What question did this study set out to answer?

This study aims to characterize neuropalliative practices and identify training opportunities for neurology residents in goals of care discussions.

May 8, 2026

Abstract Number: Esoc2026a2391 Neurology Resident Involvement in Goals of Care Conversations in the Acute Stroke Unit: Opportunities for Enhanced Neuropalliative Training

Key Points

This study aims to characterize neuropalliative practices and identify training opportunities for neurology residents in goals of care discussions.
Retrospective chart review of stroke patients who died in the acute stroke unit from January 2022 to August 2023.
Analysis of electronic health records to gather data on demographics and goals of care discussions.
Data analyzed using R software.
GOC discussions were documented for 98% of the 51 patients, with 58% needing multiple discussions.
Initial GOC conversations occurred 6.1 days post-admission, with 79.2% focusing on DNR/DNI decisions.
Resident involvement in final GOC discussions decreased to 17.6%, indicating limited exposure to advanced conversations.

Abstract

Abstract Background and aims Stroke is a leading cause of death globally, and involves sudden, unexpected and sometimes profoundly, life-changing events. Early neuropalliative integration, including timely and effective goals of care (GOC) conversations, is essential to guide patients and their families through this difficult time. There is a paucity of formal neuropalliative education during neurology residency training. We aimed to characterize current neuropalliative practices for stroke patients on our institution, to identify opportunities for improving neuropalliative training. Methods A retrospective chart review was completed for all stroke patients who died while admitted to our stroke unit between January 2022-August 2023. Electronic health records were reviewed and data was extracted including demographics and GOC discussion (time from admission, who led the conversation, outcome of conversation). Data was analyzed using R software. Results A total of 51 patients were identified (mean ± SD; age 81.9 ± 11.7 years, 64.7% female). GOC discussions were documented for 98% of patients, with 58% requiring more than one GOC discussion. Initial GOC conversations occurred 6.1 ± 8.1 days post-admission and largely resulted in isolated code-status decisions, with DNR/DNI accounting for 79.2% of outcomes. Residents conducted 31.0% of initial GOC discussions. Final GOC discussions occurred 11.4 ± 13.4 days post-admission and outcomes were predominantly comfort-focused (60.0%). Resident involvement in final GOC discussions decreased to 17.6%. Conclusions Resident exposure to advanced and potentially more difficult GOC conversations is limited at our institution. Active emphasis on resident participation in sensitive discussions may enhance neuropalliative communication skills and preparedness for independent practice. Conflict of interest Hibaa Hasan, Alexander J. Moszczynski, Al Waleed Al Batashi, Danielle Kain, Shirin Jalini: all authors have nothing to disclose

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