title: Palliative care for Parkinson's disease: a summary of the evidence and future directions.
abstract: BACKGROUND
  Parkinson's disease is a common, life-limiting, neurodegenerative condition. Despite calls for improved access to palliative care for people with Parkinson's disease, services have been slow in developing. Obstacles include poor understanding and recognition of palliative care needs, the role for specialist palliative care services and an agreed structure for sustainable palliative care provision.
  
  
  OBJECTIVE
  To summarise the evidence base for palliative care in Parkinson's disease, linking current understanding with implications for clinical practice and identifying areas for future research.
  
  
  BACKGROUND
  Convention recognises a final 'palliative phase' in Parkinson's disease, while qualitative studies suggest the presence of palliative care need in Parkinson's disease from diagnosis. Clinical tools to quantify palliative symptom burden exist and have helped to identify targets for intervention. Dementia is highly prevalent and influences many aspects of palliative care in Parkinson's disease, with particular implications for end-of-life care and advance care planning.
  
  
  CONCLUSIONS
  The 'palliative phase' represents a poor entry point for consideration of palliative care need in Parkinson's disease. An alternative, integrated model of care, promoting collaboration between specialist palliative and neurological services, is discussed, along with some specific palliative interventions. WHAT IS UNKNOWN: Limited evidence exists regarding timing of palliative interventions, triggers for specialist referral and management of terminal care.
  
  
  CONCLUSIONS
  Research examining access to palliative care and management of terminal symptoms will assist development of sustainable, integrated palliative care services for Parkinson's disease.
authors.affiliation: Supportive Care, Early Diagnosis and Advanced disease research group, University of Hull, Hull York Medical School, Hull, UK.
authors.forename: Edward W
authors.initials: EW
authors.lastname: Richfield
authors.forename: Edward J S
authors.initials: EJ
authors.lastname: Jones
authors.forename: Jane E
authors.initials: JE
authors.lastname: Alty
mesh_terms: D032722:Advance Care Planning / Q000458:organization & administration* / Q000592:standards; D017281:Cost of Illness; D003704:Dementia / Q000150:complications / Q000453:epidemiology; D019468:Disease Management; D005544:Forecasting; D006297:Health Services Accessibility; D006801:Humans; D010166:Palliative Care / Q000379:methods / Q000458:organization & administration* / Q000639:trends; D010300:Parkinson Disease / Q000523:psychology / Q000628:therapy*; D013997:Time Factors
keywords: Parkinson’s disease; advance care planning; dementia; palliative care; terminal care