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Álvarez Saúco M, García-Ramos R, Legarda Ramírez I, Carrillo García F, Fernández Bueno J, Martí Martínez S, González García B, Moya-Martínez A, Santos-García D. Palliative care management in patients with Parkinson's disease and other movement disorders in Spain. National survey of neurologists. Neurologia 2024; 39:417-425. [PMID: 37116690 DOI: 10.1016/j.nrleng.2021.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 09/02/2021] [Indexed: 04/30/2023] Open
Abstract
INTRODUCTION Palliative care in neurodegenerative diseases is useful but underused. The objective of this study is to know how palliative care (PC) is applied in Spain in order to identify limitations and unmet needs. MATERIALS AND METHODS It is a descriptive, observational, cross-sectional study, anonymous survey type of 20 questions, directed and answered by neurologists dedicated to movement disorders (MD) in Spain. RESULTS 58 responses were obtained from neurologists from 15 autonomous communities. 69% answered that they did not have a specialised MD nursing facility but did have a PC team in their centre (81%). No specific protocol for PC in MD was identified. All except one neurologist stated that they lacked sufficient training in PC, the main training need being the "advance directives explanation". Only 1 in 4 neurologists answered routinely explaining advance healthcare planning to their patients, recognising up to 84.5% of neurologists not knowing how to assess the patient's competence. 60.3% of those surveyed answered that between 10% and 30% of their patients would be candidates for PC, although 1 in 3 said they were not clear when to refer the patient to PC. 100% of neurologists affirmed the priority need to implement PC protocols in MD. CONCLUSIONS Our study shows a formative deficit in PC in this area and in the care of the patient with movement disorders and their environment, and should serve as a starting point to develop consensual care protocols.
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Affiliation(s)
- M Álvarez Saúco
- Servicio de Neurología, Hospital General Universitario de Elche, Elche, Spain.
| | - R García-Ramos
- Servicio de Neurología, Hospital Clínico San Carlos, Madrid, Spain
| | - I Legarda Ramírez
- Servicio de Neurología, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - F Carrillo García
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Spain; Equipo Multidisciplinar de Cirugía de Trastornos del Movimiento, Unidad de Gestión Clínica de Neurociencias, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - J Fernández Bueno
- Equipo de soporte de Cuidados Paliativos, Hospital Universitario La Princesa, Madrid, Spain
| | - S Martí Martínez
- Servicio de Neurología, Hospital General Universitario de Alicante, Alicante, Spain
| | - B González García
- Enfermera adscrita a Unidad de Trastornos del Movimiento, Hospital Universitario La Princesa, Madrid, Spain
| | - A Moya-Martínez
- Área de estadística, FISABIO, Hospital General Universitario de Elche, Elche, Spain; Centro de Investigación Operativa, Universidad Miguel Hernández de Elche, Elche, Spain
| | - D Santos-García
- Servicio de Neurología, CHUAC, Complejo Universitario de A Coruña, A Coruña, Spain
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Brinker D, Smilowska K, Paschen S, Antonini A, Moro E, Deuschl G. How to Use the New European Academy of Neurology/Movement Disorder Society European Section Guideline for Invasive Therapies in Parkinson's Disease. Mov Disord Clin Pract 2024; 11:209-219. [PMID: 38214401 DOI: 10.1002/mdc3.13962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 11/28/2023] [Accepted: 12/13/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND The decision to choose invasive treatments for Parkinson's disease (PD) is complex and needs careful consideration. OBJECTIVES Although the recommendations of the European Academy of Neurology/Movement Disorder Society European Section guideline for invasive therapies of PD are useful, the different clinical profiles of people with PD who seek advice for possible invasive therapy need further attention. METHODS AND RESULTS Here we describe 8 clinical standard situations of people with PD unsatisfied with their current oral treatment where invasive therapies may be considered. These are PD patients presenting with the following symptoms: (1) severe motor fluctuations, (2) beginning of levodopa-responsive fluctuations, severe tremor at (3) young or (4) advanced age, (5) impulse control disorders and related behavioral disorders, (6) hallucinations and psychosis, (7) minimal cognitive impairment or mild dementia, and (8) patients in need of palliative care. For some of these conditions, evidence at lower level or simple clinical considerations exist. CONCLUSIONS There are no one-fits-all answers, but physician and patient should discuss each option carefully considering symptom profile, psychosocial context, availability of therapy alternatives, and many other factors. The current paper outlines our proposed approach to these circumstances.
