Inpatient Palliative Care for Neurological Disorders: Lessons from a Large Retrospective Series.

BACKGROUND

Patients with neurological disorders are the second most common patient population to receive inpatient palliative care services after cancer; however, there have been few reports describing the characteristics and needs of this population.

OBJECTIVE

To understand which patients with neurological diagnoses utilized these services, reasons for consultation, and whether patterns of use changed over time.

DESIGN

Retrospective case series.

SETTING/SUBJECTS: Neurological patients seen by our academic hospital-based palliative care consult service from January 2010 through December 2014.

MEASUREMENT

Demographics, diagnoses, reasons for consultation, patient characterization, and outcomes were extracted from medical record.

METHODS

Data extracted from the chart was analyzed using primarily descriptive statistics with Chi-square used to compare group proportions and regression to examine temporal trends.

RESULTS

A total of 3170 patients received inpatient palliative care consultations, of whom 291 (9.2%) had a neurological diagnosis. Among these patients, 85 were excluded because of insufficient data, leaving 206 patients (mean age 70.0 ± 16.0 years; 111 (54%) female). Of the patients, 49% had a chronic diagnosis and 51% received a new diagnosis during their hospitalization, most commonly ischemic stroke. The proportion of patients with chronic diagnoses increased over time, with dementia representing the most common diagnosis in 2014. The most common reason for consultation was eliciting goals of care (82%). Advance directives were present at admission in 61 (30%), 130 (63%) at the time of consultation, and 190 (92%) patients after consultation. The proportion of people with advance directives after consultation significantly increased over the study period (p = 0.01).

DISCUSSION

Hospital-based palliative care is primarily utilized to clarify goals of care in neurological patients and that advance directives were commonly not completed prior to consultation.

CONCLUSIONS

Outpatient and hospital neurologists should routinely address advance directives, particularly as the proportion of patients with chronic neurological diagnoses increases.