Palliative Care for Psychiatry & Neurological Disorders

\r\n There is a substantial and growing need for neurologists to apply the principles of palliative medicine to the care of patients with progressive, chronic illnesses.  Neurologic diseases are largely incurable, reduce life expectancy and are associated with pain, depression, and other symptoms that are difficult to control. Miyasaki et al. showed that symptom burden in advanced Parkinson disease (PD) is similar to that in metastatic cancer. Caregivers of neurology patients also have similar, if not higher, rates of distress and burnout as caregivers of patients with cancer. The place of death and documentation of advance directives offer objective measures of physician performance. Hospital deaths among patients with chronic neurologic disorders are high for multiple sclerosis (MS). However, hospice deaths are extremely uncommon in PD and MS: 0.6% and 2.5%, respectively. These are striking statistics because research overwhelmingly indicates that the majority of patients prefer to die at home. All physicians, including neurologists, should have familiarity and comfort with several fundamental palliative care skills including communicating bad news, nonmotor symptom assessment and management, advance care planning, and caregiver assessment. For more complex or advanced patients, referral to palliative care specialty teams may be appropriate, including inpatient palliative care consultation, outpatient palliative care clinics, home palliative care, or hospice.

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