Emerging Subspecialties in Neurology: Cortical Careers in Neuropalliative Care

Melissa Ng, Jessica McFarlin, Robert G. Holloway, Janis Miyasaki, Neha M. Kramer

Research output: Contribution to journalArticlepeer-review


Serious neurologic illnesses are associated with significant palliative care (PC) needs, including symptom management, complex decision-making, support for caregivers, and end-of-life care. While all neurologists are responsible for the provision of primary PC, there is an increasing need for trained neurologists with expertise in palliative medicine to manage refractory symptoms, mitigate conflict around goals of care, and provide specialized end-of-life care. This has led to the emergence of neuropalliative care (NPC) as a subspecialty. There are different ways to acquire PC skills, incorporate them into one's neurology practice, and develop a neuropalliative carer. We interviewed 3 leaders in the field of NPC, Dr. Robert Holloway, Dr. Jessica McFarlin, and Dr. Janis Miyasaki, who are all neurologists with different subspecialties and training pathways working in academic centers. They share their career paths, their advice for neurology trainees interested in pursuing a career in NPC, and their thoughts on the future of the field.

Original languageEnglish
Pages (from-to)158-161
Number of pages4
Issue number3
StatePublished - Jan 17 2023

Bibliographical note

Funding Information:
Memorable patient experiences were a common catalyst for early interest in NPC for our interviewees, which led to other ways of nurturing this interest, such as attending conferences or engaging in research. During residency, Dr. Holloway found participating in family meetings rewarding and gravitated toward patients faced with difficult decision-making. He later attended the Education in Palliative and End-of-Life Care conference, where he discovered a community of PC providers who found joy in the same things he did and set him on a neuropalliative path. Dr. McFarlin's interest also began in residency when she cared for a patient with rapidly progressive dementia. She assumed the family would value a feeding tube, but they declined and enrolled him in home hospice. After reviewing the literature on feeding tubes in dementia, she discovered there is a science behind decision-making and communication. As a movement disorders specialist, Dr. Miyasaki saw patients with advanced disease for whom it seemed there was “nothing” to offer but had sources of suffering to relieve. She then received a research grant from the Parkinson Foundation to develop the first neurologist-directed PC program for Parkinson disease.

Publisher Copyright:
© American Academy of Neurology.

ASJC Scopus subject areas

  • Clinical Neurology


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