Thursday, April 03, 2014

Having the hard discussions

Photo from the U.S. Department of Veterans Affairs
We all want to recover completely - the alternatives are unpleasant, and we're tempted to shy away from even thinking about these alternatives.

But the truth is, stroke is the most common cause of disability in the United States, and it's the fourth leading cause of death. Of course, the medical community needs to continue its efforts to find better ways to prevent and treat strokes to improve these numbers.

It's sometimes hard to talk about the type of care that some stroke patients need. And I'm not 100 percent in agreement with the tone and implication of the American Heart Association/American Stroke Association statement that "the majority" stroke patients need palliative care - that is, care with the emphasis on comfort rather than dealing with the underlying problem.

Still, the ASA did come up with some potential discussion points between stroke survivors, caregivers and health professionals:
As a stroke survivor or family member, you should expect your healthcare provider to:
  • Talk about your preferences, needs and values as a guide to medical decisions.
  • Discuss what aspects of recovery are most important to you.
  • Have effective, sensitive discussions about your prognosis, how to deal with physical or mental losses from a stroke, and if necessary, of dying, among  other serious topics.
  • Guide you through choices about life-sustaining treatment options. Providers should address pros and cons of CPR, ventilators, feeding tubes, surgery, do-not-resuscitate orders (DNR), do-not-intubate (DNI) orders and natural feeding.
  • Know the best treatment options for common post-stroke symptoms, including pain, other physical symptoms and psychological problems like depression and anxiety.
  • Engage a palliative care specialist if complex issues arise.
  • Help preserve dignity and maximize comfort throughout the course of a stroke, including during the dying process and when nearing death.
Understandably, these might be very hard conversations. But avoiding these conversations might cause increased and needless suffering.

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