Palliative Care and Stroke: An Integrative Review of the Literature

Stroke survivors often experience life-altering functional and cognitive changes and burdensome symptoms. Palliative care could provide additional support to improve outcomes of stroke patients and their families. The purpose of this review was to describe how palliative care is conceptualized and implemented within stroke care. An integrative review of the literature published between 1990 and 2016 using the terms "palliative care," "stroke," or "acute stroke" was conducted. Of the 363 articles identified, 44 were screened, 21 met inclusion criteria, and 2 additional articles were identified through reference list review, resulting in a final sample of 23 articles. Palliative care was predominantly understood as end-of-life care and was most commonly offered in acute stages when patients were expected to die. Patients, families, and providers reported challenges surrounding decision making, uncertainty regarding transitions to palliative care, and needs related to communication and physical and psychosocial support. The quality of the research was moderate to good but was limited by retrospective designs, reliability of data collection procedures and tools, recall bias, and generalizability. This review highlights gaps in access to palliative care throughout the illness trajectory and underscores the need for study of models that integrate palliative care into stroke care.