The study protocol of: ‘Initiating end of life care in stroke: clinical decision-making around prognosis’

BMC Palliative Care

Study Protocol

Salah Elghenzai¹  Helen Mitchell²  Sheila Payne³  Mary Turner³  Jo Rycroft-Malone⁴  Sion Williams⁴  Christopher R Burton⁴  Lupetu Ives Ntambwe⁴  Tracey Bucknall⁵  Maria Horne⁶  Pippa Tyrrell⁷  Sarah Tyson⁸ 

[1] Betsi Cadwaladr University Health Board, Ysbyty Gwynedd, Penrhosgarnedd, LL57 2PW, Bangor, Gwynedd, UK;Betsi Cadwaladr University, Health Board, LL55 2YE, Ysbyty Eryri, Caernarfon, UK;International Observatory on End of Life Care, Faculty of Health and Medicine, Lancaster University, LA1 4YG, Lancaster, UK;School of Healthcare Sciences, Bangor University, LL57 2EF, Bangor, Gwynedd, UK;School of Nursing and Midwifery, Deakin University, 221 Burwood Hwy, VIC 3125, Burwood, Melbourne, Australia;University of Bradford, Richmond Road, BD7 1DP, Bradford, Yorkshire, UK;University of Manchester, MAHSC, Salford Royal Foundation Trust, M6 8HD, Salford, UK;University of Manchester, Oxford Road, M13 9PL, Manchester, UK;

关键词: Acute stroke;    Palliative care;    End of life care;    Decision making;    Dying trajectories;    Implementation;   

DOI  :  10.1186/1472-684X-13-55

 received in 2014-11-19, accepted in 2014-11-27,  发布年份 2014

来源: Springer

【 摘 要 】

BackgroundThe initiation of end of life care in an acute stroke context should be focused on those patients and families with greatest need. This requires clinicians to synthesise information on prognosis, patterns (trajectories) of dying and patient and family preferences. Within acute stroke, prognostic models are available to identify risks of dying, but variability in dying trajectories makes it difficult for clinicians to know when to commence palliative interventions. This study aims to investigate clinicians’ use of different types of evidence in decisions to initiate end of life care within trajectories typical of the acute stroke population.Methods/designThis two-phase, mixed methods study comprises investigation of dying trajectories in acute stroke (Phase 1), and the use of clinical scenarios to investigate clinical decision-making in the initiation of palliative care (Phase 2). It will be conducted in four acute stroke services in North Wales and North West England. Patient and public involvement is integral to this research, with service users involved at each stage.DiscussionThis study will be the first to examine whether patterns of dying reported in other diagnostic groups are transferable to acute stroke care. The strengths and limitations of the study will be considered. This research will produce comprehensive understanding of the nature of clinical decision-making around end of life care in an acute stroke context, which in turn will inform the development of interventions to further build staff knowledge, skills and confidence in this challenging aspect of acute stroke care.

【 授权许可】

CC BY   
© Burton et al.; licensee BioMed Central Ltd. 2014