Neuropalliative Care

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 addresses palliative care needs of individuals living with neurological conditions. Neurosurgeons play an important role in neuropalliative care due to neurosurgeons’ understanding of natural history and treatment strategies of neurosurgical conditions, longitudinal patient-physician relationships formed in neurosurgery, and neurosurgeon responsibility for neurosurgical emergencies. Additionally, patients with neurosurgical conditions have unique palliative care needs given trajectories of neurosurgical diseases, prognostication, psychosocial factors, communication, and behavior. Palliative care improves outcomes among neurosurgical patients. Despite the importance of neuropalliative care, neurosurgeons often lack formal training in palliative care skills. Relevant skills include identifying patients requiring palliative care, assessing understanding of illness and preferences, educating patients, building trust, managing symptoms, addressing family and caregiver needs, discussing end-of-life care, and recognizing when to refer to specialists. The future of neuropalliative care involves increasing awareness of the importance of neuropalliative care, delineating priorities for neurosurgeons with regard to neuropalliative care, increasing emphasis on palliative care skills during training and practice, expanding research efforts, and adjusting reimbursement structures to incentivize the provision of neuropalliative care by neurosurgeons.