Abstract DP186: Physician Perspectives Towards Secondary Stroke Prevention Measures and Rehabilitation for People Living with Pre-existing Disability or Dementia: Results from the SEED Mixed-Methods Study

Introduction: Patients with pre-existing disability and/or dementia (PLWD) have a high risk of recurrent stroke. High quality and nuanced evidence remains limited for physicians to guide post-stroke management in this patient population. We sought to understand physician experiences of post-acute stroke care of PLWD, particularly regarding secondary prevention measures and rehabilitation. Methods: We employed a mixed-methods approach, with a qualitative descriptive methodology embedded within an interpretive grounded theory. Semi-structured interviews were completed with physicians exploring their thoughts and experiences regarding the care of PLWD, including rehabilitation and secondary preventive measures. An online international survey was also conducted to gain a quantitative overview of current practices in this space including anti-coagulants/anti-platelets, carotid revascularization, rehabilitation, and follow-up. Results: 30 physicians were interviewed and 200 physicians consented to the survey. 23 countries and 10 specialties were counted across both interview and survey participants. Surveyed physicians reported lower enthusiasm towards post-acute stroke care with increasing severity of disability or dementia, as indicated on a scale from 0 (unwilling) to 5 (very enthusiastic). Interviews highlighted considerations stemming from the perceived ability of the patient to benefit from treatment. This included the nature of treatment such as its invasiveness or risk, resource intensity and allocation of such treatments, and patient-specific factors such as their living situation, support systems, physical and cognitive status, and rehabilitation potential. Physicians supported a more tailored approach to rehabilitation and flagged the intensity, pace, and focus on physical rather than cognitive aspects of functioning in mainstream programs as inappropriate for PLWD. Conclusions: Our study provides valuable perspectives from physicians involved in stroke care of PLWD. Increasing severity of pre-existing disability and/or dementia in PLWD played both an independent role towards lowering physician treatment enthusiasm, and a moderating role such that the impact of pre-stroke status seemed stronger for more invasive treatments or approaches that require more resources.