This page provides some resources to prepare you for giving PREP2 predictions to your patients and their families. These can be challenging conversations, and they are more likely to go well if you are well-prepared.
Giving a new prediction is more than just delivering the information. Some people will need additional support. Referral to psychological support should be considered for any patient who is having emotional/adjustment difficulties following a stroke. This is particularly important for any patient receiving a Limited or Poor prediction.
Below are two videos that provide information for how to deliver PREP2 predictions.
The PREP2 Basic: Delivering Predictions video focuses on the information and rehabilitation goals for patients in the Excellent and Good upper limb prediction categories with a day 3 SAFE score of 5 or more. The video describes several strategies that may be useful when delivering these predictions to patients and their families.
The PREP2 Advanced: Delivering Predictions video focuses on the information and rehabilitation goals for patients with a SAFE score < 5 who are in the Good, Limited and Poor upper limb prediction categories. The video highlights communication strategies that may be particularly useful when sharing life altering information with these groups of more severely affected patients.
Here are some case examples. Think about how you’d approach discussing the PREP2 prognosis with each patient and their family.
Case example 1: Mr Fisher
Clinical information: 64 year old Caucasian male with a left hemisphere PACI
PREP2 information: SAFE score = 0, MEP-, NIHSS = 5
PREP 2 prediction: Limited
Additional information: Mr Fisher has some word-finding difficulties. He has a supportive wife, and together they own and operate a small business. He is keen to return to work
Case example 2: Mrs Parata
Clinical information: 58 year old Māori female with a left hemisphere TACI
PREP2 information: SAFE score = 0, MEP-, NIHSS = 9
PREP 2 prediction: Poor
Additional information: Mrs Parata is currently unable to walk and her communication is impaired by dysarthria. She lives alone, and has a supportive daughter who lives nearby. She is right-handed.
Case example 3: Mrs Singh
Clinical information: 78 year old Indian female with a left hemisphere LACI
PREP2 information: SAFE score = 0, MEP+
PREP 2 prediction: Good
Additional information: Mrs Singh lives with her son, daughter-in-law, and their two young children. She is worried about her ability to continue caring for her grandchildren.
Here are some useful phrases that might help you to prepare for these discussions.