"There has been debate for a long time about the effects of this surgery for patients. It definitely saves lives, but we're asking whether the surgery really paid off for these patients. Did the patients value their health state? Was it worth it to them?" asks Kelly. "The answer most often is 'yes.'"
The authors say there are several types of patients for whom surgery clearly isn't a good option. These include people who were already in poor health before the stroke, people whose chances of surviving the surgery are questionable, and patients who have clearly stated that they would not want such measures to be taken.
For those who do opt for surgery, Kelly and Holloway found that living longer due to the surgery was only part of the benefit. Those patients also valued their health. That might seem difficult to understand for people who are healthy, but it does not surprise Holloway, who has worked with hundreds of patients severely limited by stroke.
"For years I've witnessed families wrestle with these decisions," said Holloway. "If the families make the decision based on what they imagine the future to be, they may decide it's a surgery the patient wouldn't want. But nearly always, when they've made the decision to go ahead with the surgery, the families are subsequently happy they made that decision.
"People who survive devastating stroke often do much better than people think they will do. People who haven't experienced a health condition, such as stroke, almost always provide a lower estimate of their quality of life compared to people who are actually living with that condition or disease," Holloway added.
Kelly has witnessed the same dynamics himself.
"People have a remarkable ability to compensate for whatever problems they face," said Kelly, whose fellowship is supported by the National Institute of Neurological Diso
|Contact: Tom Rickey|
University of Rochester Medical Center