Implementation of palliative care and its impact on acute Stroke: A literature review
DOI:
https://doi.org/10.33448/rsd-v15i2.50645Keywords:
Stroke, Palliative Care, Quality of Life, Decision Making.Abstract
Stroke is a leading cause of global mortality and disability. This study aims to analyze the impact of early palliative care implementation on quality of life and decision-making for patients with acute stroke. The methodology employed was an integrative literature review, with searches conducted in PubMed and VHL (LILACS) databases, resulting in a selection of 22 articles published between 2006 and 2025. Results demonstrate that while palliative care significantly improves symptom management, such as pain and dyspnea (increasing opioid use by up to 31 times when necessary), and reduces family anxiety, its implementation remains delayed and underutilized. Cultural barriers and failures in prognostic communication lead to futile interventions and untreated suffering. The study concludes that early integration of a palliative approach, alongside curative treatment, is essential to align medical procedures with patient values, optimizing comfort and family satisfaction without accelerating death.
References
Alonso, A., Ebert, A. D., Dörr, D., Buchheidt, D., Hennerici, M. G., & Szabo, K. (2016). End-of-life decisions in acute stroke patients: An observational cohort study. BMC Palliative Care, 15, Artigo 38. https://doi.org/10.1186/s12904-016-0113-8
Cameron, J. I., & Gignac, M. A. M. (2008). “Timing It Right”: A conceptual framework for addressing the support needs of family caregivers to stroke survivors from the hospital to the home. Patient Education and Counseling, 70(3), 305–314
Connolly, T., Coats, H., DeSanto, K., & Jones, J. (2021). The experience of uncertainty for patients, families and healthcare providers in post-stroke palliative and end-of-life care: A qualitative meta-synthesis. Age and Ageing, 50(2), 534–545. https://doi.org/10.1093/ageing/afaa229
Correia, M., von Fournier, L., Blum, D., Wegener, S., Schettle, M., Brandi, G., & Hertler, C. (2025). Factors associated with time to change of resuscitation code (Do-Not-Resuscitate) and time to death after a stroke: Palliative aspects from a tertiary center. European Neurology, 88(3-4), 113–121. https://doi.org/10.1159/000547188
Cowey, E., Schichtel, M., Cheyne, J. D., Tweedie, L., Lehman, R., Melifonwu, R., & Mead, G. E. (2021). Palliative care after stroke: A review. International Journal of Stroke, 16(6), 632–639. https://doi.org/10.1177/17474930211016603
Creutzfeldt, C. J. (2021). Palliative Care and Shared Decision Making in the Neurocritical Care Unit. CONTINUUM: Lifelong Learning in Neurology. 27. https://doi.org/1430-1443. 10.1212/CON.0000000000001003.
Creutzfeldt, C. J., Abedini, N. C., & Holloway, R. G. (2023). Neuropalliative care for stroke providers. Stroke, 54(10), e441–e444. https://doi.org/10.1161/STROKEAHA.123.043534
Creutzfeldt, C. J., Bu, J., Comer, A., Enguidanos, S., Lutz, B., Robinson, M. T., Zahuranec, D. B., & Holloway, R. G. (2024). Palliative and end-of-life care in stroke: A scientific statement from the American Heart Association. Stroke, 55(8), e198–e214. https://doi.org/10.1161/STR.0000000000000465
Creutzfeldt, C. J., Holloway, R. G., & Walker, M. (2012). Symptomatic and palliative care for stroke survivors. Journal of General Internal Medicine, 27(7), 853–860. https://doi.org/10.1007/s11606-011-1966-2
Crossetti, M. G. O. (2012). Revisão integrativa de pesquisa na enfermagem o rigor cientifico que lhe é exigido. Rev Gaúcha Enferm. 33(2):8-9.
D'Alessandro, M. P. S., Pires, C. T., & Forte, D. N. (Coords.). (2020). Manual de cuidados paliativos. Hospital Sírio-Libanês; Ministério da Saúde.
Downar, J., Goldman, R., Pinto, R., Englesakis, M., & Adhikari, N. K. J. (2022). The utility of the surprise question: A useful tool for identifying patients nearing the last phase of life? A systematic review and meta-analysis. Palliative Medicine, 36(7), 1019–1031.
