Conclusion

Having sensitive and effective conversations with patients and their families after a severe stroke can help ensure that the care is patient-centred. Patients will feel better supported and families will be more satisfied with care.

It’s important to talk openly about dying after a severe stroke, sharing information about poor prognosis, and be honest about uncertainties e.g. ‘will this person die?’ and ‘how long will this take?’

When communicating with patients and families, it’s essential to explore their understanding, expectations, goals and priorities of patients, if they are able, and involving those close to them (including any welfare attorney).

Options for treatment and care must be informed by patient goals and preferences.

Family members often experience a range of complex emotions and this can come across in different ways, e.g. anger, becoming more withdrawn. It’s important that staff are aware of these different emotions and have strategies for responding to these emotions.

When the person is dying it’s important to continue to support the family e.g. explaining what might be expected as the person dies, and acknowledging the uncertainty of how long dying will take can be difficult. Consider how best to support patients in the early phase of bereavement.

Effective communication within the team requires team members to come prepared to team meetings, express their views and contribute to decision making. Decisions made should be clearly documented and communicated to family, and to the primary care team if a patient is discharged home to die.

Talking to families about end-of-life care can be upsetting for staff, it is important to acknowledge this and provide support for you yourself and your colleagues within the team.

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In relation to end of life care issues after stroke:

How strongly do you agree with the following points?
  1. I have a clear understanding of my role in the multidisciplinary team.
  2. I am confident in my role and responsibility providing end of life care.
  3. I am confident in communicating information about end of life care issues to my colleagues.
  4. I am confident in discussing end of life care issues with patients, families and carers.
  5. I get support from the multidisciplinary team if I have difficulties caring for patients with end of life care needs.
  6. I am involved in decision making within my team about patients end of life care needs.
  7. I contribute to discussion about specific treatments such as nutrition and hydration, CPR or use of comfort care rather than treatments which are no longer working effectively.

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Page last reviewed: 20 Apr 2020