The study protocol of : 'Initiating end of life care in stroke: Clinical decision-making around prognosis

Burton, Christopher and Payne, Sheila and Turner, Mary and Bucknall, Tracey and Rycroft-Malone, Jo and Tyrrell, Pippa and Horne, Maria and Ntambwe, Lupetu Ives and Tyson, Sarah and Mitchell, Helen and Williams, Sion and Elghenzai, Salah (2014) The study protocol of : 'Initiating end of life care in stroke: Clinical decision-making around prognosis. BMC Palliative Care, 13: 55. ISSN 1472-684X

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Background 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. Discussion 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.

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Journal Article
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BMC Palliative Care
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© 2014 Burton et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.
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11 Aug 2015 08:24
Last Modified:
28 Nov 2023 11:50