Abstract WMP111: Family Perceptions of Quality of End-of-Life Care in Stroke: The OASIS Study

• Published in: Stroke (1970) 2019-02, Vol.50 (Suppl_1)
• Main Authors: Zahuranec, Darin B, Shafie-Khorassani, Fatema, Cornett, Bridget A, Kim, Sehee, Ortiz, Carmen, Lank, Rebecca J, Case, Erin, Morgenstern, Lewis
• Format: Article
• Language: English
• ISSN: 0039-2499; 1524-4628
• DOI: 10.1161/str.50.suppl_1.WMP111

Abstract only Introduction: Stroke remains the fifth leading cause of death in the US, yet there has been little effort to formally assess the quality of end-of-life stroke care. We explored family surrogate decision maker perceptions of the quality of end-of-life care in stroke and predictors of higher or lower quality. Methods: Surrogate decision makers for stroke patients in the Brain Attack Surveillance in Corpus Christi (BASIC) study were invited to participate in the Outcomes Among Surrogate decision makers In Stroke (OASIS) study. We report findings from the validated Quality of End-of-Life Care (QEOLC) questionnaire, which assesses 10 elements of end-of-life care on a 0-10 scale. Responses to individual QELOC items were dichotomized into low (0-7) or high (8-10) scores. The univariate association between pre-specified patient and surrogate factors and overall QELOC score were explored with generalized estimating equations. Results: 71 surrogates for 59 deceased stroke cases were enrolled. Characteristics were patient mean age 77, ischemic stroke (73%), patient female (56%), Mexican American (58%), surrogate mean age 58, surrogate female (70%), relationship (spouse 21%; child 68%; other 11%), and mean time from stroke to death 9.5 days. QELOC responses are summarized in the table. None of the hypothesized factors were associated with overall QEOLC score, including patient or surrogate demographics, stroke type, location of death, time to death, presence of advance directives, or surrogate self-reported confidence or understanding of patient wishes. Conclusions: Although we did not identify patient or surrogate predictors of overall quality of end-of-life care, the relatively lower ratings on consistency of information and treating the whole person may represent opportunities for improvement. Further study in larger samples is warranted, though modifications to the QELOC may be needed in stroke due to a high proportion of non-response to several items.