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Linse K, Weber C, Reilich P, Schöberl F, Boentert M, Petri S, Rödiger A, Posa A, Otto M, Wolf J, Zeller D, Brunkhorst R, Koch J, Hermann A, Großkreutz J, Schröter C, Groß M, Lingor P, Machetanz G, Semmler L, Dorst J, Lulé D, Ludolph A, Meyer T, Maier A, Metelmann M, Regensburger M, Winkler J, Schrank B, Kohl Z, Hagenacker T, Brakemeier S, Weyen U, Weiler M, Lorenzl S, Bublitz S, Weydt P, Grehl T, Kotterba S, Lapp HS, Freigang M, Vidovic M, Aust E, Günther R. Patients' and caregivers' perception of multidimensional and palliative care in amyotrophic lateral sclerosis - protocol of a German multicentre study. Neurol Res Pract 2024; 6:34. [PMID: 38961496 PMCID: PMC11223310 DOI: 10.1186/s42466-024-00328-1] [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: 04/25/2024] [Accepted: 05/22/2024] [Indexed: 07/05/2024] Open
Abstract
INTRODUCTION Amyotrophic lateral sclerosis (ALS) is an inevitably fatal condition that leads to a progressive loss of physical functioning, which results in a high psychosocial burden and organizational challenges related to medical care. Multidimensional and multiprofessional care is advised to meet the complex needs of patients and their families. Many healthcare systems, including Germany, may not be able to meet these needs because non-medical services such as psychological support or social counselling are not regularly included in the care of patients with ALS (pwALS). Specialised neuropalliative care is not routinely implemented nor widely available. Caregivers of pwALS are also highly burdened, but there is still a lack of support services for them. METHODS This project aims to assess the perceptions and satisfaction with ALS care in Germany in pwALS and their caregivers. This will be achieved by means of a cross-sectional, multicentre survey. The examination will assess, to which extend the patients' needs in the six domains of physical, psychological, social, spiritual, practical and informational are being met by current care structures. This assessment will be linked to mental well-being, subjective quality of life, attitudes toward life-sustaining measures and physician-assisted suicide, and caregiver burden. The study aims to recruit 500 participants from nationwide ALS centres in order to draw comprehensive conclusions for Germany. A total of 29 centres, mostly acquired via the clinical and scientific German Network for Motor Neuron Diseases (MND-NET), will take part in the project, 25 of which have already started recruitment. PERSPECTIVE It is intended to provide data-based starting points on how current practice of care in Germany is perceived pwALS and their caregivers and how it can be improved according to their needs. Planning and initiation of the study has been completed. TRIAL REGISTRATION The study is registered at ClinicalTrails.gov; NCT06418646.
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Affiliation(s)
- Katharina Linse
- University Hospital Carl Gustav Carus at Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany.
- German Center for Neurodegenerative Diseases Dresden, Tatzberg 41, 01307, Dresden, Germany.
| | - Constanze Weber
- University Hospital Carl Gustav Carus at Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Peter Reilich
- Department of Neurology with Friedrich-Baur-Institute, University Hospital, Ludwig-Maximilians-University (LMU), Marchioninistrasse 15, 81377, Munich, München, Germany
| | - Florian Schöberl
- Department of Neurology with Friedrich-Baur-Institute, University Hospital, Ludwig-Maximilians-University (LMU), Marchioninistrasse 15, 81377, Munich, München, Germany
| | - Matthias Boentert
- University Hospital Münster (UKM), Albert-Schweitzer-Campus 1, 48149, Münster, Germany
- Department of Medicine, UKM-Marienhospital Steinfurt, Mauritiusstr. 5, 48565, Steinfurt, Germany
| | - Susanne Petri
- Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany
| | | | - Andreas Posa
- University Hospital Halle, Ernst-Grube-Strasse 40, 06120, Halle (Saale), Germany