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Affiliation(s)
- Dana Brinker
- Department of Neurology, UKSH, Christian-Albrechts-University Kiel, Kiel, Germany
| | - Katarzyna Smilowska
- Department of Neurology, UKSH, Christian-Albrechts-University Kiel, Kiel, Germany
- Department of Neurology, Regional Specialist Hospital im. Św. Barbary, Sonowiec, Poland
| | - Steffen Paschen
- Department of Neurology, UKSH, Christian-Albrechts-University Kiel, Kiel, Germany
| | - Angelo Antonini
- Parkinson and Movement Disorders Unit, Study Center for Neurodegenerative Diseases (CESNE), Department of Neuroscience, University of Padua, Padua, Italy
| | - Elena Moro
- Grenoble Alpes University, Chu of Grenoble, Division of Neurology, Grenoble Institute of Neurosciences, Grenoble, France
| | - Günther Deuschl
- Department of Neurology, UKSH, Christian-Albrechts-University Kiel, Kiel, Germany
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Sipilä JO, Kaasinen V, Rautava P, Kytö V. Case-Fatality Rate in Parkinson's Disease: A Nationwide Registry Study. Mov Disord Clin Pract 2024; 11:152-158. [PMID: 38386489 PMCID: PMC10883402 DOI: 10.1002/mdc3.13948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 11/05/2023] [Accepted: 11/15/2023] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Patients with Parkinson's disease (PD) may have an increased risk of mortality, but robust estimates are lacking. OBJECTIVE To compare mortality rates nationally between patients with PD and controls. METHODS The case-fatality rates of Finnish PD patients diagnosed in 2004-2018 (n = 23,688; 57% male, mean age at diagnosis = 71 years) and randomly selected sex- and age-matched control subjects (n = 94,752) were compared using data from national registries. The median follow-up duration was 5.8 years (max 17 years). RESULTS The case-fatality rate in patients with PD was higher than that in matched controls (HR 2.29; 95% CI 2.24-2.33; P < 0.0001). Excess fatality among PD patients was already present at 1 year from diagnosis and then plateaued at 29% at 12 years after diagnosis. The long-term relative hazard of death in PD patients vs. matched controls did not differ based on sex. Patients with early-onset PD (age at diagnosis <50 years old) had the highest relative hazard of death (HR 3.36) compared to matched control subjects, and the relative hazard decreased with higher age at diagnosis. The seven-year excess risk of death decreased during the study period, especially in men. In patients with PD, male sex, increasing age, and increasing comorbidity burden were associated with an increased risk of death. CONCLUSIONS An increased risk of death among PD patients was evident from early on. The increase in risk was greatest among young-onset patients. The excess risk in early PD declined during the study period, particularly in men. The reasons for this are unknown.
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Affiliation(s)
- Jussi O.T. Sipilä
- Department of NeurologySiun Sote North Karelia Central HospitalJoensuuFinland
- Clinical NeurosciencesUniversity of TurkuTurkuFinland
| | - Valtteri Kaasinen
- Clinical NeurosciencesUniversity of TurkuTurkuFinland
- NeurocenterTurku University HospitalTurkuFinland
| | - Päivi Rautava
- Department of Public HealthUniversity of TurkuTurkuFinland
- Turku Clinical Research CenterTurku University HospitalTurkuFinland
| | - Ville Kytö
- Turku Clinical Research CenterTurku University HospitalTurkuFinland
- Heart CenterTurku University Hospital and University of TurkuTurkuFinland
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Seshadri S, Sugiura K, Mirham M, Aamodt WW, Kluger BM. Spirituality and Spiritual Distress in Parkinson's Disease Caregivers: A Scoping Review. JOURNAL OF RELIGION AND HEALTH 2023; 62:4222-4243. [PMID: 37702853 DOI: 10.1007/s10943-023-01913-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/25/2023] [Indexed: 09/14/2023]
Abstract
Despite recognition that spiritual concerns contribute to caregiver burden, little is known about spirituality, spiritual well-being, and spiritual distress in Parkinson's disease caregivers. In this scoping review of the literature through October 2022, we searched PubMed, PsychINFO, Embase, and CINAHL. From an initial pool of 328 studies, 14 were included. Caregiver factors (e.g., depression, age) and patient factors (e.g., faith, motor function) affected caregiver spirituality and spiritual well-being. Caregivers experienced loss of meaning, existential guilt, and loneliness, and coped through acquiescence, cultural beliefs, prayer, and gratitude. Future research should focus on the specific spiritual needs of Parkinson's disease caregivers and interventions to address them.
