The Approach to Serious-Illness Conversations

Because of the impact of serious neurologic illness on quality of life, personhood, and prognosis, neurologists must be comfortable and skillful in communicating about serious illness. This article provides an overview of the approach to serious-illness conversations for patients with neurologic disease, offers specific communication techniques, outlines strategies to address challenging situations, and recommends educational opportunities for neurologists seeking additional training in serious-illness communication.

The American Academy of Neurology (AAN), the Accreditation Council for Graduate Medical Education, and multiple other neurologic professional societies have formally acknowledged the importance of palliative care and serious-illness communication skills in neurologic care. The International Neuropalliative Care Society was recently formed to promote high-quality palliative care, including serious-illness communication, for all patients living with serious neurologic conditions. Numerous educational resources have been developed to meet the growing need for serious-illness communication skills among neurologists.

Skilled serious-illness conversations improve rapport, reduce patient anxiety and depression, and increase the likelihood that treatment choices agree with patient goals and values. Communication skills can be honed during and after neurology training.