Planning After Stroke Survival: Advance Care Planning in the Stroke Clinic

Paul D. Johnson, Angela Ulrich, Jenny Siv, Breana Taylor, David Tirschwell, Claire J. Creutzfeldt

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Stroke survivors have high rates of mortality and recurrent stroke. Stroke patients are often unable to participate in decision making, highlighting the need for advance care planning (ACP) in poststroke care. We sought to better understand experiences and perceptions around stroke risk and ACP in our stroke clinic. Methods and Results: Clinic patients completed the Planning After Stroke Survival survey assessing (1) advance directive (AD) documentation and ACP conversations, (2) factors associated with ADs and ACP, (3) perceptions of stroke risk, and (4) ACP needs. We used a physician survey and the electronic medical record to assess clinical and demographic information. We collected 219 surveys (78% response rate). Forty-five percent reported having completed ADs, although the correlation between patient report and EMS documentation of ADs was low. Most patients (73%) had discussed ACP, and 58% desired additional conversation. Predictors of completing ADs included age (≥65 years; odds ratio, 4.8; 95% CI, 2.3–10.1), white race (odds ratio, 3.1; 95% CI, 1.2–7.8), milder poststroke disability (modified Rankin Scale score ≤1; odds ratio, 2.9; 95% CI, 1.3–6.4), having previously discussed ACP with a physician (odds ratio, 4.8; 95% CI, 2.0–11.7), and discussing risk of stroke recurrence (odds ratio, 2.2; 95% CI, 1.1–4.5). Conclusions: Stroke survivors had low AD completion rates and desired more conversations about stroke risk and ACP. Completed ADs were inconsistently documented in the electronic medical record. These findings provide guidance to improve ACP in our stroke clinic and may provide a model for others interested in enhancing ACP and ultimately goal-concordant care.

Original languageEnglish (US)
Article numbere011317
JournalJournal of the American Heart Association
Volume8
Issue number9
DOIs
StatePublished - May 7 2019
Externally publishedYes

Bibliographical note

Funding Information:
Dr Creutzfeldt receives support from the NIH (K23NS099421). The remaining authors have no disclosures to report.

Funding Information:
Funding was generously provided by a research grant from the University of Washington Housestaff Association.

Publisher Copyright:
© 2019 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

Keywords

  • advance care planning
  • advance directives
  • palliative care
  • stroke
  • stroke clinic

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