Yes / The initiation of end of life care in an acute stroke context should be focused on those patients and families with greatest need. This requires clinicians to synthesise information on prognosis, patterns (trajectories) of dying and patient and family preferences. Within acute stroke, prognostic models are available to identify risks of dying, but variability in dying trajectories makes it difficult for clinicians to know when to commence palliative interventions. This study aims to investigate clinicians’ use of different types of evidence in decisions to initiate end of life care within trajectories typical of the acute stroke population. Methods/design This two-phase, mixed methods study comprises investigation of dying trajectories in acute stroke (Phase 1), and the use of clinical scenarios to investigate clinical decision-making in the initiation of palliative care (Phase 2). It will be conducted in four acute stroke services in North Wales and North West England. Patient and public involvement is integral to this research, with service users involved at each stage. Discussion This study will be the first to examine whether patterns of dying reported in other diagnostic groups are transferable to acute stroke care. The strengths and limitations of the study will be considered. This research will produce comprehensive understanding of the nature of clinical decision-making around end of life care in an acute stroke context, which in turn will inform the development of interventions to further build staff knowledge, skills and confidence in this challenging aspect of acute stroke care.

This study examined death and dying in assisted living (AL) and the various factors that influence these processes. The study is set in a 60-bed assisted living facility outside of Atlanta, Georgia. Data collection methods included participant observation and in-depth interviews with 28 residents and 6 staff. Data were analyzed using the grounded theory approach and focused on the 18 residents who were dying and/or died during the study period. Findings show that AL residents experience a variety of dying trajectories that vary in duration and shape; for the majority of residents, hospice is an important element in their death and dying experiences. In general, death is not communicated or acknowledged formally within the facility. Responses to deaths depend largely on the nature of the relationship the deceased resident had with others. Findings have implications for how to handle death and dying in AL and to improve residents‟ experiences.