Neuropalliative Care

Neuropalliative care is a growing subspecialty of neurology that focuses on maximizing quality of life for people who have serious or advanced neurologic conditions. Although there are options to specialize in palliative care, neurologists and any provider caring for patients with neurologic disease should be familiar with a palliative approach to care that addresses symptom management, goals of care, advance care planning, and support for caregivers. This issue of Practical Neurology highlights several challenging palliative care topics and aims to offer readers a framework and approach to navigating them.

The first article by Dr. Rubin and Ms. Howard discusses a key topic that is critical to medical decision-making, determining whether a patient has the capacity to make a specific decision. This determination incorporates ethical principles with which the neurologic community should be familiar. To engage patients in advance care planning, which involves identifying a surrogate decision maker and outlining preferences for care at the end of life, patients must have the capacity to make these decisions. The article elaborates on the key aspects of capacity determination and how clinicians can guide patients through the process of preparing for the end of life.

The second article by Drs. Vaughan and Sucre addresses a topic that many neurology providers will face: patients with terminal conditions who have or anticipate a poor quality of life may consider requesting assistance with dying. This article is an excellent guide for neurologists on how to best respond to these requests, how to understand the eligibility requirements, and how to delineate the neurologist’s role in the process. Table 3 in the article shares skills that neurologists can use when they are approached about medical aid in dying.

The third article by Dr. Adjepong and me broaches the many important cultural considerations clinicians need to consider so that they can deliver the highest quality patient- and family-centered care. Understanding the factors that influence patients or families in the way that they approach serious illness or the end of life can aid providers in developing relationships with them and with establishing trust. Taking a cultural history and utilizing other members of the palliative care team to address the whole person are core components of neuropalliative care.

The fourth article by Dr. Ouellette describes the benefit of having a spiritual provider participating in the care of patients with neurologic disease. Many patients with acute and chronic neurologic conditions experience existential distress, changes in their perceived identity, and grief that can occur in a number of realms. Spiritual providers can identify and address these issues, allowing the patient and their caregivers to better cope with their illness.

In this issue, a few common neurologic conditions are highlighted but the concepts can be extrapolated to patients with a variety of diseases. The hope is that the journal readership will find this compilation of articles that focus on key aspects of neuropalliative care beneficial to their practice.