| | - Markus Otto
- University Hospital Halle, Ernst-Grube-Strasse 40, 06120, Halle (Saale), Germany
| | - Joachim Wolf
- Deaconess Hospital Mannheim, Speyerer Strasse 91-93, 68163, Mannheim, Germany
| | - Daniel Zeller
- University Hospital Würzburg, Josef-Schneider-Strasse 11, 97080, Würzburg, Germany
| | - Robert Brunkhorst
- University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Jan Koch
- University Medical Center Göttingen, Robert-Koch-Strasse 40, 37075, Göttingen, Germany
| | - Andreas Hermann
- University Medical Center Rostock, Translational Neurodegeneration Section "Albrecht Kossel", Gehlsheimer Strasse 20, 18147, Rostock, Germany
- German Center for Neurodegenerative Diseases Rostock/Greifswald, Gehlsheimer Strasse 20, 18147, Rostock, Germany
| | | | - Carsten Schröter
- Hospital Hoher Meißner, Hardtstrasse 36, 37242, Bad Sooden-Allendorf, Germany
| | - Martin Groß
- Evangelic Hospital Oldenburg, Steinweg 13-17, 26122, Oldenburg, Germany
| | - Paul Lingor
- Klinikum rechts der Isar, TUM School of Medicine and Health, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
- German Center for Neurodegenerative Diseases Munich, Feodor-Lynen-Strasse 17, 81377, Munich, Germany
| | - Gerrit Machetanz
- Klinikum rechts der Isar, TUM School of Medicine and Health, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Luisa Semmler
- Klinikum rechts der Isar, TUM School of Medicine and Health, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Johannes Dorst
- University Hospital Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Dorothée Lulé
- University Hospital Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Albert Ludolph
- University Hospital Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Thomas Meyer
- Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - André Maier
- Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Moritz Metelmann
- University Hospital Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany
| | | | - Jürgen Winkler
- University Hospital Erlangen, Schwabachanlage 6, 91054, Erlangen, Germany
| | - Berthold Schrank
- DKD Helios Clinic Wiesbaden, Aukammallee 33, 65191, Wiesbaden, Germany
| | - Zacharias Kohl
- University Hospital Regensburg, Universitätsstrasse 84, 93053, Regensburg, Germany
| | - Tim Hagenacker
- Department of Neurology, Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Svenja Brakemeier
- Department of Neurology, Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Ute Weyen
- BG University Hospital Bochum, Bürkle de la Camp-Platz 1, 44789, Bochum, Germany
| | - Markus Weiler
- Department of Neurology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Stefan Lorenzl
- Hospital Agatharied, Norbert-Kerkel-Platz, 83734, Hausham, Germany
- Institute of Palliative Care and Institute of Nursing Science, Paracelsus Medical University, Salzburg, Austria
- Department of Palliative Medicine, University Hospital, Ludwig-Maximilians-University (LMU), Marchioninistrasse 15, 81377, Munich, München, Germany
| | - Sarah Bublitz
- Hospital Agatharied, Norbert-Kerkel-Platz, 83734, Hausham, Germany
- Institute of Palliative Care and Institute of Nursing Science, Paracelsus Medical University, Salzburg, Austria
| | - Patrick Weydt
- University Hospital Bonn, Venusberg Campus 1, 53127, Bonn, Germany
| | - Torsten Grehl
- Alfried-Krupp-Hospital Essen, Alfried-Krupp-Strasse 21, 45131, Essen, Germany
| | | | - Hanna-Sophie Lapp
- University Hospital Carl Gustav Carus at Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Maren Freigang
- University Hospital Carl Gustav Carus at Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Maximilian Vidovic
- University Hospital Carl Gustav Carus at Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Elisa Aust
- University Hospital Carl Gustav Carus at Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - René Günther
- University Hospital Carl Gustav Carus at Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany.
- German Center for Neurodegenerative Diseases Dresden, Tatzberg 41, 01307, Dresden, Germany.
