Look at the conversation examples below. Consider whether you think these conversations are more difficult or less difficult for people with stroke than other patients. How the specific problems after stroke might influence decision making and conversations with patient and family will be explored later in the module.
- Sudden onset (often little warning of a severe stroke so patient and family are often in shock with no time to prepare)
- Uncertain prognosis in first hours/days (very common, some patients who may seem to be very ill and at end of life can start to improve, for some the illness trajectory can be very variable)
- Dysphagia (patients who cannot swallow in the early stages can complicate the management and outcome which is difficult for families to understand)
- Speech impairment (when the patient loses speech or communication their family can be uncertain what the person actually wants or needs at end of life)
- Shock and effect on carer (the immediate focus is on the patient but carers can be affected very quickly especially if there are dependent children or others at home. Their role and responsibilities can change significantly after stroke)
- Need for quick decisions when the patient has had a life-threatening stroke (for example, hemicraniotomy or clot retrival)
- Insufficient time to get to know the patient and family (staff have to cope with distressed patient and family who they do not have time to build a relationship with)
- Slow deterioration (more common in chronic conditions than stroke)
- Time to plan for patient’s wishes (when a patient has a chronic condition they may have already discussed their wishes about what they would like to happen at the end-of-life stage in their illness, put in place equipment and services to allow the person to die at home if they wish to)
- Time to appoint power of attorney (people with chronic conditions may have put arrangements in place for power of attorney, will etc)
- Families may have spoken about preferences around death and dying e.g. preferred place of death (some families may have discussed or planned around end of life if the person has a chronic condition)
- Families may have already discussed preferences for life-saving interventions or Cardio Pulmonary Resucitation (GP may have started an Anticipatory Care Plan or made entries on to a KIS summary if the person has a chronic condition)
- Difficulty involving patients (who are too ill) and families (if they are distressed) in discussion of patient preferences/ goals at a time when prognosis is unclear, and preferences may not be known.
Page last reviewed: 16 Jan 2023
