CC BY 4.0 ATTRIBUTION 4.0 INTERNATIONAL DeedJonsdottir, GudrunHaraldsdottir, ErnaVilhjalmsson, RunarSigurdardottir, ValgerdurHjaltason, HaukurKlinke, Marianne ElisabethTryggvadottir, Gudny BergthoraJonsdottir, Helga2024-07-232024-07-232024-07-222024-04-22Jonsdottir, G., Haraldsdottir, E., Vilhjalmsson, R., Sigurdardottir, V., Hjaltason, H., Klinke, M.E., Tryggvadottir, G.B. and Jonsdottir, H. (2024) ‘Transition to end-of-life care in patients with neurological diseases in an acute hospital ward’, BMC Neurology, 24(1), p. 253. Available at: https://doi.org/10.1186/s12883-024-03768-z.https://eresearch.qmu.ac.uk/handle/20.500.12289/13819https://doi.org/10.1186/s12883-024-03768-zFrom Springer Nature via Jisc Publications RouterHistory: received 2024-04-22, registration 2024-07-16, accepted 2024-07-16, epub 2024-07-22, online 2024-07-22, collection 2024-12-01Acknowledgements: We thank the data abstractors Andrea Jona Eggertsdottir, Berglind Osk Olafsdottir, Mona Sif Hadaya and Kristin Asgeirsdottir for their invaluable contribution to this study.Publication status: PublishedFunder: The Icelandic Nurses´ Association; Grant(s): 71545Funder: The University of Iceland Research Fund of Ingibjorg R. MagnusdottirFunder: Landspitali, The National University Hospital of IcelandErna Haraldsdottir - ORCID: 0000-0003-4891-0743 https://orcid.org/0000-0003-4891-0743Background: Transitioning to end-of-life care and thereby changing the focus of treatment directives from life-sustaining treatment to comfort care is important for neurological patients in advanced stages. Late transition to end-of-life care for neurological patients has been described previously. Objective: To investigate whether previous treatment directives, primary medical diagnoses, and demographic factors predict the transition to end-of-life care and time to eventual death in patients with neurological diseases in an acute hospital setting. Method: All consecutive health records of patients diagnosed with stroke, amyotrophic lateral sclerosis (ALS), and Parkinson’s disease or other extrapyramidal diseases (PDoed), who died in an acute neurological ward between January 2011 and August 2020 were retrieved retrospectively. Descriptive statistics and multivariate Cox regression were used to examine the timing of treatment directives and death in relation to medical diagnosis, age, gender, and marital status. Results: A total of 271 records were involved in the analysis. Patients in all diagnostic categories had a treatment directive for end-of-life care, with patients with haemorrhagic stroke having the highest (92%) and patients with PDoed the lowest (73%) proportion. Cox regression identified that the likelihood of end-of-life care decision-making was related to advancing age (HR = 1.02, 95% CI: 1.007–1.039, P = 0.005), ischaemic stroke (HR = 1.64, 95% CI: 1.034–2.618, P = 0.036) and haemorrhagic stroke (HR = 2.04, 95% CI: 1.219–3.423, P = 0.007) diagnoses. End-of-life care decision occurred from four to twenty-two days after hospital admission. The time from end-of-life care decision to death was a median of two days. Treatment directives, demographic factors, and diagnostic categories did not increase the likelihood of death following an end-of-life care decision. Conclusions: Results show not only that neurological patients transit late to end-of-life care but that the timeframe of the decision differs between patients with acute neurological diseases and those with progressive neurological diseases, highlighting the particular significance of the short timeframe of patients with the progressive neurological diseases ALS and PDoed. Different trajectories of patients with neurological diseases at end-of-life should be further explored and clinical guidelines expanded to embrace the high diversity in neurological patients.Licence for this article: http://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.http://creativecommons.org/licenses/by/4.0/Parkinson’s DiseaseALSTerminal CareTertiary HospitalHospitalisationStrokeLength of StayAcute Hospital WardNeurodegenerative Diseasesarticle2024-07-22