Abstract TMP106: Decisions on Life-Sustaining Treatments After Stroke: The OASIS Project

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Introduction: Surrogate decision makers are commonly asked to make critical decisions after stroke, though there has been little formal study of stroke surrogates. We report initial results on surrogate decisions in a community that does not have an academic medical center from the Outcomes Among Surrogate decision makers In Stroke (OASIS) project. Methods: Patients with ischemic stroke or intracerebral hemorrhage (ICH) from the Brain Attack Surveillance in Corpus Christi (BASIC) project, Texas, USA, were screened for presence of a surrogate decision maker. Surrogates self-identified as being involved in decisions about life-sustaining treatments: do-not-resuscitate (DNR), brain surgery, ventilator, feeding tube, or transition to hospice/comfort measures only. The scope of decisions including surrogate report of patient and healthcare team participation are presented. Results: Between 4/2016 and 8/2018, 230 stroke patients with at least one eligible surrogate were identified; 199 surrogates for 160 stroke patients enrolled (160/230=70% enrolled). Patient characteristics were mean age 74, female 53%, Mexican American 56% ICH 24%, median NIHSS 11.5 (IQR 4, 21), ICU admission 51%, deceased at time of surrogate interview 38%. Surrogates had a mean age of 55 years, were mostly women (74%), and were most commonly the child of the patient (64%) followed by the spouse (21%). Treatments discussed with the healthcare team are shown in the table. DNR was the most common discussion (90%). While physicians typically discussed brain surgery, surrogates reported that a nurse or other non-physician was the primary person talking to them in nearly half of the other discussions about life-sustaining treatment. Conclusions: Women are responsible for a large proportion of surrogate decision making after stroke. Further study of the role of nursing participation in decisions on life-sustaining treatment is warranted, particularly in non-academic medical centers.

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