Table 4 Policy recommendations

[A] Seeking healthcare services post-stroke

A.1. Factoring influencing seeking care

A.1.1. Financial

Provision of financial counselling to caregivers, especially spousal caregivers, providing information on subsidies available

A.1.2. Structural or healthcare system related

Provision of affordable transport related information/support to family caregivers, especially spousal caregivers

A.2. Decision to seek care

A.2.1. Caregiver decides

Engage caregivers to optimise the use of primary care and outpatient rehabilitation services; making caregivers partners in stroke survivor’s healthcare journey to keep them motivated to continue seeking services for stroke survivors

Inform caregivers about stroke survivors’ care needs and healthcare appointments; provide a direct line with a care coordinator or designated personnel who can be contacted at times when caregivers are not sure of the healthcare setting they should visit during “crises”

A.2.2. Not one person’s decision to make

Healthcare providers should inquire about and be aware of caregiving arrangement of stroke survivors and engage the main caregiver in healthcare information exchange and decision making or ensuring the information is passed on to the relevant person(s)

Training healthcare professionals in successfully holding family conferences, where needs and ethical dimension of including family members are factored into healthcare decisions of stroke survivors

A.3. Role of caregiver in seeking care

A.3.1. Recognize symptoms

Educate the caregivers, especially spousal caregivers, about symptoms or red flags to look for in stroke survivors in community setting

A.3.2. Coordinate care

Inform and educate caregivers, especially adult-child caregivers, on healthcare services available and subsequent scheduled appointments during each healthcare encounter

A.3.3. Accompany to appointments

Scheduling appointments for stroke survivors taking into consideration the availability of family caregivers (and their other commitments like work), especially adult-child caregivers, to reduce rescheduling or no show at booked appointments

[B] Experience of healthcare encounters post-stroke

B.1. Service around the patient

B.1.1. Patient choice or preference

Ensure principles of person-centred care are embedded in healthcare system, especially in acute care setting, with due consideration to patient choice

B.1.2. Dignity and respect

Adoption of holistic management approach in both training and practice, which is inclusive of biopsychosocial elements, seeing stroke survivors as individuals, enabling them to maintain their dignity and giving them space during vulnerable moments

B.2. Service with care

B.2.1. Communication during a healthcare encounter

Healthcare professionals should invest time in communication aspects of a consult with sharing of information with the stroke survivors and their caregivers in a simplified manner, ensuring they understand

Tailoring of communication in a healthcare encounter to the needs of different types of caregivers, keeping in mind that spousal caregivers value relational aspects (e.g., the manner they are spoken to and so forth) and adult-child caregivers value transactional aspects (e.g., timely sharing of information and technical content and so forth)

B.2.2. Trust in the healthcare system

Ensuring stroke survivors and family caregivers have a good healthcare experience aligned with their expectations, so that the trust in the healthcare system is maintained, especially in acute care setting

Strategies to improve communication between healthcare professional and stroke survivor and family caregivers will facilitate building and maintaining of trust

B.2.3. Personal touch experienced in a healthcare encounter

Inclusion of empathy and compassion training in medical curriculum and promoting healthcare professionals to practice learnt principles in healthcare encounters with stroke survivors and their family caregivers

B.3. Role of caregiver in healthcare encounters

B.3.1. Advocate for the stroke survivor

Incorporate feedback given by family caregivers towards improving processes of care and making healthcare delivery more “patient- and family-centred”

B.3.2. Active participant in healthcare encounter

Promote partnership across healthcare professionals, stroke survivors and family caregivers towards collaborative care for the stroke survivors