End-of-life communication in surgery and neurosurgery: challenges, opportunities, and insights from a systematic...

The aim of this systematic review was to synthesize current evidence on end-of-life (EOL) communication in surgical and neurocritical care settings. While effective EOL communication is essential to support patient-centered decision-making and ethical care, its implementation in surgical and neurosurgical contexts remains inconsistent and insufficiently characterized.

Using advanced search terms, a systematic review of the literature was conducted, comprising PubMed and Scopus. Studies published from January 2016 to January 2026 were included if they involved adult patients, family members, or clinicians engaged in EOL communication within surgical, neurosurgical, or oncological settings and reported empirical data on communication practices, barriers, ethical issues, family involvement, or training interventions. Observational, interventional, and qualitative studies were eligible. Due to substantial heterogeneity in study design and outcomes, findings were synthesized qualitatively.

Twenty-six studies met the inclusion criteria. Across studies, EOL communication was characterized by significant challenges related to time constraints, emotional burden, prognostic uncertainty, and variability in clinician communication skills. Structured training interventions, particularly simulation-based programs, were associated with improved clinician confidence and perceived competence, although their implementation was inconsistent. Neurosurgical and neuro-oncological settings presented distinct challenges, including rapid disease progression, early cognitive impairment, and increased reliance on family members for surrogate decision-making. Ethical dilemmas surrounding medical futility, autonomy, and conflict resolution were recurrent.

The available evidence highlights persistent gaps between recommended and actual EOL communication practices in surgical and neurocritical care. Improving outcomes will require earlier and structured communication, formal training embedded in surgical education, and multidisciplinary collaboration. Future research should prioritize prospective designs and standardized outcome measures to strengthen the evidence base and support more informed clinical decision-making for patients, families, and clinicians. Systematic review registration no.: CRD420261320726 (www.crd.york.ac.uk/prospero/).