The National Palliative Care Research Center

Curing suffering through palliative care research.

Comer

Amber Comer PhD, JD

Professor

Indiana University

Grant Year
2019
Grant Term
2 years
Grant Type
Kornfeld Scholars Program

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