Project Description
Treatment Decisions and Outcomes after Stroke: A Retrospective Study
In
2016, stroke was the 5th leading cause of death and a primary cause of
permanent disability in the United States. Stroke mainly impacts older adults,
with the risk of stroke more than doubling every 10 years after age 55.
Additionally, older adults tend to have more comorbidities and functional
impairments which affect prognosis, decreasing the patient’s chance for
independence and complicating decision making - especially after severe stroke.
After severe stroke, patients, families, and clinicians often face difficult,
time-sensitive decisions about whether to continue or forgo life sustaining
treatments. High quality medical decisions require physicians to balance and
integrate, among other things, quality of life, uncertainty, emotions,
individual care preferences, suffering, and patient preferences. In order for
stroke patients and caregivers to make these complex treatment decisions, goals
of care conversations are paramount. The struggle for clinicians to have
conversations about serious news is particularly important for stroke care
providers as the need to communicate prognosis and set goals of care to
alleviate suffering is both time sensitive and common. Goals of care
conversations after stroke are challenging because of the high variability in
specific deficits after a stroke and the uncertainty in predicting an
individual’s functional recovery. Only a few prior studies have examined
medical decisions after stroke. These studies identified multiple communication
challenges across all stages of end-of-life stroke care. This study will
address these gaps in the literature. Aim 1 seeks to understand how the receipt
of goals of care conversations influences decisions about life sustaining care
and goals of care, including the use of DNR orders, mechanical ventilation, ICU
utilization, hospice referrals, discharge location, mortality, and advance
directives/ POLST forms. Aim 2 will identify how neurologists, patients, and
families currently understand and communicate about prognosis and treatment
decisions after severe stroke.
Bio
Amber Comer, PhD, is a Professor and Scientific
Researcher at the Indiana University School of Health and Human Sciences in the
Department of Health Sciences. Dr. Comer earned a PhD and JD from Indiana
University. Additionally, she completed a Medical Ethics Fellowship at Indiana
University Health Fairbanks Center for Medical Ethics. In addition to her
appointment in Health Sciences, Dr. Comer is an Associate Professor of Law at
Indiana University McKinney School of Law. Dr. Comer’s research focuses on
acute stroke treatment, palliative care, and medical ethics. Her research goal is to reduce suffering at
the end-of-life by improving quality medical decision making.
Email: comer@iu.edu