Abstract
The palliative care needs of inpatients with neurologic illness are varied, depending
on diagnosis, acuity of illness, available treatment options, prognosis, and goals
of care. Inpatient neurologists ought to be proficient at providing primary palliative
care and effective at determining when palliative care consultants are needed. In
the acute setting, palliative care should be integrated with lifesaving treatments
using a framework of determining goals of care, thoughtfully prognosticating, and
engaging in shared decision-making. This framework remains important when aggressive
treatments are not desired or not available, or when patients are admitted to the
hospital for conditions related to advanced stages of chronic neurologic disease.
Because prognostic uncertainty characterizes much of neurology, inpatient neurologists
must develop communication strategies that account for uncertainty while supporting
shared decision-making and allowing patients and families to preserve hope. In this
article, we illustrate the approach to palliative care in inpatient neurology.
Keywords
palliative care - critical care - stroke - traumatic brain injury