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Affiliation(s)
- Sandhya Seshadri
- Department of Neurology, University of Rochester, 265 Crittenden Boulevard, CU 420694, Rochester, NY, 14642, USA.
| | - Kei Sugiura
- Department of Neurology, University of Rochester, 265 Crittenden Boulevard, CU 420694, Rochester, NY, 14642, USA
| | - Miray Mirham
- School of Medicine, University of Rochester, Rochester, NY, USA
| | - Whitley W Aamodt
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
| | - Benzi M Kluger
- Department of Neurology, University of Rochester, 265 Crittenden Boulevard, CU 420694, Rochester, NY, 14642, USA
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Seshadri S, Dini M, Macchi Z, Auinger P, Norton SA, Holtrop JS, Kluger BM. Reach of Palliative Care for Parkinson Disease: Results From a Large National Survey of Patients and Care Partners. Neurol Clin Pract 2023; 13:e200214. [PMID: 37854173 PMCID: PMC10581080 DOI: 10.1212/cpj.0000000000200214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 09/15/2023] [Indexed: 10/20/2023]
Abstract
Background and Objectives People with Parkinson disease (PWP) and their care partners have high palliative care needs resulting from disabling motor and nonmotor symptoms. There is growing support for palliative care (PC) approaches to Parkinson disease. However, little is known regarding the extent to which the palliative needs of PWP and care partners are currently being met. This study's primary objective is to describe PWP's and care partners' perceptions of the extent to which their PC needs are being met. Secondary objectives are to describe their perceptions of the quality of clinical communication and their knowledge of PC. Methods PWPs and care partners (n = 12,995) who had consented to receiving surveys from the Parkinson's Foundation were emailed an electronic survey. PC was operationalized as comprising 5 key components: systematic assessment and management of (1) nonmotor symptoms, (2) PWPs' emotional and spiritual needs, (3) care partners' needs, (4) the completion of annual advance care planning, and (5) timely referrals to specialist palliative care and hospice when appropriate. Results A total 1,882 individuals (1,266 PWP and 616 care partners) responded to the survey (response rate 14.5%). Few PWP (22%) reported that their neurologists never asked regarding bothersome nonmotor symptoms or did so or only if they brought it up. Fifty percent of PWP reported that pain as a specific nonmotor symptom was never managed or managed only if they brought it up. Similarly, PWPs' emotional and spiritual needs (55%), care partners' well-being (57%), and completion of advance care planning documentation (79%) were never addressed or only addressed if PWP brought it up. The quality of clinical communication was generally rated as open and honest (64% PWP). Fewer PWP (30%) reported that doctors helped them deal with the uncertainties of Parkinson disease. Most PWP (85%) reported being knowledgeable regarding PC, and 68% reported that the goal of PC was to help friends and family cope with the illness. Discussion Although some elements of PC are currently being addressed in routine care for PWP, there are many gaps and opportunities for improvement. These data may facilitate focused attention and development of resources to improve the quality and availability of PC for Parkinson disease.
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Affiliation(s)
- Sandhya Seshadri
- Department of Neurology (SS, PA, BMK), University of Rochester; Parkinson's Foundation (MD), New York; Department of Neurology (ZM), University of Colorado Anschutz Medical Campus; Center for Health & Technology (PA), University of Rochester; University of Rochester School of Nursing (SAN), NY; and Department of Family Medicine at the University of Colorado School of Medicine (JSH), Anschutz Medical Campus
| | - Megan Dini
- Department of Neurology (SS, PA, BMK), University of Rochester; Parkinson's Foundation (MD), New York; Department of Neurology (ZM), University of Colorado Anschutz Medical Campus; Center for Health & Technology (PA), University of Rochester; University of Rochester School of Nursing (SAN), NY; and Department of Family Medicine at the University of Colorado School of Medicine (JSH), Anschutz Medical Campus
| | - Zachary Macchi
- Department of Neurology (SS, PA, BMK), University of Rochester; Parkinson's Foundation (MD), New York; Department of Neurology (ZM), University of Colorado Anschutz Medical Campus; Center for Health & Technology (PA), University of Rochester; University of Rochester School of Nursing (SAN), NY; and Department of Family Medicine at the University of Colorado School of Medicine (JSH), Anschutz Medical Campus
| | - Peggy Auinger
- Department of Neurology (SS, PA, BMK), University of Rochester; Parkinson's Foundation (MD), New York; Department of Neurology (ZM), University of Colorado Anschutz Medical Campus; Center for Health & Technology (PA), University of Rochester; University of Rochester School of Nursing (SAN), NY; and Department of Family Medicine at the University of Colorado School of Medicine (JSH), Anschutz Medical Campus
| | - Sally A Norton
- Department of Neurology (SS, PA, BMK), University of Rochester; Parkinson's Foundation (MD), New York; Department of Neurology (ZM), University of Colorado Anschutz Medical Campus; Center for Health & Technology (PA), University of Rochester; University of Rochester School of Nursing (SAN), NY; and Department of Family Medicine at the University of Colorado School of Medicine (JSH), Anschutz Medical Campus
| | - Jodi S Holtrop