GBD 2021 Stroke Risk Factor Collaborators. (2024). Global, regional, and national burden of stroke and its risk factors, 1990–2021: A systematic analysis for the Global Burden of Disease Study 2021. The Lancet Neurology, 23(10), 973–1003. https://doi.org/10.1016/S1474-4422(24)00369-7
Gélinas, C., Bérubé, M., Puntillo, K. A., Boitor, M., Richard-Lalonde, M., Bernard, F., Williams, V., Joffe, A. M., Steiner, C., Marsh, R., Rose, L., Dale, C. M., Tsoller, D. M., Choinière, M., & Streiner, D. L. (2021). Validation of the Critical-Care Pain Observation Tool-Neuro in brain-injured adults in the intensive care unit: A prospective cohort study. Critical Care, 25, Artigo 142. https://doi.org/10.1186/s13054-021-03561-1
Govind, N., Ferguson, C., Phillips, J. L., & Hickman, L. (2023). Palliative care interventions and end-of-life care as reported by patients' post-stroke and their families: A systematic review. European Journal of Cardiovascular Nursing, 22(5), 445–453. https://doi.org/10.1093/eurjcn/zvac112
Johnson, P. D., Ulrich, A., Siv, J., Taylor, B., Tirschwell, D., & Creutzfeldt, C. J. (2019). Planning after stroke survival: Advance care planning in the stroke clinic. Journal of the American Heart Association, 8(8), e011317. https://doi.org/10.1161/JAHA.118.011317
Kendall, M., Cowey, E., Mead, G., Barber, M., McAlpine, C., Stott, D. J., Boyd, K., & Murray, S. A. (2018). Outcomes, experiences and palliative care in major stroke: A multicentre, mixed-method, longitudinal study. CMAJ, 190(9), E238–E246. https://doi.org/10.1503/cmaj.170604
Khosravani, H., Mahendiran, M., Gardner, S., Zimmermann, C., & Perri, G. A. (2023). Attitudes of Canadian stroke physicians regarding palliative care for patients with acute severe stroke: A national survey. Journal of Stroke and Cerebrovascular Diseases, 32(4), Artigo 106997. https://doi.org/10.1016/j.jstrokecerebrovasdis.2023.106997
Khosravani, H., Mahendiran, M., Sivanandan, B., Gardner, S., Saposnik, G., Brookes, J., Berall, A., & Perri, G. A. (2025). Retrospective analysis of the integration of palliative care into the care of stroke patients admitted to a regional stroke center. American Journal of Hospice & Palliative Medicine, 42(3), 273–281. https://doi.org/10.1177/10499091241253538
Kosminsky, L., Shah, N. Y., & Chang, P. (2019). Prognosis after stroke #374. Journal of Palliative Medicine, 22(5), 589–591. https://doi.org/10.1089/jpm.2019.0085
Kuckel, D. P., Jones, A. L., & Smith, D. K. (2022). The spiritual assessment. American Family Physician, 106(4), 415–419.
Molidor, S., James, D., Overbaugh, K. J., & White, C. L. (2018). Palliative care and stroke: An integrative review of the literature. Journal of Hospice & Palliative Nursing, 20(4), 346–357. https://doi.org/10.1097/NJH.0000000000000450
Oliver, D. J., Borasio, G. D., Caraceni, A., de Visser, M., Grisold, W., Lorenzl, S., Veronese, S., & Voltz, R. (2016). A consensus review on the development of palliative care for patients with chronic and progressive neurological disease. European Journal of Neurology, 23(1), 30–38.
Pereira, A. S. et al. (2018). Metodologia da pesquisa científica. Editora da UFSM. https://repositorio.ufsm.br/bitstream/handle/1/15824/Lic_Computacao_Metodologia-Pesquisa-Cientifica.pdf?sequence=1.
Risemberg, R. I. C., Wakin, M., & Shitsuka, R. (2026). A importância da metodologia científica no desenvolvimento de artigos científicos. E-Acadêmica. 7(1), e0171675. https://eacademica.org/eacademica/article/view/675.
Snyder, H. (2019). Literature review as a research methodology: An overview and guidelines. Journal of Business Research. 104, 333-9. https://doi.org/10.1016/j.jbusres.2019.07.039.
Tramonte, M. S., Carvalho, A. C. P., Pucci, G. F., Pinheiro, M. S., Fornazari, A. E. V., Boas, G. D. L. V., Lange, M. C., Minicucci, M. F., Bazan, R., & Lopes, L. C. G. (2024). Palliative care and the self-fulfilling prophecy in stroke patients: Is there anything to fear? A retrospective study of patients who died during hospitalization in a quaternary care hospital. American Journal of Hospice & Palliative Medicine, 42(10), 981–988. https://doi.org/10.1177/10499091241286059
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