Hobden Georgina, Tang Eugene Yee Hing, Demeyere Nele
Department of Experimental Psychology, University of Oxford, Oxford, UK.
Population Health Sciences Institute, Newcastle University, Newcastle, UK.
Neuropsychol Rehabil. 2024 Dec;34(10):1404-1421. doi: 10.1080/09602011.2024.2314882. Epub 2024 Feb 17.
Cognitive impairment is common early after stroke but trajectories over the long term are variable. Some stroke survivors make a full recovery, while others retain a stable impairment or decline. This study explored the perceived advantages and disadvantages of discussing potential cognitive trajectories with stroke survivors and their family members. Stroke survivors at least six-months post-stroke were purposively sampled from an existing pool of research volunteers recruited originally for the OCS-Recovery study. They were invited, alongside a family member, to participate in a semi-structured interview. Interviews were audio recorded, transcribed, and analyzed using reflexive thematic analysis. Twenty-six stroke survivors and eleven family members participated. We identified one overarching theme and three related subthemes. The overarching theme was: One size does not fit all. The subthemes were: (1) Hearing about potential cognitive trajectories helps to develop realistic expectations; (2) Discussions about cognitive trajectories may be motivating; (3) Cognitive decline and post-stroke dementia discussions may be anxiety-provoking and depressing. Healthcare professionals should adopt a person-centred approach to sharing information about post-stroke cognitive trajectories. Discussions should be tailored to individual needs and preferences, with dementia-related topics in particular addressed with the utmost selectivity and sensitivity.
认知障碍在中风后早期很常见，但长期轨迹各不相同。一些中风幸存者完全康复，而另一些人则保持稳定的损伤或出现衰退。本研究探讨了与中风幸存者及其家庭成员讨论潜在认知轨迹的利弊。从最初为OCS-康复研究招募的现有研究志愿者库中，有目的地抽取了中风后至少六个月的幸存者。他们与一名家庭成员一起被邀请参加半结构化访谈。访谈进行了录音、转录，并采用反思性主题分析进行分析。26名中风幸存者和11名家庭成员参与了访谈。我们确定了一个总体主题和三个相关子主题。总体主题是：一刀切并不适用。子主题为：(1) 了解潜在认知轨迹有助于形成现实的期望；(2) 关于认知轨迹的讨论可能具有激励作用；(3) 关于认知衰退和中风后痴呆症的讨论可能会引发焦虑和抑郁。医疗保健专业人员应采用以人为本的方法来分享中风后认知轨迹信息。讨论应根据个人需求和偏好进行调整，特别是与痴呆症相关的话题，应极其有选择性和敏感性地加以处理。
