• Nathan A Shlobin, Mark Sheldon, and Mark Bernstein.
• Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA. Electronic address: nathan.shlobin@northwestern.edu.
• World Neurosurg. 2022 Dec 1; 168: 139145139-145.

BackgroundNeurosurgical 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.MethodsThis was a case-based narrative review. PubMed and Google Scholar were searched with no restrictions on date. Studies relevant to the topic were included.ResultsAfter 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.ConclusionsIt 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.Copyright © 2022 Elsevier Inc. All rights reserved.

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