Table 2: Primary Palliative Care Skills for Patients with Disorders of Consciousness.

Adapted from Creutzfeldt CJ, Holloway RG, Curtis JR. Palliative Care: A Core Competency for Stroke Neurologists. Stroke. 2015;46(9):2714-2719; with permission

	Primary palliative care skills
Symptom management	Recognize subtle signs of awareness and address all patients as if they are aware Recognize and treat reproducible signs of pain, agitation, delirium Offer pleasant experiences and minimize uncomfortable experiences for all patients, including those whose subjective experience is unknown
Communication skills and goals of care	Communicate with patients and surrogates with empathy and compassion Effectively elicit the patient’s goals, values, and treatment preferences Effectively communicate information to surrogate decision-makers in language they understand Offer evidence-based prognostic estimates and avoid overly negative or positive prognostication Effectively communicate about uncertainty Avoid making assumptions about the quality of life for noncommunicative patients Provide anticipatory guidance regarding treatment trajectories Help decision-makers establish goals of care based on the patient’s values, goals, and treatment preferences Incorporate ethical principles into communication and decision-making Develop consensus for difficult decisions Identify and manage moral distress among interdisciplinary team members
Psychosocial and spiritual support	Identify psychosocial and emotional needs among the patient’s loved ones / caregivers Identify needs for spiritual or religious support and provide referrals Access resources to support the patient’s loved ones / caregivers Practice cultural humility
Systems of care	Establish a follow-up plan in which the patient’s / caregivers’ palliative care needs will continue to be addressed
End of life care	Emphasize non-abandonment and provide continued emotional support through the dying process Provide anticipatory guidance regarding the dying process Facilitate bereavement support