Advance care planning in neuro-oncology

Advance care planning (ACP) for a patient with a malignant brain tumor is an ongoing process that should ideally be started early in the treatment course. Here, we discuss and recommend appropriate ACP steps that should occur through the disease journey from the time of diagnosis, through treatment/plateau and recurrence, to end of life. The healthcare team should be able to concurrently broach the topic of ACP while providing cancer-directed treatment. At each stage, we introduce the topics that should be addressed or readdressed, as well as how to approach and confirm both with the patient and care partners of how information should be communicated and received, with particular emphasis on the healthcare proxy. Special topic considerations also include understanding the key role of a surrogate decision maker and atypical, complex situations that clinical teams may come across.