Advance care planning in neurological disease to improve end-of-life care and reduce healthcare utilisation: cohort study.

OBJECTIVES: To evaluate the first year of a neurologist-led Advance Care Planning (ACP) consultation implemented within a tertiary hospital neurology department, and to assess its impact on end-of-life (EOL) care, alignment with patient preferences, and healthcare utilisation among patients with advanced neurological disease. METHODS: A retrospective observational study of all patients referred to a specialised ACP consultation between May 2023 and June 2024 at the Fundación Jiménez Díaz University Hospital (Madrid, Spain). Referral was guided by a NECPAL (NECesidades PALiativas) - based tool. ACP discussions followed the LagunAdvance framework and generated individualised care plans documented using structured communication and therapeutic appropriateness fields. Fisher's exact test was used to compare differences before and after referral, and Bayesian methods were used where appropriate. RESULTS: Eighty-six patients (median 83 years) were included. Severe cognitive impairment (68%) and moderate-severe dependency (88%) were common. Communication limitations affected 38%. ACP planning was completed for all patients. Engagement with palliative care teams occurred in 24%, and 47% used Web Dialogue. Healthcare utilisation decreased significantly following ACP: emergency department visits fell from 48% to 22% (p<0.001), and hospital admissions from 32% to 16% (p=0.020). Thirty-two patients (37%) died during follow-up; 66% died in their preferred location. Diagnostic interventions in the last week of life were infrequent (15%). CONCLUSIONS: A neurologist-led ACP consultation is feasible and improves key EOL outcomes for patients with advanced neurological disease, including reduced acute care use and greater alignment with patient preferences. This model may support broader integration of palliative principles within neurology services.