安寧緩和醫療的發展自西元1967年，英國Cicely Saunders於倫敦創立第一間臨終照護機構開始，至今已五十多載。隨著善終的概念漸漸植入人心，法條跟著改變、安寧機構也日益增加。可惜的是目前大部分接受緩和醫療的病人，仍然以癌症末期病人為主。我們鮮少將安寧緩和醫療介入遭遇突發性腦血管或腦外傷事件的神經外科病人和家屬。但這些族群其實承受巨大的心理創傷，也面臨醫療決策大難題；外科醫師在評估預後時也有許多未知數，這些安寧共照團隊都可以提供幫助。本專論蒐集了近年內國內外的學術文章，討論(1)神經外科重症病人的疾病特性，及安寧需求。(2)神經外科醫師照會安寧團隊的最佳時機點。(3)安寧團隊在神經外科病房的角色、介入的技巧及評估介入的成效。(4)病人自主權利法上路後帶來的影響。(5)神經外科住院醫師訓練中應包含的安寧概念與溝通技巧。

Hospice care has emerged and evolved over the past 50 years since Dame Cicely Saunders founded the first terminal care facility in London. The idea of maximizing life quality at the end of life has spread throughout the world, triggering the establishment of an increasing number of hospices and monumental changes in regulations. However, hospice care for neurosurgical patients has remained understudied. The patients themselves have to endure tremendous pain, and their families suffer from enormous physical and mental stress, as well as difficulty in decision making. Physicians too are challenged with predicting prognosis. In this article, we reviewed studies regarding indications, benefits and optimal timing of palliative care among victims of traumatic brain injury or severe stroke patients in neurology intensive care units. We discussed the following issues: (1) Disease characteristics of neurosurgical patients and their palliative care needs; (2) The optimal timing for initiating palliative care in these patients; (3) The intervention of the palliative care team in helping patients; (4) The impacts of the promulgated Patient Right to Autonomy Act on neuro-palliative care; and (5) Palliative care skills that should be emphasized during surgery residency.