Early palliative care consultation should be considered to manage symptoms and facilitate advance care planning
WEDNESDAY, March 9, 2022 (HealthDay News) — The importance of providing palliative care to patients with neurologic conditions is addressed in an American Academy of Neurology position statement published online March 7 in Neurology.
Noting that in recent years, evidence has shown a benefit for palliative care in serious neurologic illnesses, Lynne P. Taylor, M.D., from the University of Washington in Seattle, and colleagues provide clinical guidance for neuropalliative care.
The authors note that early palliative care consultation should be considered to maximize symptom management and facilitate advance care planning and setting of goals of care. Neurologists need training in serious illness communication due to the high prevalence of life-altering neurologic conditions. These skills include delivering bad news, explaining prognosis, assisting patients in the process of decision-making, and setting limits for care that is objectively futile. Discussions of prognosis are critical to facilitating disease understanding and decision-making but are complicated by prognostic uncertainty. Once communication has taken place, care decisions should be documented clearly; neurologists can help elicit broad preferences and focus on anticipated complications of the disease process. When neurologic prognosis is poor, the ethical obligation to sustain life must be evaluated in the context of balancing the benefits and burdens of medical interventions, relief of suffering, and respect for patient autonomy. Hospice can provide comfort-focused medical care and other support at the end of life. However, hospice clinicians may not be familiar with the nuances of end-of-life care for patients with neurologic disorders, and collaboration between the referring neurologist and the accepting hospice clinicians is crucial.
“Neurologists provide palliative care to people living with life-altering neurologic illnesses not just at the end of life but throughout the course of a disease, improving lives with symptom control,” Taylor said in a statement.
One author disclosed financial ties to the pharmaceutical industry.
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