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By CAFMI AI From JAMA
Stroke remains one of the leading causes of long-term disability worldwide, creating a complex spectrum of physical, emotional, and cognitive challenges for survivors. Despite advances in acute stroke treatment and rehabilitation, many survivors continue to experience substantial symptom burdens that are often inadequately addressed. Notably, palliative care—an approach focusing on relief from symptoms, psychosocial support, and quality of life—has been markedly underused in this population. Unlike its common mischaracterization as solely end-of-life care, palliative care can and should be integrated at any stage of illness, including alongside curative treatments, to support stroke survivors’ multifaceted needs. Its holistic approach is designed not only to manage pain and physical symptoms but also to attend to emotional and spiritual distress, which are prevalent among stroke patients.
Several barriers have limited the widespread adoption of palliative care within the stroke survivor community. A significant obstacle is the lack of awareness and understanding among clinicians and patients alike; many healthcare providers mistakenly equate palliative care only with terminal illness, thus delaying referrals or foregoing palliative interventions altogether. Further complicating access are system-level issues such as limited availability of specialized palliative care teams trained specifically in stroke-related needs, and the absence of structured pathways that seamlessly integrate palliative approaches within standard stroke care. Despite these challenges, the benefits of palliative care integration are compelling. Stroke survivors often endure persistent symptoms like pain, fatigue, depression, and cognitive impairments, which are not adequately managed through conventional stroke rehabilitation strategies. Additionally, caregivers—the often overlooked pillars of post-stroke recovery—face high levels of stress and burnout, necessitating psychosocial support mechanisms that palliative care frameworks are well-suited to provide. Clinically, incorporating palliative care can improve symptom control, facilitate advance care planning, enhance caregiver support, and ultimately elevate the overall quality of life for both patients and their families.
To mitigate existing gaps, multiple strategies must be adopted to promote palliative care integration into stroke management. Education is paramount; clinicians require targeted training to dispel misconceptions and to enhance their competency in identifying symptom burdens that warrant palliative interventions. Moreover, embedding palliative care principles directly into stroke care pathways ensures that symptom control and psychosocial needs are systematically addressed throughout the patient’s journey. Interdisciplinary teams that combine stroke expertise with palliative care specialty knowledge offer an optimal model for delivering tailored care. Research efforts should continue to focus on refining the timing and modalities of palliative interventions to meet the diverse and evolving needs of stroke survivors effectively. From a clinical workflow perspective, incorporating routine screening for symptoms such as pain, depression, and fatigue, alongside systematic caregiver assessments, can enable timely palliative referrals. Counseling patients and families about palliative care’s role early in the recovery process can aid in setting realistic expectations and facilitate advance care planning discussions. Ultimately, enhancing access and delivery of palliative care promises to address the multidimensional challenges faced by stroke survivors and their caregivers, fostering improved outcomes, patient satisfaction, and holistic recovery.
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