Place of Death, Care Intensity, Symptom Prevalence, and Symptom Management for Patients With Stroke at End-of-Life.
Hanna Ramsburg, Janice L Hinkle, Meredith MacKenzie Greenle
PMID 41911569WHAT IT FOUND
For 257 patients who died after stroke, proxies reported pain in 62.6%, breathlessness in 50.6%, emotional distress in 57.6%; hospital death was linked to more breathlessness and better breathlessness management.
Key findings
01Proxy-reported pain, breathlessness (dyspnea), and emotional distress were common (62.6%, 50.6%, 57.6%), but adequate management was reported for only 46.3%, 38.1%, and 30.4%, and management data were missing for 45.5%, 57.2%, and 62.6%.
02Dying in hospital was linked to half as much reported pain (OR 0.51, 95% CI 0.27-0.95), twice as much reported dyspnea (OR 2.07, 95% CI 1.02-4.21), and almost twice as much adequate dyspnea management (OR 1.97, 95% CI 1.06-3.67); emotional distress prevalence and management of pain and emotional distress were not linked.
03Care intensity was not linked to symptom prevalence or management; older patients were half as likely to die in a high-acuity inpatient setting (OR 0.56, 95% CI 0.36-0.88), and Black non-Hispanic patients were over four times more likely (OR 4.8, 95% CI 1.15-19.99).
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Symptoms and symptom management were reported by proxy respondents after death, not by patients, so the reports may not match what the patient felt or needed. Large amounts of symptom-management data were missing, especially for dyspnea and emotional distress, and the authors said the study lacked power. Participants were Medicare beneficiaries aged 65 or older who had a stroke within 2 years of death, so findings may not apply to younger patients or to all stroke types. Stroke type, acuity, cause of death, and comorbidities were not available or adjusted for, so associations may reflect other conditions. The study is observational and cannot show that place of death or care intensity caused better or worse symptom care. The racial disparity finding for high-acuity death had a very wide confidence interval and should be read cautiously.
Declared interests
The authors reported no conflicts of interest. The underlying NHATS data were funded by the National Institute on Aging under a cooperative agreement with Johns Hopkins University Bloomberg School of Public Health and the University of Michigan Institute for Social Research, with data collection by Westat.
The easy way to misread this
Do not conclude that hospital or high-acuity stroke care improves symptom management. The study used proxy reports, had large missing symptom-management data, and did not show that care intensity was associated with symptom prevalence or management.