Background: Palliative care (PC) needs in patients with neurological diseases are becoming more recognized by neurologists and PC physicians. Objective: To qualify and quantify the PC education available in the United States adult neurology programs since the Accreditation Council for Graduate Medical Education (ACGME) published updated mandates in 2009. Design: A 22-question survey was electronically distributed to each neurology residency program in the United States. Setting/Subjects: All program directors (PDs) and assistant/associate program directors (APDs) of adult neurology programs. Results: This study had a 35% survey response rate (49 programs). Of the participating programs, 20% offer no PC education to residents. Communication, prognostication, and withdrawing life-prolonging therapies were the domains identified as the most important for resident education; these were also the domains PDs/APDs were most comfortable providing for their own patients, and the domains their residents are the best trained in currently. Addressing spiritual distress was the domain considered the least important, the domain PDs/APDs were least comfortable providing for their own patients, and the domains residents are currently the least well-trained in. Forty-two percent of programs were dissatisfied with the PC education available at their program. Time for teaching, availability of faculty, and faculty expertise were the most common barriers. Conclusions: PC education varies greatly across the United States adult neurology residency programs despite ACGME requirements. As time and resources limit current training, utilization of interdisciplinary educational teams and nationally available PC educational material may improve implementation of PC education in these residency programs.

This Viewpoint discusses the considerations and challenges affecting the palliative care specialty and delivery of palliative care in the COVID-19 era, as well as potential solutions.

Background: The medical profession increasingly recognizes the growing need to educate nonpalliative physicians in palliative care. Objective: This study aims to provide a scoping review of the primary palliative care (PPC) education currently available to graduate medical trainees in primary and specialty tracks. Design: Studies of PPC interventions in U.S. residency or fellowship programs of all subspecialties published in English and listed on MEDLINE, CINAHL, and EMBASE through January 2020 were included. To meet admission criteria, studies had to describe the content, delivery methods, and evaluation instruments of a PPC educational intervention. Results: Of 233 eligible full texts, 85 studies were included for assessment, of which 66 were novel PPC educational interventions and 19 were standard education. Total number of publications evaluating PPC education increased from 8 (2000–2004) to 36 (2015–2019), across 11 residency and 10 fellowship specialties. Residency specialties representing the majority of publications were emergency medicine, general surgery, internal medicine, and pediatric/medicine-pediatrics. PPC content domains most taught in residencies were communication and symptom management; the primary delivery method was didactics, and the outcome assessed was attitudes. Fellowship specialties representing the majority of publications were pediatric subspecialties, nephrology, and oncology. The PPC content domain most taught in fellowships was communication; the primary delivery method was didactics and the outcome evaluated was attitudes. Conclusions: While PPC education has increased, it remains varied in content, delivery method, and intervention evaluations. Future studies should include more widespread evaluation of behavioral outcomes, longitudinal persistence of use, and clinical impact.

Objective To describe some current models of outpatient neuropalliative care (NPC) available to patients with amyotrophic lateral sclerosis at different institutions within the United States. Methods Six NPC physicians were asked to contribute written descriptions about the PC available in their ALS clinics. Descriptions were then compiled and assessed for similarities and differences. Results All clinics are multidisciplinary, with regular appointments every 3 months and similar appointment times for new visits (60–120 minutes) and follow-up visits (20–45 minutes). Four clinics have an NPC specialist embedded within the ALS clinic, 1 institution has a separate clinic for NPC, and 1 institution has both. The NPC physician at 5 institutions is a neurologist with formal palliative care training and at 1 institution is an internist with formal palliative care training. NPC is part of routine care for all patients at 2 institutions, and the primary reasons for consultation are goals of care (GOC) and severe symptom management. Conclusion NPC is provided to patients with ALS heterogeneously throughout the United States with some variation in services and delivery, but all clinics are addressing similar core needs. Given the poor prognosis and high PC needs, those with ALS are the ideal patients to receive NPC. Future studies are necessary given the paucity of data available to determine best practices and to better define meaningful outcomes.