A Scoping Review of End-of-Life Discussions and Palliative Care: Implications for Neurological Intensive Care in Latin America and the Caribbean.

Abstract

Background: Palliative care (PC) is essential to improve quality of life for individuals with life-limiting acute neurological conditions, particularly in resource-limited settings. In Latin America and the Caribbean (LAC), there is limited health care professional training and education on PC. Objective: We reviewed the peer-reviewed literature discussing end-of-life care, withdrawal of life-sustaining treatments (WOLST), and PC in the acute inpatient setting. Methods: We searched 10 databases, including peer-reviewed published conference abstracts and articles published until May 22, 2024, and included literature describing goals-of-care discussions or availability of PC services in an inpatient setting in LAC countries. Results: We identified 34 articles that highlighted end-of-life discussions, WOLST, and PC utilization in inpatient settings in LAC. We identified several themes across literature as follows: limitations to PC referrals, hospice/end-of-life care, and the role of advanced directives in LAC. Our review found that several articles highlight the limitations of PC usage in LAC and inadequate access to treatments, including gastrostomy and tracheostomy tube placement. Conclusions: Our review demonstrates a need to improve PC knowledge and access to end-of-life care resources. Regional educational efforts are needed to improve PC knowledge among health care providers who care for patients with acute neurological conditions in LAC.