In the first few hours

Framework for discussion

Within the first few hours of stroke, the priority for communication will depend to some extent on the severity of the stroke and the immediate prognosis, but generally conversations will need to include communication about the diagnosis, immediate care and management. If the patient is likely to die imminently this needs to be communicated clearly. The first conversation is important to help establish trust with the family.

Here are some tips about the first meeting with a family.

Initial conversation within first few hours of admission.

  • Be honest with severity of situation. Use the word ‘dying’ if patient is moribund and avoid euphemisms or vague descriptions
  • If death is not imminent but likely in the next hours to days, the person is still ‘dying’ and we can talk about how we care for people who are dying. (see NHS Scotland: Palliative Care Guidelines)
  • Find out if there is anything important for this person or their family. These things may include spiritual/religious care
  • Give clear information about what is likely to happen in the next few hours
  • In some settings it is possible to show scan results to explain the seriousness of the stroke
  • Probe as to what the family think the patient would want if able to express themselves
  • Emphasise the need for family to plan next 24 hours/rest/contacting other family members
  • Answer any questions the family may have, and emphasise uncertainty of outcome if appropriate
  • Take relevant contact details that suit family arrangements e.g. first contact person/day and night
  • Document conversation in medical records and communicate same with clinical team caring for the patient at that time. Be clear about what agreed care and what treatments should and should not be given. If some decisions are still to be made, ensure this is highlighted and will be discussed again at the next meeting with relatives
  • Some families may ask about organ or tissue donation, especially if the person had previously expressed this and is on the organ donation register

Page last reviewed: 15 Apr 2020