Ethics of Transitioning from Curative Care to Palliative Care: Potential Conflicts of Interest Using the Example of Neurosurgery.
Bioethics
Medical ethics
Neurological surgery
Palliative care
Palliative medicine
Journal
World neurosurgery
ISSN: 1878-8769
Titre abrégé: World Neurosurg
Pays: United States
ID NLM: 101528275
Informations de publication
Date de publication:
12 2022
12 2022
Historique:
received:
29
09
2022
accepted:
02
10
2022
pubmed:
11
10
2022
medline:
21
12
2022
entrez:
10
10
2022
Statut:
ppublish
Résumé
Neurosurgical conditions are often incurable and lead to disability, severe physical symptoms, and distress for patients and families. Neurosurgeons may be responsible for transitioning management from curative to palliative. We sought to analyze the ethics of transitioning care from curative to palliative in patients in one's own specialty. This was a case-based narrative review. PubMed and Google Scholar were searched with no restrictions on date. Studies relevant to the topic were included. After providing an introductory case, we defined the curative and palliative neurosurgical treatment paradigms, clarified the concept of transition of care from curative to palliative, and contrasted generalist and specialist palliative care. Next, we provided an overview of core ethical principles. We then described key considerations involved in transitioning patients from curative to palliative care in one's own specialty, namely, knowledge, communication, uncertainty, and futility. Finally, we provided an analysis of the introductory case, highlighting the conflict of interest inherent in the transition. It is acceptable for neurosurgeons and other specialists with adequate palliative care training to manage the transition to palliative care in most cases, preferably as part of multidisciplinary care teams. While we discuss the example of neurosurgery, this analysis applies to other specialties where care transitions from curative to palliative intent occur. Across specialties, patient preferences and values are foundational in the timing and specifics of this transition.
Sections du résumé
BACKGROUND
Neurosurgical conditions are often incurable and lead to disability, severe physical symptoms, and distress for patients and families. Neurosurgeons may be responsible for transitioning management from curative to palliative. We sought to analyze the ethics of transitioning care from curative to palliative in patients in one's own specialty.
METHODS
This was a case-based narrative review. PubMed and Google Scholar were searched with no restrictions on date. Studies relevant to the topic were included.
RESULTS
After providing an introductory case, we defined the curative and palliative neurosurgical treatment paradigms, clarified the concept of transition of care from curative to palliative, and contrasted generalist and specialist palliative care. Next, we provided an overview of core ethical principles. We then described key considerations involved in transitioning patients from curative to palliative care in one's own specialty, namely, knowledge, communication, uncertainty, and futility. Finally, we provided an analysis of the introductory case, highlighting the conflict of interest inherent in the transition.
CONCLUSIONS
It is acceptable for neurosurgeons and other specialists with adequate palliative care training to manage the transition to palliative care in most cases, preferably as part of multidisciplinary care teams. While we discuss the example of neurosurgery, this analysis applies to other specialties where care transitions from curative to palliative intent occur. Across specialties, patient preferences and values are foundational in the timing and specifics of this transition.
Identifiants
pubmed: 36216247
pii: S1878-8750(22)01409-7
doi: 10.1016/j.wneu.2022.10.003
pii:
doi:
Types de publication
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
139-145Informations de copyright
Copyright © 2022 Elsevier Inc. All rights reserved.