- Department of Neurology (SS, PA, BMK), University of Rochester; Parkinson's Foundation (MD), New York; Department of Neurology (ZM), University of Colorado Anschutz Medical Campus; Center for Health & Technology (PA), University of Rochester; University of Rochester School of Nursing (SAN), NY; and Department of Family Medicine at the University of Colorado School of Medicine (JSH), Anschutz Medical Campus
| | - Benzi M Kluger
- Department of Neurology (SS, PA, BMK), University of Rochester; Parkinson's Foundation (MD), New York; Department of Neurology (ZM), University of Colorado Anschutz Medical Campus; Center for Health & Technology (PA), University of Rochester; University of Rochester School of Nursing (SAN), NY; and Department of Family Medicine at the University of Colorado School of Medicine (JSH), Anschutz Medical Campus
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Hvisdak V, Huang AP, Kluger BM. Palliative Care of End Stage Parkinsonism: An Overview Including the Five Pillars Framework. Mov Disord Clin Pract 2023; 10:S63-S67. [PMID: 37637979 PMCID: PMC10448122 DOI: 10.1002/mdc3.13620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 07/07/2022] [Accepted: 07/10/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Veronica Hvisdak
- Department of NeurologyUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Andrew Phillip Huang
- Department of NeurologyUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Benzi Michael Kluger
- Department of NeurologyUniversity of Rochester Medical CenterRochesterNew YorkUSA
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Velaga VC, Cook A, Auret K, Jenkins T, Thomas G, Aoun SM. Palliative and End-of-Life Care for People Living with Motor Neurone Disease: Ongoing Challenges and Necessity for Shifting Directions. Brain Sci 2023; 13:920. [PMID: 37371398 DOI: 10.3390/brainsci13060920] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 05/31/2023] [Accepted: 06/05/2023] [Indexed: 06/29/2023] Open
Abstract
Although the progressive clinical trajectory of motor neurone disease (MND) is widely understood, multiple challenges remain preventing optimal end-of-life care for this population with unique needs from the patient, carer and service provider perspectives. This paper reports on the experiences, gaps in service and unmet needs of MND patients and family carers and explores public health palliative care approaches that would facilitate coordinated and integrated care to respond to their changing needs. This is a qualitative study of responses to questions in an online consumer survey (353 respondents) in Western Australia (2020), focusing on a subset of 29 current and bereaved carers of people with MND who have used health services in the last five years. The analysis identified themes, highlighting the insufficient integration of services across health and social care; poor and unequal access to coordinated palliative care; significant gaps in the knowledge base of the workforce and a failure to meet the consumer expectations of person-centred care. For palliative care to be accessible to those living with MND and other under-served conditions, there needs to be a shift to more comprehensive, inclusive and sustainable options, such as the public health approach to palliative/end-of-life care that engages the assets of local communities in partnership with health services, one example being the "Compassionate Communities Connectors" model of care. Further considerations include advocacy for policy changes, fostering partnerships and developing indicators for evaluating the impact of the proposed models of care. The end result is not only better care but substantial savings for the health system.
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Affiliation(s)
- Vivek C Velaga
- Perron Institute for Neurological and Translational Science, 8 Verdun St, Nedlands, WA 6009, Australia
| | - Angus Cook
- School of Population and Global Health, University of Western Australia, Clifton Street Building, Clifton Street, Nedlands, WA 6009, Australia
| | - Kirsten Auret
- Rural Clinical School of Western Australia, University of Western Australia, Building M701/31 Stirling Terrace, Albany, WA 6330, Australia
| | - Tom Jenkins
- St John of God Midland Hospital, 1 Clayton Street, Midland, WA 6056, Australia
| | - Geoff Thomas
- Thomas MND Research Group, 48 Grevillea Way, Blackwood, SA 5051, Australia
| | - Samar M Aoun
- Perron Institute for Neurological and Translational Science, 8 Verdun St, Nedlands, WA 6009, Australia
- Medical School, University of Western Australia, 8 Verdun St, Nedlands, WA 6009, Australia
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Trahair ED, Mantri S. Examining the Role of Narrative in Palliative Care for Parkinson Disease: Changing the Story. Neurol Clin Pract 2023; 13:e200150. [PMID: 37081942 PMCID: PMC10112858 DOI: 10.1212/cpj.0000000000200150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 02/10/2023] [Indexed: 04/22/2023]
Abstract
Recent years have seen growing interest in neuropalliative care as a subspecialty. Simultaneously, the rise of narrative medicine in patient support groups and clinician training programs offers a way to listen deeply to the stories of those living with chronic illness and may inform corresponding health interventions. This commentary examines the ways in which an understanding of illness narrative schemata, particularly the so-called "chaos narrative," can contribute to patient and care partner distress, which in turn can be alleviated by a palliative care approach. Through examples of stories of people with Parkinson disease and their care partners, the article emphasizes the intersections between narrative medicine, neurology, and palliative care. Specific opportunities for bringing narrative medicine into the clinic are discussed.
