Impact of Palliative Care Training for Neurology Residents on Stroke Unit Outcomes: A Retrospective Matched Study

Background Neurologists frequently care for patients with serious neurological illnesses such as stroke, yet formal training in palliative care (PC) during neurology residency remains limited. Educational interventions may improve patient-centered care in acute neurological settings. Objective To evaluate whether integrating structured PC training into neurology residency is associated with changes in clinical outcomes of patients admitted to a stroke unit. Methods We conducted a retrospective matched case-control study analyzing medical records of stroke patients admitted to a Stroke Unit in Brazil before (2018-2019) and after (2020-2021) implementation of a structured PC training program for neurology residents. Patients were matched using coarsened exact matching based on age, sex, admission NIHSS, and pre-stroke modified Rankin Scale (mRS). Primary outcomes included total hospital and Stroke Unit length of stay (LOS). Secondary outcomes included opioid use, discontinuation of clinically-assisted nutrition and hydration (CANH), family meeting documentation, and PC consultation. Results Among 270 matched patients (141 pre-training; 129 post-training), patients treated by residents who had completed PC training had shorter total hospital LOS (median 6 vs 8 days, P = 0.002) and shorter Stroke Unit LOS (median 6 vs 7 days, P < 0.001). No significant differences were observed in opioid use, discontinuation of CANH, or PC consultations. Among patients with unfavorable outcomes (mRS 4-6), PC training remained associated with reduced Stroke Unit LOS. Conclusions Palliative care training was associated with shorter hospital stays among stroke patients but limited differences in specific PC practices. These findings suggest that primary PC education may influence care processes in acute neurological settings.