End-of-Life Care and Hospice

This article provides an overview of what neurologists need to know about hospice and basic symptom management at the end of life, addressing issues relevant to both outpatient and inpatient settings.

Randomized, placebo-controlled trials are challenging in this patient population, and many of the recommendations for symptom management represent expert opinion and common practices in hospice and palliative care. More high-quality evidence is needed to guide best practices.

Core competencies in end-of-life care are necessary for any clinician who cares for patients with serious and potentially life-limiting illnesses. Comprehensive end-of-life care integrates knowledge of the biomedical aspects of disease with patients' values and preferences for care; psychosocial, cultural, and spiritual needs; and support for patients and their families. Communication with patients and their surrogate decision-makers helps ensure their perspective is heard and their needs are met. Both inpatient and outpatient neurologists should be able to start conversations about hospice and answer general questions from patients and surrogate decision-makers. In the hospital setting, neurologists may be responsible for managing common end-of-life symptoms. Hospice and palliative care specialists can be important collaborators in navigating the end of life.