Article

OBJECTIVE: To identify factors influencing clinicians decision-making about
ongoing stroke rehabilitation for people with pre-existing dementia/cognitive
impairment and the impact on clinical practice.
DESIGN: Qualitative
semi-structured interviews with stroke specialist healthcare professionals
analysed using thematic analysis. SETTING: Acute stroke unit, inpatient stroke
rehabilitation units, and community stroke services. PARTICIPANTS: Twenty three
professionals from six multidisciplinary stroke teams involved in decision-making
about stroke patients' rehabilitation potential and clinical pathways. RESULTS:
Factors influencing decision-making about ongoing rehabilitation were (1) gaining
understanding of the individual patient, (2) clinician's knowledge of
dementia/cognitive impairment, (3) predicting rehabilitation potential, (4)
organizational constraints, and (5) clinician's perceptions of their role within
the team. Decision-making led to two outcomes, either accommodating the
pre-existing dementia/cognitive impairment within delivery of rehabilitation or
ending rehabilitation for that patient to allocate limited resources where they
were perceived more likely to be effective. Participants felt that patients with
pre-existing dementia/cognitive impairment had difficulty demonstrating the
required rehabilitation potential within the short timescales available in the
current model of service delivery. Participants identified a need for training to
improve their knowledge and confidence for decision-making and delivery of
rehabilitation for this growing population. CONCLUSION: Clinicians'
decision-making about ongoing rehabilitation for patients with prestroke
dementia/cognitive impairments is influenced by gaps in their knowledge and by
service constraints. Increased training and more flexible, patient-centred
services would enable clinicians to better accommodate these patients in
rehabilitation.

Langue : ANGLAIS