Inpatient Palliative Care for Neurological Disorders: Lessons from a Large Retrospective Series

Abstract

Outpatient and hospital neurologists should routinely address advance directives, particularly as the proportion of patients with chronic neurological diagnoses increases.

Neurological Symptoms in Palliative Care Patients

“…In our study, the overwhelming majority (91%) of decisions regarding termination of life-sustaining measures (e.g., terminal extubation, termination of artificial hydration, and nutrition) were taken in patients with primary neurological diseases. This is in line with the findings of Liu et al ( 6 ), who showed that “eliciting goals of care” was the most frequent reason for palliative care consultations among neurological patients. In-depth knowledge of the course and prognosis of neurological diseases is indispensable when discussing treatment options with the patients’ families.…”

“…The percentage of patients with a primary neurological diagnosis (16%) in our retrospective cohort is higher than the proportions found in previous studies (9.2 and 8.8%) ( 5 , 6 ); one of which however excluded patients with primary brain tumors ( 5 ). In our study, the overwhelming majority (91%) of decisions regarding termination of life-sustaining measures (e.g., terminal extubation, termination of artificial hydration, and nutrition) were taken in patients with primary neurological diseases.…”

“…Although differences between countries exist, palliative care has been linked traditionally to oncological diseases and internal medicine/oncology specialists still constitute the largest part of the palliative care workforce in many countries (e.g., Germany, USA, Japan, and Canada) ( 1 – 4 ), while neurologists constitute less than 3% of physicians that are certified in palliative care ( 1 , 2 , 4 ). On the other hand, neurological and neurosurgical diseases have been found to be the second most common conditions in patients seen by a palliative care inpatient consultation service ( 5 ) and the most common diagnostic group in patients with non-malignant diseases ( 6 ).…”

Palliative Care for Hospitalized Patients With Stroke

“…Early integration of palliative care into acute stroke care has been recently endorsed by the American Heart 6 /American Stroke Association 7 and Neurocritical Care Society, 8 but data remain limited about how to best implement these recommendations and how to measure their benefit. 9 – 11 Palliative care services are available in an increasing number of US hospitals, but substantial variations remain in access and use across regional, socioeconomic, racial, and ethnic groups. 12 , 13 …”

Wie unterscheiden sich Bedürfnisse und Versorgung in der SAPV in Abhängigkeit von der Grunderkrankung? Auswertungen aus dem Nationalen Hospiz- und Palliativregister

“…Ähnliche Belastungsspektren und Strukturdiskussionen zeigen sich bei Patienten mit neurologischen Erkrankungen wie Schlaganfall, Morbus Parkinson, Demenz, amyotropher Lateralsklerose (ALS) und Hirntumoren [17,18]. Cheung et al zeigten, dass Patienten mit einer fortgeschrittenen neurologischen Erkrankung häufig bereit sind, sich mit der Versorgung am Lebensende zu beschäftigen, diese Thematik aber oft nicht ausreichend besprochen wird [19].…”