuable resource for this process.