End-of-life care needs of people dying from stroke in Australia, New Zealand and Singapore : a space for palliative care
O'Connor, M.; Beattie, J.; Hong, E.; McKechnie, Roz; Lee, K.
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Citation:O'Connor, M., Beattie, J., Hong, E., McKechnie, R., & Lee, K. (2014). End-of-life care needs of people dying from stroke in Australia, New Zealand and Singapore: A space for palliative care. Asia Pacific Journal of Health Management, 9(1), pp.35-44.
Permanent link to Research Bank record:https://hdl.handle.net/10652/4040
AIMS: 1. Investigate the illness pathway of people dying of stroke in Singapore, New Zealand and Australia; and 2. Undertake a comparison of the needs of people dying of stroke between these countries. METHODS: A pilot retrospective medical record review was conducted with patients who died of stroke aged 18 years and over during 2008 to 2011 within acute care hospitals in Australia (n=10), New Zealand (n=10) and Singapore (n=7). This sample was designed to identify significant issues in the treatment and care of people who die of stroke, and will be used to inform a larger study. Sites chosen represented the key hospital for the treatment of people with stroke for a population of 200,000. Medical record data were collected using an agreed template and concerns of patients, relatives and health professionals were also extracted. One researcher led the analysis, which included descriptive statistics and thematic analysis. Electronic and telephone discussions between researchers ensured consistency of data. PRINCIPAL FINDINGS: The majority of patients in Australia and New Zealand were transferred to stroke wards for care; those in Singapore were transferred to intensive care and lived longer. A stroke care pathway was followed in all countries, with a palliation pathway identified in two records (Australia and New Zealand). Palliative care was documented in the majority of Australian and New Zealand records. Concerns related to impaired consciousness and deterioration in patients’ conditions. There was a lack of documented advance care plans and care directives; where present, staff had difficulty following them. Palliative care referral could make a difference to these patients and families. CONCLUSION: Stroke happens suddenly. Time to death is often short. This pilot indicates there is space for palliative care in the management of stroke patients to assist in end-of-life decision-making and symptom management. A larger study on this issue is justified