Burton Christopher R, Payne Sheila, Turner Mary, Bucknall Tracey, Rycroft-Malone Jo, Tyrrell Pippa, Horne Maria, Ntambwe Lupetu Ives, Tyson Sarah, Mitchell Helen, Williams Sion, Elghenzai Salah
School of Healthcare Sciences, Bangor University, Bangor, Gwynedd LL57 2EF UK.
International Observatory on End of Life Care, Faculty of Health and Medicine, Lancaster University, Lancaster, LA1 4YG UK.
BMC Palliat Care. 2014 Dec 5;13:55. doi: 10.1186/1472-684X-13-55. eCollection 2014.
The initiation of end of life care in an acute stroke context should be focused on those patients and families with greatest need. This requires clinicians to synthesise information on prognosis, patterns (trajectories) of dying and patient and family preferences. Within acute stroke, prognostic models are available to identify risks of dying, but variability in dying trajectories makes it difficult for clinicians to know when to commence palliative interventions. This study aims to investigate clinicians' use of different types of evidence in decisions to initiate end of life care within trajectories typical of the acute stroke population.
METHODS/DESIGN: This two-phase, mixed methods study comprises investigation of dying trajectories in acute stroke (Phase 1), and the use of clinical scenarios to investigate clinical decision-making in the initiation of palliative care (Phase 2). It will be conducted in four acute stroke services in North Wales and North West England. Patient and public involvement is integral to this research, with service users involved at each stage.
This study will be the first to examine whether patterns of dying reported in other diagnostic groups are transferable to acute stroke care. The strengths and limitations of the study will be considered. This research will produce comprehensive understanding of the nature of clinical decision-making around end of life care in an acute stroke context, which in turn will inform the development of interventions to further build staff knowledge, skills and confidence in this challenging aspect of acute stroke care.
在急性卒中背景下启动临终关怀应聚焦于最有需求的患者及其家庭。这要求临床医生综合预后信息、死亡模式（轨迹）以及患者和家庭的偏好。在急性卒中领域，有预后模型可用于识别死亡风险，但死亡轨迹的变异性使得临床医生难以知晓何时开始姑息治疗干预。本研究旨在调查临床医生在急性卒中人群典型轨迹内启动临终关怀决策时对不同类型证据的使用情况。
方法/设计：这项两阶段的混合方法研究包括对急性卒中患者死亡轨迹的调查（第一阶段），以及使用临床场景来调查姑息治疗启动过程中的临床决策（第二阶段）。研究将在北威尔士和英格兰西北部的四个急性卒中服务机构开展。患者和公众参与是本研究不可或缺的部分，服务使用者将参与每个阶段。
本研究将首次检验在其他诊断组中报告的死亡模式是否可应用于急性卒中护理。将考虑本研究的优势和局限性。本研究将全面了解急性卒中背景下围绕临终关怀的临床决策本质，这反过来将为开发干预措施提供依据，以进一步提升医护人员在急性卒中护理这一具有挑战性方面的知识、技能和信心。
