Neuropalliative care for the neurosurgeon: a primer

Nathan A. Shlobin BA1, Roxanna M. Garcia MD, MS, MPH1, and Mark Bernstein MD, MHSc, FRCSC2,3
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  • 1 Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois;
  • | 2 Division of Neurosurgery, Toronto Western Hospital, University of Toronto; and
  • | 3 Temmy Latner Center for Palliative Care, Mount Sinai Hospital, University of Toronto, Ontario, Canada
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Many neurosurgical conditions are incurable, leading to disability or severe symptoms, poor quality of life, and distress for patients and families. The field of neuropalliative care (NPC) addresses the palliative care (PC) needs of individuals living with neurological conditions. Neurosurgeons play an important role within multidisciplinary NPC teams because of their understanding of the natural history of and treatment strategies for neurosurgical conditions, longitudinal patient-physician relationships, and responsibility for neurosurgical emergencies. Moreover, patients with neurosurgical conditions have unique PC needs given the trajectories of neurosurgical diseases, the realities of prognostication, psychosocial factors, communication strategies, and human behavior. PC improves outcomes among neurosurgical patients. Despite the importance of NPC, neurosurgeons often lack formal training in PC skills, which include identifying patients who require PC, assessing a patient’s understanding and preferences regarding illness, educating patients, building trust, managing symptoms, addressing family and caregiver needs, discussing end-of-life care, and recognizing when to refer patients to specialists. The future of NPC involves increasing awareness of the approach’s importance, delineating priorities for neurosurgeons with regard to NPC, increasing emphasis on PC skills during training and practice, expanding research efforts, and adjusting reimbursement structures to incentivize the provision of NPC by neurosurgeons.

ABBREVIATIONS

ICU = intensive care unit; LMICs = low- and middle-income countries; MAiD = medical assistance in dying; NPC = neuropalliative care; PC = palliative care; QOL = quality of life.

Schematics of transseptal interforniceal resection of a superiorly recessed colloid cyst. ©Mark Souweidane, published with permission. See the article by Tosi et al. (pp 813–819).

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