Shared Decision-Making in Neurologic Palliative Care and End of Life

Shared decision-making (SDM) is a part of patient-centered care, and it enables patient autonomy and preferences, which are the cornerstones of palliative care (PC) and end-of-life (EOL) care. SDM holds significant value in tailoring care to individual patient needs. This systematic literature review was designed to investigate the role of SDM within palliative care and end-of-life in the field of neurology. Relevant studies were retrieved from PubMed and Embase. Searches and data retrieval were conducted between June 23, 2023, and January 15, 2024, without date restrictions. All search terms yielded 429 articles; 33 were included. SDM, patient care preferences, and goals of care prominently directed the PC and EOL conversations. The themes of life extension versus prioritized comfort generated mixed results. Other themes included the nature and inception of advance care planning conversations, obstacles hindering these discussions, and the respective roles of health care providers and family caregivers. Lastly, a discrepancy in PC and EOL decisions was evident between patients, their families, and health care providers. There is a clear benefit for SDM for patients with neurologic diseases associated with PC and EOL decisions. However, there are several challenges, including the timing and depth of PC and EOL discussions while navigating the unpredictable trajectory of neurologic diseases and engaging in conversations with patients and their family members.