Emerging Subspecialties in Neurology: Palliative care

Dallara, Alexis; Tolchin, Dorothy W.

doi:10.1212/wnl.0000000000000121

Cited by 32 publications

(30 citation statements)

References 8 publications

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“…The palliative care needs of patients with neurologic conditions in an ICU are likely to be different from medical patients and may require different strategies to address them [6-8]. In this context, our project examined an approach to screening for palliative care needs that focuses on the actual palliative care needs of patients and families as perceived by the ICU clinicians on rounds and suggests that palliative care needs are common in the neuro-ICU.…”

Section: Discussionmentioning

confidence: 99%

Palliative Care Needs in the Neuro-ICU

Creutzfeldt

Engelberg

Healey

et al. 2015

Critical Care Medicine

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Objective Patients admitted to the neurological or neurosurgical intensive care unit (neuro-ICU) are likely to have palliative care needs. The goals of this project are to encourage the ICU team to identify palliative care needs for patients and their families and potential ways to meet those needs. Design Quality improvement project using a parallel-group prospective cohort design. Setting Single neuro-ICU at a large, academic medical center. Patients All patients admitted to the neuro-ICU from September 1, 2013 to November 30, 2013. Intervention We developed a Palliative Care Needs Screening Tool consisting of 4 questions: (1) Does the patient have distressing physical or psychological symptoms? (2) Are there specific support needs for patient or family? (3) Are treatment options matched with patient-centered goals? (4) Are there disagreements among teams and family? We implemented this daily screening tool on morning rounds for 1 of 2 neurocritical care services that alternate admitting days to a single neuro-ICU. We examined prevalence and nature of palliative care needs and actions to address those needs, comparing the services with and without screening. Measurements and main results Over the 3-month period, 130 patients were admitted to the service with screening, and 132 patients to the service without screening. The two groups did not differ in regards to age, gender, Glasgow coma scale or diagnosis. Palliative care needs were identified in 62% of screened patients (80/130). Needs were mainly social support (53%) and establishing goals of care (28%). Screening was associated with more documented family conferences (p=0.019) and a trend towards more palliative care consultations (p=0.056). Conclusions We developed a brief palliative care needs screening tool that identified palliative care needs for 62% neuro-ICU patients. This tool was associated with actions to meet these needs, potentially improving care for patients and their families.

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Section: Discussionmentioning

confidence: 99%

Palliative Care Needs in the Neuro-ICU

Creutzfeldt

Engelberg

Healey

et al. 2015

Critical Care Medicine

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“…Prior research on the palliative care needs specific to patients in the neuroICU is limited, but suggests a different pattern of palliative care indicators compared to medical and surgical ICUs [4,5,[9][10][11]. Recent guidelines for the management of patients with stroke have emphasized the importance of integrating palliative care into the general care of these patients [12].…”

Section: Discussionmentioning

confidence: 99%

Prevalence and Outcomes of Patients Meeting Palliative Care Consultation Triggers in Neurological Intensive Care Units

et al. 2015

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Among neuroICU patients, 15.8 % met triggers for palliative care consultation. Although prevalence of admissions meeting any trigger was similar amongst all ICUs, neuroICU admissions met different types of triggers and were more likely to have withdrawal of life-sustaining therapy. These data suggest that palliative care needs are common among neuroICU patients and discussions with patients and families regarding limitation of life-sustaining therapy may differ in this setting.

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“…In some types of MS, PD, or MND, the progression may be very rapid. There can be enormous prognostic uncertainty in neurological diagnoses, with few validated prognostic markers [29]. Oliver et al [ We also tried to find out the relationship between the patients´ adaptation to their disease and the information they were given.…”

Section: Discussionmentioning

confidence: 99%

Informing patients with progressive neurological disease of their health status, and their adaptation to the disease

Bužgová

Kozáková

2019

Preprint

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Background Progressive neurological diseases, such as multiple sclerosis, Parkinson's disease, Huntington's disease, significantly interfere with patients' lives, and those of their families. The aim of the research was to establish whether the extent of the information on patients' health conditions, and the way patients learn this information from doctors affect their adaptation to chronic and progressive diseases.Methods Qualitative methodology was used for a total of 52 participants (patients with progressive neurological diseases, their family members, and health and social workers). Data were collected using individual, in-depth interviews and focus groups. Analysis of data for interpretation, conceptualization, and re-integration was performed by open, axial, and selective coding.Results It was determined that adequate information about patients’ health status, and the use of coping strategies are related to their adaptation to their disease, and consequently, to their quality of life. The participants often considered the extent of the information provided, and the way they were informed to be inadequate. Receiving the diagnosis, the progression of the disease, and the end of life were found to be the most burdensome.Conclusion Our results show that Czech neurologist should develop better communication skills, particularly for informing patients with progressive neurological diseases. Open communication, emotional support, and support in selecting effective coping strategies can help patients adapt more readily to their disease, and improve their quality of life.

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Emerging Subspecialties in Neurology: Palliative care

Cited by 32 publications

References 8 publications

Palliative Care Needs in the Neuro-ICU

Palliative Care Needs in the Neuro-ICU

Prevalence and Outcomes of Patients Meeting Palliative Care Consultation Triggers in Neurological Intensive Care Units

Informing patients with progressive neurological disease of their health status, and their adaptation to the disease

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