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Watt CL, Smith IC, Rice J, Murphy R, Breiner A, Duff MLV, Nogo D, Bush SH, McNeely S, Buenger U, Zehrt B, Zwicker J. Qualitative Analysis of Initial Palliative Care Consultations in Amyotrophic Lateral Sclerosis. J Pain Symptom Manage 2024; 68:43-52.e2. [PMID: 38574876 DOI: 10.1016/j.jpainsymman.2024.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 02/27/2024] [Accepted: 03/25/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND Palliative care (PC) benefits patients with amyotrophic lateral sclerosis (ALS), however the needs of patients and caregivers and the optimal timing of PC discussions remains unclear. This study reports the analysis of PC consult notes from a larger feasibility trial. The specific aims of this analysis were to i) identify the PC needs of patients with ALS via qualitative analysis and ii) identify characteristics of patients and caregivers that could predict specific PC needs. METHODS This study was nested within a nonrandomized, prospective study of patients with ALS (and their caregivers) being treated at a multidisciplinary ALS clinic. Exclusion criteria of the main study were age <18 years, inability to complete questionnaires, and prior receipt of PC. All patients were offered a PC consultation (PCC); those who accepted were included in this nested study. Consultation notes were reviewed and thematic and content analyses were conducted. The occurrence of themes across patient and caregiver contextual variables were examined. RESULTS Thirty-two PCCs were completed between October 2020 and April 2022. Six major themes were identified: PC roles (with subthemes encompassing the spectrum of specialist PC practice including symptom management and advance care planning), engagement with PC, patients' concerns for their caregivers, caregiver-specific concerns, finances, and COVID-19. An average of 12 topics were discussed per PCC (range = 3-22). Discussion of advance care planning, care coordination, and symptom management was common, and these topics were not discussed more frequently in PCCs with patients with lower functional status, more bulbar symptoms, or lower quality of life. Time from diagnosis did not impact topics of discussion. Patients reporting more symptoms of depression more frequently required psychological support, particularly regarding loss of independence, employment, and leisure activities. DISCUSSION Patients with ALS and their caregivers have a wide range of PC needs. These needs vary irrespective of time from diagnosis, functional status, or quality of life, therefore PCC is recommended for all patients with ALS. PCC should be individualized based on patient and caregiver preferences. TRIAL REGISTRATION INFORMATION The study was registered with ClinicalTrials.gov (NCT04257760; https://clinicaltrials.gov/ct2/show/NCT04257760) on February 6, 2020. The first enrollment occurred on October 20, 2020.
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Affiliation(s)
- Christine L Watt
- Department of Medicine, Division of Palliative Care (C.L.W., J.R., R.M., S.H.B.), University of Ottawa, 451 Smyth Road, Ottawa, Ontario K1H 8M5, Canada; The Ottawa Hospital (C.L.W., J.R., R.M., A.B., S.M., B.Z., J.Z.), 501 Smyth Rd, Ottawa, Ontario K1H 8L6, Canada; Bruyère Continuing Care (C.L.W., J.R., R.M., S.H.B.), 60 Cambridge St. N., Ottawa, Ontario K1R 7A5, Canada; Bruyère Research Institute (C.L.W., J.R., S.H.B.), 43 Bruyère St., Ottawa, Ontario K1N 5C8, Canada; Ottawa Hospital Research Institute (C.L.W., I.C.S., J.R., A.B., M.D., D.N., S.H.B., J.Z.), 1053 Carling Ave, Ottawa, Ontario K1Y 4E9, Canada.
