Although patient survival after stroke has improved, stroke remains a leading cause of death and severe disability. It is the second leading cause of death globally1 and fifth in the United States. The risk of death in the first 5 years after stroke is â‰ˆ50%, with the greatest risk in the first year. With advances in acute stroke treatment, stroke survivors and their family members are faced with making potentially life-altering decisions in both acute and chronic phases of stroke. Patient and family engagement in decision-making is critical, especially when faced with treatment decisions that may include transitioning from active treatment to a palliative approach to care.