Psychological and emotional needs, assessment, and support post-stroke: a multi-perspective qualitative study

BACKGROUND: International stroke care guidelines recommend the routine assessment and management of psychological and emotional problems post-stroke. Understanding the experiences of those delivering and receiving these services is vital to improving the provision of psychological support post-stroke. OBJECTIVES: To explore patients', carers', and health professionals' experiences of psychological need, assessment, and support post-stroke while in hospital and immediately post-discharge. METHODS: Participants were recruited from seven specialist stroke services in the north of England. Qualitative semi-structured interviews and focus groups were conducted with 31 stroke patients, 28 carers, and 66 health professionals. The interviews were recorded and transcribed verbatim and analyzed using thematic analysis. RESULTS: Two central themes emerged minding the gap: psychological expertise, and protective factors perceived to reduce the need for formal psychological support. The lack of psychological expertise among healthcare professionals working on stroke units was a source of frustration and resulted in other disciplines assuming the role of a psychologist without the required skills and training. Multiple stakeholders discussed the importance of protective factors, including downward social comparison, social support, peer support, communication, and information provision, that were perceived to reduce the need for formal psychological support. DISCUSSION: Stroke patients need better access to psychological support, including information, advice, and peer or social support. More research is required to establish the effectiveness of alternative options to formal psychological support.