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Affiliation(s)
- Esme D Trahair
- Department of Neurology (EDT, SM); and Trent Center for Bioethics, Humanities, and History of Medicine (EDT, SM), Duke University School of Medicine, Durham, NC
| | - Sneha Mantri
- Department of Neurology (EDT, SM); and Trent Center for Bioethics, Humanities, and History of Medicine (EDT, SM), Duke University School of Medicine, Durham, NC
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Lewis MM, Van Scoy LJ, De Jesus S, Hakun JG, Eslinger PJ, Fernandez-Mendoza J, Kong L, Yang Y, Snyder BL, Loktionova N, Duvvuri S, Gray DL, Huang X, Mailman RB. Dopamine D 1 Agonists: First Potential Treatment for Late-Stage Parkinson's Disease. Biomolecules 2023; 13:biom13050829. [PMID: 37238699 DOI: 10.3390/biom13050829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 03/17/2023] [Accepted: 05/08/2023] [Indexed: 05/28/2023] Open
Abstract
Current pharmacotherapy has limited efficacy and/or intolerable side effects in late-stage Parkinson's disease (LsPD) patients whose daily life depends primarily on caregivers and palliative care. Clinical metrics inadequately gauge efficacy in LsPD patients. We explored if a D1/5 dopamine agonist would have efficacy in LsPD using a double-blind placebo-controlled crossover phase Ia/b study comparing the D1/5 agonist PF-06412562 to levodopa/carbidopa in six LsPD patients. Caregiver assessment was the primary efficacy measure because caregivers were with patients throughout the study, and standard clinical metrics inadequately gauge efficacy in LsPD. Assessments included standard quantitative scales of motor function (MDS-UPDRS-III), alertness (Glasgow Coma and Stanford Sleepiness Scales), and cognition (Severe Impairment and Frontal Assessment Batteries) at baseline (Day 1) and thrice daily during drug testing (Days 2-3). Clinicians and caregivers completed the clinical impression of change questionnaires, and caregivers participated in a qualitative exit interview. Blinded triangulation of quantitative and qualitative data was used to integrate findings. Neither traditional scales nor clinician impression of change detected consistent differences between treatments in the five participants who completed the study. Conversely, the overall caregiver data strongly favored PF-06412562 over levodopa in four of five patients. The most meaningful improvements converged on motor, alertness, and functional engagement. These data suggest for the first time that there can be useful pharmacological intervention in LsPD patients using D1/5 agonists and also that caregiver perspectives with mixed method analyses may overcome limitations using methods common in early-stage patients. The results encourage future clinical studies and understanding of the most efficacious signaling properties of a D1 agonist for this population.
