LAUSR

AIMS Internationally there is urgency to implement guidelines supporting integration of palliative care into stroke clinical practice. Despite considerable advances in acute stroke management approximately 20% of all acute stroke patients die within the first 30 days. Palliative care is well established in diseases such as cancer or advanced heart failure, but evidence base interventions of high quality are limited in stroke populations. This systematic review aims to identify and evaluate quantitative studies that describe palliative care interventions and end of life care as reported by patient's post-stroke and their families. METHODS AND RESULTS A systematic review following PRISMA guidelines was conducted in CINAHL, PubMed, Cochrane, Embase, Ovid, Proquest and Scopus from 1990 - April 2021. The National Heart, Lung and Blood Institute (NHLBI) standardised quality rating tools for quality assessment was used. The protocol was registered in PROSPERO. Seven studies were identified and all used descriptive quantitative designs. There were no interventional studies. Results were synthesised narratively according to the elements of palliative care interventions and end of life care: symptom burden and satisfaction, loss of autonomy and end of life and acknowledging uncertainty. CONCLUSION This review highlights the limited empirical evidence that describe palliative care interventions and end of life care as reported by patient's post-stroke and their families. Most of the current evidence focuses on the provision of care during the final days and hours of life, or end-of-life care, with little evidence to guide the integration of palliative care into post-stroke clinical care, especially for patients with an uncertain prognosis. Acute stroke is sudden, unexpected and life-changing, and patients and families would benefit from well-designed targeted interventions to determine strategies that address the diverse palliative needs of this patient population. REGISTRATION PROSPERO CRD42021254536.