黑料网

Many people with non-cancer conditions seek palliative care. Individuals with neurologic and neurosurgical illnesses have unique palliative care needs that are poorly recognized. As a result of advancements in acute stroke care, particularly in specialty hospitals, overall stroke mortality has reduced. If a patient with an acute ischemic stroke comes early enough in the hospital, procedures should be in place to provide tissue-type plasminogen activator within an hour of their arrival, effectively tripling the patient's chances of future autonomy. Palliative stroke treatment is an important part of high-quality stroke care and should be a focus of our research as well as internship and fellowship training [1].

Palliative care and stroke

Palliative care needs are common and significant after a stroke, but little research has been done on the precise nature of these needs and the best approaches for detecting and managing them. The majority of palliative care and stroke research focuses on end-of-life care and dying, with an emphasis on symptomatic therapy for the dying and support for family members dealing with difficult decisions and loss. Patients with neurologic or neurosurgical illnesses had their in-patient charts and computerized data examined [2, 3]. Cancer patients were not permitted to take part. There is a major information gap about the specialized palliative care needs of stroke patients, according to one comprehensive study, and "collaborative research involving practitioners in specialist palliative care and stroke communities" is needed.

Palliative care integration with primary and specialist care

Palliative care is provided by several members of the multidisciplinary care team. Because the role of palliative care has expanded and the popularity of early palliative care is growing across the spectrum of chronic conditions, an approach has been developed that distinguishes primary palliative care (skills that all clinicians should have) from specialized palliative care (skills that only a few clinicians should have) (provided by clinicians who are boarded in medicine and are trained in managing more challenging and complicated cases).

Palliative care professionals offer patients, family caregivers, and physicians an extra degree of support [4]. They may be called upon to aid with the ramifications of conflicting goals of treatment, transition to end-of-life or hospice care, and bereavement support, as well as to manage complex or refractory clinical indicators or uncomfortable family gatherings.

Special palliative care for severe stroke

Palliative care is beneficial to all stroke patients and their families, but it is especially vital for those who have experienced a catastrophic stroke. Because there are no agreed-upon criteria, the National Institute of Health Stroke Scale is one way to characterise severe stroke. A severe stroke, on the other hand, is defined as a stroke that requires long-term institutional care or cannot be survived without urgent medical or surgical intervention, such as intubation and mechanical respiration or brain surgery. This definition includes ischemic strokes, as well as intraparenchymal and subarachnoid haemorrhages. Despite the importance of palliative care for people who have had a symptomatic stroke, there is no guideline on how to include it into the care of these patients who are considering ending their treatment, resulting in significant heterogeneity in care.

Formulating personal treatment objectives

The most appropriate, patient-centered therapy recommendations require an accurate evaluation of patient preferences. Future health states and associated trade-offs are valued differently by different people. Neurosurgeons are expert medical detectives because they ask critical questions, observe key symptoms, and focus on specific syndromes. As we integrate primary palliative care into our practices, we must refine our narrative skills so that we can extract not only objective data, but also the patients' or their families' personal knowledge of the condition, ambitions, and worries. The ability to listen empathise, and suffer alongside the patient and family aids in the development of a courteous and cost-effective collaboration between the surgical department, which is an expert in diagnosing and treating the specific illness, and the patient and their family, who are experts on their own story, as well as their values, goals, and priorities [5].

Conclusion

Patients with severe stroke require immediate palliative care, which includes psychological support for the patient and caregiver, a group decision for preference-sensitive treatment decisions, the establishment of patient-centered care objectives, and pain and symptom control. Depending on the capabilities of the multidisciplinary palliative care team, early stroke palliative care should be integrated with life-saving and neuro-restorative therapies and offered by stroke therapists, when these experts can provide additional support for patients, family members, or doctors. Vascular neurology fellowships should include palliative care competencies to ensure that all practitioners are knowledgeable in basic palliative care skills as well as adept at triaging recognized needs to consultation specialists. PM services are required for patients with a variety of neurologic and neurosurgical illnesses. Palliative care interventions could be customized to these patients if the demands were better understood.

Acknowledgement

Not applicable.

Conflict of Interest

Author declares no conflict of interest.

1. Koton S, Schneider AL, Rosamond WD, Shahar E, Sang Y, et al. (2014) JAMA 312:259-268.

, ,

2. Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, et al. (2015) Circulation 131:e29-e322.

, ,

3. National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group (1995) N Engl J Med. 333(24):1581-1588.

, ,

4. Hacke W, Donnan G, Fieschi C, Kaste M, von Kummer R, et al. (2004) Lancet 363(11):768-774.

, ,

5. Berkhemer OA, Fransen PS, Beumer D, van den Berg LA, Lingsma HF, et al. (2015) N Engl J Med 372:11-20.

, ,