Abstract Details

Title End of Life Decisions in Severe Stroke: A French National Survey

Topic Ethics, Pain and Palliative Care

Presentation(s) S17 - (-)

Poster/Presentation
Number 002

Objective

Background In some patients with severe stroke, aggressive treatment may be considered as futile, leading to WHDT. Decision making process in such situations remains poorly known and is complex because it's based on uncertain "catastrophic"neurological outcome.

Design/Methods A national survey in the French stroke-units (SU) based on self-administered questionnaires sent by e-mail was performed. Questionnaires included 100 closed and open-ended questions concerning : 1) stroke unit organizational aspects completed by the medical responsible of the SU; 2) decision making process and different points of view and difficulties encountered in severe stroke management completed by senior neurologists working in the SU.

Results We received 127 questionnaires from 48 French SU. While the vast majority of the physicians (90%) said they have already taken decisions of WDHT and considered (86%) that "it is part of their mission", these decisions were nevertheless experienced as difficult or very difficult by about 90% of them. The difficulty was mainly attributed to prognostic uncertainty or disagreements with family. Otherwise, physician's perceptions of severe disability seemed to be quite negative. Most of neurologists (90%) believed that decisions WDHT were morally acceptable but nearly 16% considered these decisions equivalent to euthanasia. It was noted that these percentages were 73 % and 25% for withdrawal of artificial nutrition and hydration respectively. Call to mobile palliative care unit in these situations was reported as systematic for 41% of the physicians.

Conclusions These results showed that the neurologists felt really concerned by the difficulty of the decisions of WDHT. Prognosis uncertainty of stroke and negative perceptions of severe disability partly explain the difficulties encountered.

Authors/Disclosures
Sophie Crozier PRESENTER	No disclosure on file
	No disclosure on file
Robert L. Carruthers, MD	Dr. Carruthers has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Novartis. Dr. Carruthers has received personal compensation in the range of $0-$499 for serving as a Consultant for Roche and Genentech. The institution of Dr. Carruthers has received research support from Roche and Genentech .
	No disclosure on file
	No disclosure on file

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