Implementation and feasibility of integrated psychological care in acute stroke: an implementation perspective

Abstract

Beyond clinical effects, integrating psychological care into the acute/subacute stroke pathway hinges on operational feasibility—workflow fit, coverage, adherence, acceptability, and safety. We evaluated the implementation of a brief, structured psychological care pathway in routine practice. Prospective servicedevelopment cohort (April–August 2025) including consecutive adults with ischemic or hemorrhagic stroke. The intervention comprised up to six sessions emphasizing psychoeducation, coping skills, problem-solving, and support. Implementation indicators: eligibility and coverage (proportion enrolled of those admitted), adherence (sessions completed), acceptability (completion of standardized measures: EQ-5D/VAS, CANSAS, GAD-7, HAM-A, HAM-D, PHQ-9; MMSE at entry when appropriate), safety (intervention-related adverse events), and workflow integration (ability to deliver sessions during acute/subacute care). A total of 121 patients were enrolled, with cardiometabolic comorbidities common. The pathway was delivered without disrupting medical care; most patients completed ≥4 sessions and pre/post assessments, indicating good acceptability and manageable administrative load. No intervention-related adverse events were reported. Standardized tools facilitated interdisciplinary communication and needs prioritization (via CANSAS), while early in-hospital initiation improved coverage. From an implementation standpoint, brief integrated psychological care proved feasible in an acute setting and shows potential to improve patient-reported outcomes and continuity of care after discharge.