Another stroke client provided the example of a previous

operation to support the feasibility of a family-centered approach post-stroke: “They did it [family-centered Doxorubicin approach] for my liver transplant, but not for my stroke, where my wife fell into a depression.” One health professional mentioned that a family-centered approach post-stroke is indeed provided in acute care but only in extremely complex cases: “We have case files where the patient has a file and the family has a file. It’s the same file number, but A, B, C, in cases, for example, when a patient is in a coma and we have to intervene with the family, especially with the family… That’s when we work with families for specific objectives that are in some way related to the patient, that provide information about the patient, specific objectives to work with the family. But it’s not the majority of cases…” Overall, health professionals were also in favor of implementing a systematic family-centered approach since it would increase clinical efficiency by reducing current barriers to collaborative work: “I wanted to use a more family-centered than

individual approach; it really would have been worthwhile; find more it’s so much easier being in a partnership with people in the network. For example, you have a child and her mother has had a stroke and is aphasic, it’s not going well at school, our social worker tries to contact the school social worker or psychologist, and one of them says it’s not part of their mandate, doesn’t call back, and refuses to provide essential information; it’s tedious and time-consuming… but that’s reality. The main objective Exoribonuclease of the study was to document ethical issues involved in the systematic inclusion of relatives as clients in the rehabilitation process, from three perspectives: that of relatives, individuals with a first stroke (stroke clients), and health professionals. Although

the Canadian Best Practice Recommendations for Stroke Care (www.strokebestpractices.ca) include involving relatives early on and throughout the continuum of stroke care, methods for doing so remain vague, and relatives are not systemically involved at present. Should relatives be involved only as partners, as sources of information, and therefore as caregivers? Or should they also be involved as clients with their own needs, even though they may not present specific medical conditions? Our results suggest that the predominant role for relatives is still that of a caregiver, despite the well-expressed needs of all stakeholders. None of the three groups of participants perceived relatives truly as clients. We will now discuss three important issues stemming from our data in relationship to the literature: (1) the clinical and ethical value of involving relatives, (2) who should be responsible for providing services to relatives post-stroke, and (3) the importance of communication.