A Review of End-of-Life Discussions and Palliative Care: Implications for Neurological Intensive Care in Latin America and the Caribbean
Monica Diaz1, Lesley Guarena2, Bettsie Garcia1, Christoper Alarcon-Ruiz3, Stella Seal4, Clio Rubinos1, Dulce Cruz-Oliver5, Juan Carhuapoma6
1Department of Neurology, University of North Carolina at Chapel Hill, 2Department of Psychology, University of Arizona, 3Instituto Nacional de Ciencias Neurológicas, 4Welch Medical Library, 5Department of Medicine, Johns Hopkins University, 6Departments of Neurology, Neurosurgery and Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine
Objective:
To review the peer-reviewed literature discussing end-of-life care, withdrawal of life-sustaining treatments (WOLST) and palliative care in the acute inpatient setting, with a focus on acute neurological care in Latin America and the Caribbean (LAC).
Background:

Palliative care is essential for improving quality of life for individuals with life-limiting acute neurological conditions, particularly in many resource-limited settings where access to life-sustaining treatments may not be widely accessible. In LAC, there is limited healthcare professional training and education on palliative care, particularly in the acute neurological setting.

Design/Methods:

We searched 10 databases including peer-reviewed published conference abstracts and manuscripts published until March 10, 2022 in English, Spanish or Portuguese. We included literature describing the goals of care discussions or availability of palliative care in an inpatient setting in LAC countries.

Results:

We included 34 articles (17 from Brazil, 6 Argentina, and 1-2 articles each from Colombia, Cuba, Chile, Mexico, Peru) that met inclusion criteria. Several themes were identified, including: limitations to palliative care referrals in LAC; hospice/end-of-life care access in LAC; role of advanced directives in GoC discussions. Our review found that several articles highlight the limitations of palliative care usage in LAC and inadequate access to treatments including gastrostomy and tracheostomy tube placement. We also found that several other articles described that the most patients in LAC do not receive do-not-resuscitate orders and there is inadequate knowledge among providers of do-not-resuscitate orders.

Conclusions:

Our review demonstrates a need to improve palliative care knowledge and access to end-of-life care resources. Regional educational efforts are needed to improve palliative care knowledge among healthcare providers that care for patients with acute neurological conditions in LAC. Initiatives should prioritize patient-centered care and early integration of palliative care into acute neurological care. Strengthening the healthcare infrastructure of LAC countries to provide appropriate end-of-life comfort or curative care is warranted.

10.1212/WNL.0000000000206584