ArticleBMC medical ethics2017
Critical appraisal of advance directives given by patients with fatal acute stroke: an observational cohort study.
Article in BMC medical ethics, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers.
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Who cites it
13 citing papers in PubMed.
- Care Consistency With Care Preferences in Nursing Homes: A Cluster-Randomized Study of the Effects of an Advance Care Planning Program (BEVOR).Deutsches Arzteblatt international · 2025Trial
- Communicating with Families after Severe Acute Brain Injury.Neurocritical care · 2025Review
- Palliative Care in the Neurocritical Care Unit: Increasing Primary Palliative Care Skills.Neurocritical care · 2025Article
- Advance care planning among stroke patients: A scoping review.International journal of nursing sciences · 2025Review
- An Update on Palliative Care in Neurocritical Care: Providing Goal‑Concordant Care in the Face of Prognostic Uncertainty.Current treatment options in neurology · 2023Article
- Translation of patients' advance directives in intensive care units: are we there yet?Journal of intensive care · 2023Review
- Aneurysmal Subarachnoid Hemorrhage and Clinical Decision-Making: A Qualitative Pilot Study Exploring Perspectives of Those Directly Affected, Their Next of Kin, and Treating Clinicians.International journal of environmental research and public health · 2023Article
- Prognostic humility and ethical dilemmas after severe brain injury: Summary, recommendations, and qualitative analysis of Curing Coma Campaign virtual event proceedings.Frontiers in human neuroscience · 2023Article
- Article
- End-of-Life Care Decision-Making in Stroke.Frontiers in neurology · 2021Review
- Planning After Stroke Survival: Advance Care Planning in the Stroke Clinic.Journal of the American Heart Association · 2019Article
- The COAST stroke advance directive: A novel approach to preserving patient autonomy.Neurology. Clinical practice · 2018Article
- Advance directives, proxy opinions, and treatment restrictions in patients with severe stroke.BMC palliative care · 2017Article
Corrections and comments
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Authors and funding
3 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundAdvance directives (AD) imply the promise of determining future medical treatment in case of decisional incapacity. However, clinical practice increasingly indicates that standardized ADs often fail to support patients' autonomy. To date, little data are available about the quality and impact of ADs on end-of-life decisions for incapacitated acute stroke patients.
methodsWe analyzed the ADs of patients with fatal stroke, focusing on: (a) their availability and type, (b) stated circumstances to which the AD should apply, and (c) stated wishes regarding specific treatment options.
resultsBetween 2011 and 2014, 143 patients died during their hospitalization on our stroke unit. Forty-two of them (29.4%) had a completed and signed, written AD, as reported by their family, but only 35 ADs (24.5%) were available. The circumstances in which the AD should apply were stated by 21/35 (60%) as a "terminal condition that will cause death within a relatively short time" or an ongoing "dying process." A retrospective review found only 16 of 35 ADs (45.7%) described circumstances that, according to the medical file, could have been considered applicable by the treating physicians. A majority of patients objected to cardiopulmonary resuscitation (22/35, 62.9%), mechanical ventilation (19/35, 54.3%), and artificial nutrition (26/35, 74.3%), while almost all (33/35, 94.3%) directed that treatment for alleviation of pain or discomfort should be provided at all times even if it could hasten death.
conclusionsThe prevalence of ADs among patients who die from acute stroke is still low. A major flaw of the ADs in our cohort was their attempt to determine single medical procedures without focusing on a precise description of applicable scenarios. Therefore, less than half of the ADs were considered applicable for severe acute stroke. These findings stress the need to foster educational programs for the general public about advance care planning to facilitate the processing of timely, comprehensive, and individualized end-of-life decision-making.
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