Abrahm JL, Advances in Palliative Medicine and End-of-Life Care Annu Rev Med. 2011;62:187-99            doi:10.1146/annurev-med-050509-163946.

SUMMARY: Palliative care improves the quality and cost-effectiveness of adult and pediatric patient care, and it decreases unwanted hospitalizations and aggressive care at the end of life. National palliative care quality standards and preferred practices can be used for benchmarking by institutions, health care systems, and accrediting bodies. Pain and symptom management and the management of delirium for patients is now possible for the vast majority of patients, even those with advanced disease. However, because of shortages of specialists providing “tertiary” palliative care, significant improvements are needed in generalist-level palliative care among oncologists, intensivists, and specialists caring for patients with advanced cardiac, pulmonary, renal, and hepatic diseases. POLST (Physician Orders for Life-Sustaining Treatment) forms are a major advance in end-of-life care. They enable patients’ advance directives to be valid wherever they are cared for (home, hospital, or nursing facility).

American College of Physicians, Improving Your End-of-Life Care Practice: Patient Education and Caring: End-of-Life (PEACE) Series (2014) ACP Center for Ethics and Professionalism www.acponline.org/ethics.            Brochure: Improving Your End-of-life Care Practice

Holloway, Robert MD, MPH; Arnold, Robert MD, Creutzfeldt, Claire MD, Lewis, Eldrin, MD, MPH, Lutz, Barbara PhD, RN, CRRN, FAHA, FAAN, McCann, Robert, MD, Rabinstein, MD, FAHA, Saposnik, Gustavo, MD, MSc, FAHA, FRCPC, Sheth, Kevin, MD, FAHA, Zahuranec, Darin, MD, MS, FAHA, Zipfel, Gregory MD, Zorowitz, MD, FAHA; American Heart Association/American Stroke Association Scientific Statement, Palliative and End of Life Care in Stroke: A Statement of Healthcare Professionals from the AHA/ASA Stroke 3/27/2014 stroke.ahajournals.org/content/early/2014/3/27/STR.0000000000000015


Results—
The palliative care needs of patients with serious or life-threatening stroke and their families are enormous: complex decision making, aligning treatment with goals, and symptom control. Primary palliative care should be available to all patients with serious or life-threatening stroke and their families throughout the entire course of illness. To optimally deliver primary palliative care, stroke systems of care and provider teams should (1) promote and practice patient- and family-centered care; (2) effectively estimate prognosis; (3) develop appropriate goals of care; (4) be familiar with the evidence for common stroke decisions with end-of-life implications; (5) assess and effectively manage emerging stroke symptoms; (6) possess experience with palliative treatments at the end of life; (7) assist with care coordination, including referral to a palliative care specialist or hospice if necessary; (8) provide the patient and family the opportunity for personal growth and make bereavement resources available if death is anticipated; and (9) actively participate in continuous quality improvement and research.