Evidence map›Paper›PMID 29137615›Full record

ArticleBMC palliative care2017

Advance directives, proxy opinions, and treatment restrictions in patients with severe stroke.

Floor A S de Kort, Marjolein Geurts, Paul L M de Kort, Julia H van Tuijl, Ghislaine J M W van Thiel, L Jaap Kappelle, H Bart van der Worp

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in BMC palliative care, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
9citing papers in PubMed, 1 pooled it
0.7field-weighted citation impact, top 22% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

9 citing papers in PubMed, 1 synthesis or guideline pooled it, 17 citations in OpenAlex.

  1. Pooled it
  2. Article
  3. Advance care planning among stroke patients: A scoping review.International journal of nursing sciences · 2025
    Review
  4. Article
  5. Quality of dying after acute stroke.European stroke journal · 2021
    Article
  6. Palliative care after stroke: A review.International journal of stroke : official journal of the International Stroke Society · 2021
    Review
  7. End-of-Life Care Decision-Making in Stroke.Frontiers in neurology · 2021
    Review
  8. Article
  9. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors at 2 institutions in 1 country.

Floor A S de KortDepartment of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands.
Marjolein GeurtsDepartment of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands. m.geurts-2@umcutrecht.nl.
Paul L M de KortDepartment of Neurology, Elisabeth-Twee Steden ziekenhuis, Tilburg, the Netherlands.
Julia H van TuijlDepartment of Neurology, Elisabeth-Twee Steden ziekenhuis, Tilburg, the Netherlands.
Ghislaine J M W van ThielJulius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.
L Jaap KappelleDepartment of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands.
H Bart van der WorpDepartment of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands.
University Medical Center Utrecht · NLElisabeth-TweeSteden Ziekenhuis · NL

Funding

Hartstichting 2010B239Hartstichting 2010T075
6 · The paper itself

Abstract

backgroundPatients with severe stroke often do not have the capacity to participate in discussions on treatment restrictions because of a reduced level of consciousness, aphasia, or another cognitive disorder. We assessed the role of advance directives and proxy opinions in the decision-making process of incapacitated patients.

methodsSixty patients with severe functional dependence (Barthel Index ≤6) at day four after ischemic stroke or intracerebral hemorrhage were included in a prospective two-center cohort study. The decision-making process with respect to treatment restrictions was assessed by means of a semi-structured questionnaire administered to the treating physician at the day of inclusion.

resultsForty-nine patients (82%) did not have the capacity to participate in the decision-making process. In eight patients, there was no discussion on treatment restrictions and full care was installed. In 41 patients, the decision whether to install treatment restrictions was discussed with proxies. One patient had a written advance directive. In the remaining 40 patients, proxies based their opinion on previously expressed wishes of the patient (18 patients) or advised in the best interest of the patient (22 patients). In 36 of 41 patients, treatment restrictions were installed after agreement between physician and proxy. At six months, 23 of 49 patients had survived. In only three of them the decision on treatment restrictions was based on previously expressed wishes. Remarkably, two of these survivors could not recall any of their alleged previously expressed wishes.

conclusionsTreatment restrictions were installed in the majority of incapacitated patients after stroke. Proxy opinions frequently served as the best way to respect the patients' autonomy, but their accuracy remains unclear.

Indexed as

Decision MakingAdvance DirectivesAgedAged, 80 and overAttitudeFemaleHumansMaleMiddle AgedProxyStrokeTerminal CareAdvance care planningAdvance directivesEnd-of-life decisionsEthicsProxy opinionsStrokeSurrogate decision making

Identifiers

PMID29137615
PMCPMC5686946
OpenAlexW2770523909

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.