| | - Ian C Smith
- Ottawa Hospital Research Institute (C.L.W., I.C.S., J.R., A.B., M.D., D.N., S.H.B., J.Z.), 1053 Carling Ave, Ottawa, Ontario K1Y 4E9, Canada
| | - Jill Rice
- Department of Medicine, Division of Palliative Care (C.L.W., J.R., R.M., S.H.B.), University of Ottawa, 451 Smyth Road, Ottawa, Ontario K1H 8M5, Canada; The Ottawa Hospital (C.L.W., J.R., R.M., A.B., S.M., B.Z., J.Z.), 501 Smyth Rd, Ottawa, Ontario K1H 8L6, Canada; Bruyère Continuing Care (C.L.W., J.R., R.M., S.H.B.), 60 Cambridge St. N., Ottawa, Ontario K1R 7A5, Canada; Bruyère Research Institute (C.L.W., J.R., S.H.B.), 43 Bruyère St., Ottawa, Ontario K1N 5C8, Canada; Ottawa Hospital Research Institute (C.L.W., I.C.S., J.R., A.B., M.D., D.N., S.H.B., J.Z.), 1053 Carling Ave, Ottawa, Ontario K1Y 4E9, Canada
| | - Rebekah Murphy
- Department of Medicine, Division of Palliative Care (C.L.W., J.R., R.M., S.H.B.), University of Ottawa, 451 Smyth Road, Ottawa, Ontario K1H 8M5, Canada; The Ottawa Hospital (C.L.W., J.R., R.M., A.B., S.M., B.Z., J.Z.), 501 Smyth Rd, Ottawa, Ontario K1H 8L6, Canada; Bruyère Continuing Care (C.L.W., J.R., R.M., S.H.B.), 60 Cambridge St. N., Ottawa, Ontario K1R 7A5, Canada; Queensway Carleton Hospital (R.M.), 3045 Baseline Road, Ottawa, Ontario K2H 8P4, Canada
| | - Ari Breiner
- The Ottawa Hospital (C.L.W., J.R., R.M., A.B., S.M., B.Z., J.Z.), 501 Smyth Rd, Ottawa, Ontario K1H 8L6, Canada; Ottawa Hospital Research Institute (C.L.W., I.C.S., J.R., A.B., M.D., D.N., S.H.B., J.Z.), 1053 Carling Ave, Ottawa, Ontario K1Y 4E9, Canada; Department of Medicine (A.B.), Department of Neurology, University of Ottawa, 451 Smyth Road, Ottawa, Ontario K1H 8M5, Canada
| | - Maria L V Duff
- Ottawa Hospital Research Institute (C.L.W., I.C.S., J.R., A.B., M.D., D.N., S.H.B., J.Z.), 1053 Carling Ave, Ottawa, Ontario K1Y 4E9, Canada
| | - Danica Nogo
- Ottawa Hospital Research Institute (C.L.W., I.C.S., J.R., A.B., M.D., D.N., S.H.B., J.Z.), 1053 Carling Ave, Ottawa, Ontario K1Y 4E9, Canada
| | - Shirley H Bush
- Department of Medicine, Division of Palliative Care (C.L.W., J.R., R.M., S.H.B.), University of Ottawa, 451 Smyth Road, Ottawa, Ontario K1H 8M5, Canada; Bruyère Continuing Care (C.L.W., J.R., R.M., S.H.B.), 60 Cambridge St. N., Ottawa, Ontario K1R 7A5, Canada; Bruyère Research Institute (C.L.W., J.R., S.H.B.), 43 Bruyère St., Ottawa, Ontario K1N 5C8, Canada; Ottawa Hospital Research Institute (C.L.W., I.C.S., J.R., A.B., M.D., D.N., S.H.B., J.Z.), 1053 Carling Ave, Ottawa, Ontario K1Y 4E9, Canada
| | - Susan McNeely
- The Ottawa Hospital (C.L.W., J.R., R.M., A.B., S.M., B.Z., J.Z.), 501 Smyth Rd, Ottawa, Ontario K1H 8L6, Canada
| | - Usha Buenger
- Faculty of Medicine (U.B.), Division of Physical Medicine and Rehabilitation, The Ottawa Hospital Rehabilitation Centre 505 Smyth Road, Ottawa, Ontario K1H 8M2, Canada
| | - Belinda Zehrt
- The Ottawa Hospital (C.L.W., J.R., R.M., A.B., S.M., B.Z., J.Z.), 501 Smyth Rd, Ottawa, Ontario K1H 8L6, Canada
| | - Jocelyn Zwicker
- The Ottawa Hospital (C.L.W., J.R., R.M., A.B., S.M., B.Z., J.Z.), 501 Smyth Rd, Ottawa, Ontario K1H 8L6, Canada; Ottawa Hospital Research Institute (C.L.W., I.C.S., J.R., A.B., M.D., D.N., S.H.B., J.Z.), 1053 Carling Ave, Ottawa, Ontario K1Y 4E9, Canada; Department of Medicine (A.B.), Department of Neurology, University of Ottawa, 451 Smyth Road, Ottawa, Ontario K1H 8M5, Canada
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Mehta AK, Sarmet M, Maiser S, Meyer JA, Kolodziejczak S, Washington K, Simmons Z. Quality-of-life assessment instruments used across ALS clinics. Muscle Nerve 2023; 68:865-872. [PMID: 37823580 DOI: 10.1002/mus.27985] [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: 06/09/2023] [Revised: 09/23/2023] [Accepted: 09/27/2023] [Indexed: 10/13/2023]
Abstract
