Palliative Tracheostomy Decision-Making: A Targeted Scoping Review

Tracheostomy is usually placed to support recovery or long-term survival, but it is also placed in patients with life-limiting illness whose goals of care are palliative. In these patients, a technology built for long-term life support is placed where the aim is not to prolong life. Little is known about how these decisions are made.

To map how decisions to place a palliative tracheostomy are made, including the populations and settings in which they arise, the factors that shape them, the stakeholders involved, and their communicative and ethical dimensions.

Eligibility turned on the documented goal of the decision to place a tracheostomy, taken from the authors' stated aim read together with the reported trajectory and care plan. Sources in which the procedure served life prolongation, recovery, rehabilitation, or weaning toward those ends were excluded, even where the patient had a life-limiting illness or was receiving palliative care. English-language sources published in peer-reviewed journals from January 2016 to February 2026 were eligible.

A systematic search of PubMed/MEDLINE, developed with a biomedical research librarian and executed on February 15, 2026, yielded 183 records.

A charting form developed a priori covered source characteristics, clinical and decisional context, ethical and communicative dimensions, quality of life, and structural constraints on care.

Four sources were included: two adult case reports, a pediatric case series, and an ethics analysis of one infant. None formally defined palliative tracheostomy. Each tracheostomy served a stated goal, such as communication, time with family, or going home or to hospice, judged by the patient or, for children, with the parents. In three sources, the goal depended on care the hospital does not provide, and only one reported weighing that care before the offer. Caregiver burden was weighed in the decision in one source. No source followed a patient beyond placement to a later decision about the tracheostomy or the ventilation it carried.

In these sources, the aim of a palliative tracheostomy was set in the hospital, but going home or to hospice depended on external care that was not guaranteed. Teams should confirm that this care can be arranged in time and that the family can sustain its share, weigh the procedure against withdrawal with comfort care, and record a purpose stated by the patient or family, with agreed triggers for revisiting it. Whether the reported patterns hold more broadly remains to be tested.