Mike: Hello, I'm Mike Clarke, podcast editor for the Cochrane Library. Every year, approximately 14 million around the world have a stroke, and the Cochrane Stroke Group has produced more than 200 reviews in the last 25 years. In November 2021, they updated the review of information provision for stroke survivors and their carers, and two of the authors, Tom Crocker and Lesley Brown from the Bradford Teaching Hospitals NHS Foundation Trust in the UK discuss the latest findings in this podcast.

Lesley: Hello Tom. Perhaps you could begin with a few words about stroke and the problem that information provision is seeking to address?

Tom: Hello Lesley. A stroke is a loss of brain function caused by a lack of blood supply and its sudden and unexpected nature, and the huge physical and mental problems it can cause, can be devastating for the person who experiences it, and for their family. The right information at the right time may help people to cope with life after stroke and to reduce the risk of further strokes.

Lesley: So, why is it important to have a review of information provision for stroke survivors?

Tom: People often say they haven't been given enough information after their stroke but some also report feeling overwhelmed. There are also many different ways in which information can be provided. So, we wanted to find out whether people who were given information did better or worse, and to contrast two types of information provision: passive, where the information is given but not reinforced, such as by giving a leaflet or personal booklet; and active, where people get opportunities to ask questions about the information, such as in meetings and by phone. We hope that bringing the evidence together in this review will help healthcare professionals decide how best to approach information provision.

Lesley: What evidence was relevant to the review?

Tom: We were looking for trials of information provision and were particularly interested in the effects on people's knowledge and anxiety. Improving knowledge is central to many of the intended benefits of information provision and may be an important goal itself for people after a stroke. We also decided to focus on anxiety to reflect the turmoil people often feel, and because it may be worsened if people feel overwhelmed with information.

Lesley: And how much was found?

Tom: We found 33 trials. 11 of these were of passive information provision and 22 were of active information provision. None of the studies compared active and passive information directly. Also, many of the studies did not measure knowledge or anxiety. But, we were still able to make some tentative findings.

Lesley: What were they?

Tom: For stroke survivors, providing information actively may improve knowledge of stroke and stroke care. It may also slightly reduce anxiety but this might not be by a noticeable amount. The evidence was less clear for providing information passively. However, it may slightly worsen anxiety, although, again, this may not be by a noticeable amount.
For informal carers – that is, friends and family members - the evidence was very uncertain.

Lesley: So, what's your take home message?

Tom: Although the evidence is uncertain, it seems that strategies which actively involve stroke survivors and carers and include planned follow‐up and an opportunity for clarification and reinforcement are probably better than nothing, and so they should be used in routine practice. These active approaches should also be favoured over passive approaches such as simply providing a leaflet to someone. 

Lesley: Thanks Tom. If people would like to know more, where can they go?

Tom: Thanks Lesley. The review is available online in the Cochrane Library, that's at Cochrane library dot com and a search for 'information for stroke' will show our review near the top of the list.