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Affiliation(s)
- Mechelle M Lewis
- Department of Neurology, Pennsylvania State University College of Medicine, Hershey, PA 17033, USA
- Department of Pharmacology, Pennsylvania State University College of Medicine, Hershey, PA 17033, USA
- Translational Brain Research Center, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, PA 17033, USA
| | - Lauren J Van Scoy
- Translational Brain Research Center, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, PA 17033, USA
- Department of Medicine, Pennsylvania State University College of Medicine, Hershey, PA 17033, USA
- Department of Humanities, Pennsylvania State University College of Medicine, Hershey, PA 17033, USA
| | - Sol De Jesus
- Department of Neurology, Pennsylvania State University College of Medicine, Hershey, PA 17033, USA
| | - Jonathan G Hakun
- Department of Neurology, Pennsylvania State University College of Medicine, Hershey, PA 17033, USA
| | - Paul J Eslinger
- Department of Neurology, Pennsylvania State University College of Medicine, Hershey, PA 17033, USA
- Department of Medicine, Pennsylvania State University College of Medicine, Hershey, PA 17033, USA
- Department of Radiology, Pennsylvania State University College of Medicine, Hershey, PA 17033, USA
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA 17033, USA
| | - Julio Fernandez-Mendoza
- Department of Neurology, Pennsylvania State University College of Medicine, Hershey, PA 17033, USA
- Department of Psychiatry, Pennsylvania State University College of Medicine, Hershey, PA 17033, USA
| | - Lan Kong
- Translational Brain Research Center, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, PA 17033, USA
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA 17033, USA
| | - Yang Yang
- Department of Neurology, Pennsylvania State University College of Medicine, Hershey, PA 17033, USA
- Translational Brain Research Center, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, PA 17033, USA
| | - Bethany L Snyder
- Department of Neurology, Pennsylvania State University College of Medicine, Hershey, PA 17033, USA
- Translational Brain Research Center, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, PA 17033, USA
| | - Natalia Loktionova
- Department of Pharmacology, Pennsylvania State University College of Medicine, Hershey, PA 17033, USA
| | | | - David L Gray
- Cerevel Neurosciences LLC, Cambridge, MA 02141, USA
| | - Xuemei Huang
- Department of Neurology, Pennsylvania State University College of Medicine, Hershey, PA 17033, USA
- Department of Pharmacology, Pennsylvania State University College of Medicine, Hershey, PA 17033, USA
- Translational Brain Research Center, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, PA 17033, USA
- Department of Radiology, Pennsylvania State University College of Medicine, Hershey, PA 17033, USA
- Department of Kinesiology, Pennsylvania State University, University Park, PA 16802, USA
- Department of Neurosurgery, Pennsylvania State University College of Medicine, Hershey, PA 17033, USA
| | - Richard B Mailman
- Department of Neurology, Pennsylvania State University College of Medicine, Hershey, PA 17033, USA
- Department of Pharmacology, Pennsylvania State University College of Medicine, Hershey, PA 17033, USA
- Translational Brain Research Center, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, PA 17033, USA
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Zeng Y, Huang J, Tang X, Wang T, Chen S. The Impact of Triangle Hierarchical Management on Self-Management Behavior and Quality of Survival in Parkinson's Patients. Front Surg 2022; 9:878477. [PMID: 35495769 PMCID: PMC9051069 DOI: 10.3389/fsurg.2022.878477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 03/17/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveTo investigate the effect of Triangle tiered and graded management on the self-management behavior and quality of survival of Parkinson's Disease (PD) patients.MethodsEighty ambulatory PD patients admitted to the neurology outpatient clinic of our hospital from June 2020 to January 2021 were selected for the study. Eighty patients were divided into 40 cases each in the test group and the control group using the random number table method. Patients in the control group were given conventional treatment and care, while in the test group, Triangle hierarchical management was applied on the basis of the control group. Non-motor symptoms [assessed by the Montreal Cognitive Inventory (MoCA), the Scale for Outcomes in PD for Autonomic Symptoms disability Scale (SCOPA-DS) and the Nocturnal Scale (SCOPA-NS)], motor symptoms [assessed by the Functional Gait Assessment (FGA), the Modified Ashworth Scale, and the Unified Parkinson's Disease Rating Scale (UPDRS-III)], quality of life (assessed by Barthel Index), medication adherence (self-administered medication adherence questionnaire), quality of survival (assessed by the 39-item Parkinson's Disease Quality of Survival Questionnaire, PDQ-39), and self-management effectiveness (assessed by the Chronic Disease Self-Efficacy Scale, symptom management and disease co-management) were compared between the two groups before and after the intervention. The two groups were also observed for satisfaction with care.ResultsAfter the intervention, the MoCA score, FGA score, Barthel Index, Medication adherence and all scores of self-management effectiveness were significantly higher in the test group than in the control group (P < 0.05); the SCOPA-DS score, SCOPA-NS score, Ashworth score, UPDRS-III score and PDQ-39 score were significantly lower than in the control group (P < 0.05). Satisfaction with nursing care was significantly higher in the test group than in the control group (P < 0.05).ConclusionThe application of Triangle's tiered and graded management to the home care of ambulatory PD patients was effective in improving their non-motor and motor symptoms, their ability to perform daily activities, medication adherence and self-management effectiveness, and their overall survival outcome.
