SYMPTOM CONTROL, COMMUNICATION WITH HEALTH-PROFESSIONALS, AND HOSPITAL-CARE OF STROKE PATIENTS IN THE LAST YEAR OF LIFE AS REPORTED BY SURVIVING FAMILY, FRIENDS, AND OFFICIALS

Background and Purpose The needs of and appropriate service provision for patients dying from stroke have received little attention. The qua lity of care in the last year of life received by a population-based s ample of stroke patients is described here, focusing on symptom contro l, communication with health professionals, and hospital care. Methods Secondary analysis was made of data from the Regional Study of Care f or the Dying, a retrospective interview survey in 20 nationally repres entative English health districts. Subjects were 237 persons who died from stroke in 1990. Of informants, 20% were spouses, 48% relatives, 1 1% friends or neighbors, and 20% officials. Results More than half the patients were reported to have experienced pain (65%), mental confusi on (51%), low mood (57%), and urinary incontinence (56%) in the last y ear of life. Pain control was inadequate: 51% of those treated for pai n by hospital doctors and 45% of those treated by general practitioner s were reported to have received treatment that relieved pain partiall y if at all. One third of respondents thought that hospital doctors ha d been too rushed (37%), and 25% thought that the patient had had insu fficient choice about treatment. Two fifths had been unable to get all the information they had wanted about the patient's condition. Conclu sions Improvements in symptom control and psychosocial support for pat ients who die from stroke are needed, as is better communication betwe en health professionals and patients and their families. Education of doctors and nurses working with stroke patients in the principles of p alliative care may help ensure that all dying stroke patients receive high-quality care.