Table 4.

Summary of the literature on unmet palliative care needs among patients with high-grade glioma.

Author	Country	Number of Centers	Study Type	#Of Participants	Gaps Identified
Pace (2017) [13]	N/A	N/A	Systematic Review and Expert Opinion	223 articles on palliative care needs and management of glioma	Overall limited evidence on palliative care delivery for glioma Need to study fatigue, behavioral symptoms, caregiver needs, and ACP
Halkett (2018) [36]	Australia	4	Prospective cohort	118 caregivers of HGG patients	Caregivers have high levels of unmet supportive care needs throughout the disease trajectory Over 25% of caregivers reported a lack of information about prognosis as important at all stages
Sizoo (2012) [27]	Netherlands	3	Cross-sectional survey	101 providers 50 relatives of decedents with HGG	• Physicians are often unaware of patients’ end-of-life preferences
Gofton (2012)40	USA	1	Retrospective data analysis	101 deceased HGG patients	15% of patients had no documented end-of-life discussions 23% had no health care proxy 35% had no DNR order
Hemminger (2017) [43]	USA	1	Retrospective cohort	117 decedents with GBM	• Patients received late ACP documentation and minimal early palliative care
Diamond (2017) [46]	USA	1	Mixed methods (prognostic awareness assessment tool and semi-structured interviews)	50 patients with HGG with 32 matched caregivers	20% of patients had no prognostic awareness 40% of patients had limited prognostic awareness 42% of patients and 50% of caregivers desired more prognostic information
Sizoo (2014) [49]	N/A	N/A	Systematic Review	17 studies addressing the end-of-life phase for HGG patients	• Limited research and no adequate guidelines on end of life care for HGG patients, including symptom management, ACP, and organization of care
Collins (2014) [55]	Australia	4	Retrospective cohort	1160 decedents with PMBT	• Under-utilization of palliative care in patients who survived a first hospital admission but died within 120 days
Forst (2017) [56]	USA	1	Retrospective analysis	12,437 decedents with malignant glioma	• Patients often referred late (<7 days before death) to hospice
Mehta (2018) [61]	USA	17	Cross-sectional survey	17 neuro-oncology fellowship program directors	• No consistent palliative care education for neuro-oncology fellows
Philip (2014) [62]	Australia	2	Qualitative interviews	10 patients with HGG	• Patients perceived providers as focused on “here and now,” lacking openness about the future, reluctant to discuss palliative care

HGG: High-grade glioma; DNR: Do not resuscitate; GBM: Glioblastoma; ACP: Advance care planning; PMBT: Primary malignant brain tumor.