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Affiliation(s)
- Yahua Zeng
- The First Affiliated Hospital, Department of Rehabilitation, Hengyang Medical School, University of South China, Hengyang, China
| | - Jianghua Huang
- The First Affiliated Hospital, Department of Rehabilitation, Hengyang Medical School, University of South China, Hengyang, China
| | - Xuan Tang
- The First Affiliated Hospital, Department of Rehabilitation, Hengyang Medical School, University of South China, Hengyang, China
| | - Ting Wang
- The First Affiliated Hospital, Department of Neurology, Hengyang Medical School, University of South China, Hengyang, China
| | - Shuangqin Chen
- The First Affiliated Hospital, Department of Neurology, Hengyang Medical School, University of South China, Hengyang, China
- *Correspondence: Shuangqin Chen
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11
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Kluger BM, Miyasaki JM. Key concepts and opportunities. HANDBOOK OF CLINICAL NEUROLOGY 2022; 190:3-15. [PMID: 36055718 DOI: 10.1016/b978-0-323-85029-2.00014-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Neuropalliative care is an emerging field dedicated to applying palliative care approaches to meet the needs of persons living with neurologic illness and their families. The development of this field acknowledges the unique needs of this population, including in terms of neuropsychiatric symptoms, the impact of neurologic illness on personhood, and the logistics of managing neurologic disability. In defining the goals of this field, it is important to distinguish between neuropalliative care as an approach to care, as a skillset, as a medical subspecialty, and as a public health goal as each of these constructs offers their own contributions and opportunities. As a newly emerging field, there are nearly unlimited opportunities to improve care through research, clinical care, education, and advocacy.
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Affiliation(s)
- Benzi M Kluger
- Department of Neurology, University of Rochester, Rochester, NY, United States
| | - Janis M Miyasaki
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada.
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12
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Zwicker J, Qureshi D, Talarico R, Webber C, Watt C, Kim W, Milani C, Ramanathan U, Mestre T, Tanuseputro P. Dying with Parkinson's Disease: Healthcare Utilization and Costs in the Last Year of Life. JOURNAL OF PARKINSON'S DISEASE 2022; 12:2249-2259. [PMID: 36120791 DOI: 10.3233/jpd-223429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND The end-of-life period is associated with disproportionately higher health care utilization and cost at the population level but there is little data in Parkinson's disease (PD). OBJECTIVE The goals of this study were to 1) compare health care use and associated cost in the last year of life between decedents with and without PD, and 2) identify factors associated with palliative care consultation and death in hospital. METHODS Using linked administrative datasets held at ICES, we conducted a retrospective, population-based cohort study of all Ontario, Canada decedents from 2015 to 2017. We examined demographic data, rate of utilization across healthcare sectors, and cost of health care services in the last year of life. RESULTS We identified 291,276 decedents of whom 12,440 (4.3%) had a diagnosis of PD. Compared to decedents without PD, decedents with PD were more likely to be admitted to long-term care (52% vs. 23%, p < 0.001) and received more home care (69.0 vs. 41.8 days, p < 0.001). Receipt of palliative homecare or physician palliative home consultation were associated with lower odds of dying in hospital (OR: 0.24, 95% CI: 0.19- 0.30, and OR: 0.38, 95% CI: 0.33- 0.43, respectively). Mean cost of care in the last year of life was greater for decedents with PD ($68,391 vs. $59,244, p < 0.001). CONCLUSION Compared to individuals without PD, individuals with PD have higher rates of long-term care, home care and higher health care costs in the last year of life. Palliative care is associated with a lower rate of hospital death.
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Affiliation(s)
- Jocelyn Zwicker
- The Ottawa Hospital, Division of Neurology, Ottawa, ON, Canada
- The University of Ottawa, Ottawa, ON, Canada
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Danial Qureshi
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- Bruyère Research Institute, Ottawa, ON, Canada
| | | | - Colleen Webber
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada
- ICES, Ottawa, ON, Canada
- Bruyère Research Institute, Ottawa, ON, Canada
| | - Christine Watt
- The Ottawa Hospital, Division of Palliative Care, Ottawa, ON, Canada
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Elisabeth Bruyère Hospital, Ottawa, ON, Canada
| | - WooJin Kim
- The Ottawa Hospital, Division of Neurology, Ottawa, ON, Canada
- The University of Ottawa, Ottawa, ON, Canada
| | | | - Usha Ramanathan
- Scarborough Health Network, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - Tiago Mestre
- The Ottawa Hospital, Division of Neurology, Ottawa, ON, Canada
- The University of Ottawa, Ottawa, ON, Canada
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada
- University of Ottawa Mind and Brain Institute, Ottawa, ON, Canada
| | - Peter Tanuseputro
- The Ottawa Hospital, Division of Palliative Care, Ottawa, ON, Canada
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada
- ICES, Ottawa, ON, Canada
