Stroke is life-altering and often deadly. Beyond acute treatment, patients and families face lasting physical, cognitive, and psychosocial challenges. Palliative care should be integrated from admission through recovery and, when needed, at the end of life.
• Clarify goals of care early and revisit often; ensure care is goal-concordant.
• Provide whole-person support (physical, emotional, social, spiritual) for the patient–care partner “dyad.”
Primary Palliative Care
• Skilled communication (best-/worst-case framing, time-limited trials, advance care planning).
• Routine screening for needs and caregiver distress.
• Basic symptom management: post-stroke pain (including central pain), dyspnea, mood symptoms, spasticity/shoulder pain; use nonverbal pain tools when aphasia or low consciousness limits reporting.
When to Involve Specialist Palliative Care
Complex symptoms, high prognostic uncertainty, decisional conflict, cultural/linguistic needs, or significant caregiver strain; support for spiritually distressed families.
End of Life & Hospice
• Anticipate common symptoms (pain, dyspnea, agitation; secretions) and treat proactively.
• Consider hospice when prognosis is ≤6 months and goals prioritize comfort. For example, persistent coma with pressure ulcers, recurrent infections such as aspiration pneumonia, or limited intake when artificial nutrition is not pursued.
Conclusion:
According to the AHA scientific statement on palliative care and stroke (Holloway et al.,2014) “the palliative care approach has been established as an important part of high-quality stroke care not limited to patients who are dying”.
Reference
Creutzfeldt CJ, Bu J, Comer A, et al; on behalf of the American Heart Association Stroke Council; Council on Cardiovascular and Stroke Nursing; and Council on Clinical Cardiology. Palliative and end-of-life care in stroke: a scientific statement from the American Heart Association. Stroke. 2025;56(2):e75–e86. doi:10.1161/STR.0000000000000479
Holloway RG, Arnold RM, Creutzfeldt CJ, Lewis EF, Lutz BJ, McCann RM, Rabinstein AA, Saposnik G, Sheth KN, Zahuranec DB, et al; on behalf of the American Heart Association Stroke Council; Council on Cardiovascular and Stroke Nursing; and Council on Clinical Cardiology. Palliative and end-of-life care in stroke: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2014;45:1887–1916. doi: 10.1161/STR.0000000000000015
Creutzfeldt CJ, Kluger B, Kelly AG, Lemmon M, Hwang DY, Galifianakis NB, Carver A, Katz M, Curtis JR, Holloway RG. Neuropalliative care: priorities to move the field forward. Neurology. 2018;91:217–226. doi: 10.1212/WNL.0000000000005916