Voluntades anticipadas en pacientes con cuadriplejia por lesión medular: desafíos y oportunidades en cuidados paliativos

Objective: The available evidence on the challenges, opportunities, and benefits of advance care planning (ACP) and advance directives (AD) in adult patients with quadriplegia due to spinal cord injury was analyzed, given its relevance for autonomy, therapeutic congruence, and the humanization of care in the palliative context. Methodology: A systematic review based on PRISMA 2020 was conducted. The search was conducted in PubMed, Scopus, and Taylor & Francis Online, in English, Spanish, and Portuguese, between 2019 and 2025. Studies with full text on adults with spinal cord injury and content related to ACP, VA, and end-of-life decision-making were included. The final synthesis included 16 studies. Results: The evidence showed that ACP and VA favored informed decision-making, strengthened patient autonomy, improved communication between patients, family, and healthcare team, reduced unwanted interventions, and contributed to more appropriate family coping. Persistent barriers were also identified, such as the lack of professional training, the absence of institutional protocols, regulatory heterogeneity, and cultural and religious tensions surrounding the end of life. Conclusions: The early, structured, and culturally sensitive implementation of PAC and VA was key to improving the quality of care for patients with spinal cord injury, requiring training, standardized protocols, and formal registration mechanisms to strengthen its clinical application.