In regards to doing a Stroke Bypass for a palliative patient that is not end-stage, the directive clearly states Terminally Ill or palliative care patient. I think the blanket term palliative care patient is misleading, as many people who are palliative are not close to dying. Are we to make our own decision about 'how palliative' a patient is and only apply this portion of the directive if they are truly end-stage? I think there should be something about their goals of care in the directive or something more clear so as to not rule out patients just because their palliative status (which could still allow them a good amount of time with quality of life). I think many medics may call for direction in this case, but there are others who would read the directive verbatim, thereby causing some patients to miss out on life-improving interventions. Is there any direction on this or am I on the right track with my thinking?
Please see the SWORBHP Webinar from 2011 that reviews the rationale for the Stroke Bypass from best practices as directed by the Canadian Stroke Network. Jump to 44:01 in the video to hear the discussion surrounding the grey terminally ill or palliative care patient. The intent is to not transfer those patients that are terminally ill and undergoing palliative care at home (no longer receiving active medical treatment, however may be receiving comfort care medications).
As mentioned in the SWORBHP webinar, if you are unsure, err on the side of treatment and consider transport and bypass. Make sure to be ready to help communicate to the neurologist and team the patients condition, quality of life, contact information for POA, family and care home should they need further information about the patients condition and quality of life in-hospital, to direct further treatment.
Of note remember that Do Not Resuscitate applies only to how to treat someone when they are near death. It does not bear treatment considerations for stroke care of bypass.