Abstract WP431: Advance Directives and Comfort Measures Only During Stroke Hospitalization

• Published in: Stroke (1970) Vol. 50; no. Suppl_1
• Main Authors: Lank, Rebecca J, Shafie-Khorassani, Fatema, Ortiz, Carmen, Kim, Sehee, Sánchez, Brisa N, Case, Erin, Morgenstern, Lewis B, Zahuranec, Darin B
• Format: Journal Article
• Language: English
• Published: 01-02-2019
• ISSN: 0039-2499; 1524-4628
• DOI: 10.1161/str.50.suppl_1.WP431

Abstract only
Introduction:
Advance directives are often promoted as a way to ensure that patient wishes are followed; however, the impact of advance directives on actual care is controversial, and little is known about the impact on in-hospital stroke treatment. We explored the association between pre-stroke advance directives and transition to comfort measures only (CMO) during stroke hospitalization among patients with surrogate-decision makers.
Methods:
Ischemic stroke and intracerebral hemorrhage (ICH) stroke cases from the Brain Attack Surveillance in Corpus Christi (BASIC) project and their surrogate decision makers from the Outcomes Among Surrogate Decision Makers in Stroke (OASIS) were enrolled. Patient records were abstracted for time to CMO. Surrogates were asked about patient pre-stroke advance directives (advance directive, living will, or durable power of attorney for health care). Cox-proportional-hazards models assessed the relationship between advance directives and time to CMO (censored at death, discharge, or 30 days). Based on the available sample size, adjustment factors were pre-specified and included age, NIHSS, and stroke type.
Results:
144 stroke patients were included (ischemic 76%; ICH 24%; age ≥75 45%; female 52%; Mexican American (MA) 59%, NIHSS mean (SD) 13(11)). 22% of cases transitioned to CMO during the hospitalization (median time to CMO 3 days); 39% of patients had an advance directive. Younger individuals, MAs and men were less likely to have advance directives. After adjusting for stroke type, age, and NIHSS, advance directives were not associated with time to CMO (Table).
Conclusions:
Fewer than half of stroke patients had advance directives; however, the presence of advance directives did not appear to impact in-hospital transitions to CMO, suggesting limited utility of advance directives. Further study in larger samples is needed to determine the best way to ensure patient wishes are followed after stroke.