- Bruyère Research Institute, Ottawa, ON, Canada
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13
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Álvarez Saúco M, García- Ramos R, Legarda Ramírez I, Carrillo García F, Fernández Bueno J, Martí Martínez S, González García B, Moya-Martínez A, Santos-García D. Manejo de la atención paliativa de los pacientes con enfermedad de Parkinson y otros trastornos del movimiento en España. Encuesta Nacional a neurólogos. Neurologia 2021. [DOI: 10.1016/j.nrl.2021.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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14
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Meinders MJ, Gentile G, Schrag AE, Konitsiotis S, Eggers C, Taba P, Lorenzl S, Odin P, Rosqvist K, Chaudhuri KR, Antonini A, Bloem BR, Groot MM. Advance Care Planning and Care Coordination for People With Parkinson's Disease and Their Family Caregivers-Study Protocol for a Multicentre, Randomized Controlled Trial. Front Neurol 2021; 12:673893. [PMID: 34434156 PMCID: PMC8382049 DOI: 10.3389/fneur.2021.673893] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 06/30/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Parkinson's disease (PD) is a progressive neurodegenerative disease with motor- and non-motor symptoms. When the disease progresses, symptom burden increases. Consequently, additional care demands develop, the complexity of treatment increases, and the patient's quality of life is progressively threatened. To address these challenges, there is growing awareness of the potential benefits of palliative care for people with PD. This includes communication about end-of-life issues, such as Advance Care Planning (ACP), which helps to elicit patient's needs and preferences on issues related to future treatment and care. In this study, we will assess the impact and feasibility of a nurse-led palliative care intervention for people with PD across diverse European care settings. Methods: The intervention will be evaluated in a multicentre, open-label randomized controlled trial, with a parallel group design in seven European countries (Austria, Estonia, Germany, Greece, Italy, Sweden and United Kingdom). The “PD_Pal intervention” comprises (1) several consultations with a trained nurse who will perform ACP conversations and support care coordination and (2) use of a patient-directed “Parkinson Support Plan-workbook”. The primary endpoint is defined as the percentage of participants with documented ACP-decisions assessed at 6 months after baseline (t1). Secondary endpoints include patients' and family caregivers' quality of life, perceived care coordination, patients' symptom burden, and cost-effectiveness. In parallel, we will perform a process evaluation, to understand the feasibility of the intervention. Assessments are scheduled at baseline (t0), 6 months (t1), and 12 months (t2). Statistical analysis will be performed by means of Mantel–Haenszel methods and multilevel logistic regression models, correcting for multiple testing. Discussion: This study will contribute to the current knowledge gap on the application of palliative care interventions for people with Parkinson's disease aimed at ameliorating quality of life and managing end-of-life perspectives. Studying the impact and feasibility of the intervention in seven European countries, each with their own cultural and organisational characteristics, will allow us to create a broad perspective on palliative care interventions for people with Parkinson's disease across settings. Clinical Trial Registration:www.trialregister.nl, NL8180.
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Affiliation(s)
- Marjan J Meinders
- Scientific Center for Quality of Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands.,Department of Neurology, Center of Expertise for Parkinson and Movement Disorders, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, Netherlands
| | | | - Anette E Schrag
- Department of Clinical and Movement Neurosciences, UCL Institute of Neurology, University College London, London, United Kingdom
| | - Spiros Konitsiotis
- Department of Neurology, Medical School, University of Ioannina, Ioannina, Greece
| | - Carsten Eggers
- Department of Neurology, Philipps University Marburg, Marburg, Germany.,Knappschaftskrankenhaus Bottrop GmbH, Department of Neurology, Bottrop, Germany
| | - Pille Taba
- Department of Neurology and Neurosurgery, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia.,Neurology Clinic, Tartu University Hospital, Tartu, Estonia
| | - Stefan Lorenzl
- Institute of Nursing Science and Practice, Paracelsus Medical University, Salzburg, Austria.,Department of Neurology and Department of Palliative Care, Ludwig-Maximilians-University, Munich, Germany.,Department of Neurology, Klinikum Agatharied, Hausham, Germany
| | - Per Odin
- Division of Neurology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Kristina Rosqvist
- Division of Neurology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - K Ray Chaudhuri
- Department of Basic and Clinical Neuroscience, Parkinson's Foundation Centre of Excellence, King's College London, London, United Kingdom
| | - Angelo Antonini
- Department of Neuroscience, University of Padua, Padua, Italy
| | - Bastiaan R Bloem
- Department of Neurology, Center of Expertise for Parkinson and Movement Disorders, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, Netherlands
| | - Marieke M Groot
- Department of Anesthesiology, Pain and Palliative Care, Radboud University Medical Center, Nijmegen, Netherlands
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