INTRODUCTION/AIMS Instruments have been developed to assess quality of life (QoL) among people with amyotrophic lateral sclerosis (ALS). It is unclear whether these are utilized regularly in the clinical setting to guide individual patient care. In this study we aimed to understand the current use of instruments and existing barriers to assessing QoL in clinical ALS care. METHODS An anonymous survey developed by Northeast ALS (NEALS) Consortium Palliative Committee members was distributed to all multidisciplinary NEALS members. Data were summarized via calculation of descriptive statistics. ALS Center characteristics were compared using chi-square and Fisher exact tests for categorical variables. RESULTS Seventy-three (6.4%) of the 1132 NEALS members responded to the survey, representing 148 clinics, 49.3% of whom reported assessing QoL during clinic visits. The most used ALS-specific instruments were the ALS Assessment Questionnaire (19.4%) and Amyotrophic Lateral Sclerosis Specific Quality of Life scale (16.6%). Barriers reported were uncertainty regarding which instrument to use and length of visits. QoL assessment was not significantly correlated with length of clinic visit but with access to specialty palliative care. DISCUSSION QoL assessments are performed by some, but not all, ALS centers during clinical visits. Although this study did have a low number of responding centers, the percentage, the proportion is similar to that seen in earlier studies, which limits the findings' generalizability. The value of QoL assessments' impact on outcomes should be further investigated and, if warranted, creative ways sought to increase the frequency of their use, including patient self-assessments before clinic and/or the use of teleheath to reduce the length of clinic visits.
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Affiliation(s)
- Ambereen K Mehta
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Max Sarmet
- Graduate Department of Health Science and Technology, University of Brasília, Brasília, Brazil
| | - Samuel Maiser
- Department of Neurology, Hennepin Healthcare, Minneapolis, Minnesota, USA
| | - Jenny A Meyer
- Department of Neurology, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Sherry Kolodziejczak
- ALS Care Clinic/Cardiac Pulmonary Rehab/Therapy Services/Worker's Program, Crestwood Medical Center, Huntsville, Alabama, USA
| | - Karla Washington
- Department of Medicine, School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Zachary Simmons
- Department of Neurology, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
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Mercadante S, Al-Husinat L. Palliative Care in Amyotrophic Lateral Sclerosis. J Pain Symptom Manage 2023; 66:e485-e499. [PMID: 37380145 DOI: 10.1016/j.jpainsymman.2023.06.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 05/25/2023] [Accepted: 06/21/2023] [Indexed: 06/30/2023]
Abstract
Amyotrophic lateral sclerosis (ALS) is an incurable neurodegenerative disease of the motor neurons. Given the evolutive characteristics of this disease, palliative care principles should be a foundation of ALS care. A multidisciplinary medical intervention is of paramount importance in the different phases of disease. The involvement of the palliative care team improves quality of life and symptoms, and prognosis. Early initiation is of paramount importance to ensuring patient-centered care, when the patient has still the capability to communicate effectively and participate in his medical care. Advance care planning supports patients and family members in understanding and sharing their preferences according to their personal values and life goals regarding future medical treatment. The principal problems which require intensive supportive care include cognitive disturbances, psychological distress, pain, sialorrhrea, nutrition, and ventilatory support. Communication skills of health-care professionals are mandatory to manage the inevitability of death. Palliative sedation has peculiar aspects in this population, particularly with the decision of withdrawing ventilatory support.
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Affiliation(s)
- Sebastiano Mercadante
- Main Regional Center of Pain Relief and Supportive/Palliative Care (S.M.), La Maddalena Cancer Center, Palermo, Italy; Regional Home Care Program, SAMOT (S.M.), Palermo, Italy.
| | - Lou'i Al-Husinat
- Department of Clinical Medical Sciences (L.A.H.), Yarmouk University, Irbid, Jordan
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Zwicker J, Smith IC, Rice J, Murphy R, Breiner A, McNeely S, Duff M, Buenger U, Zehrt B, Nogo D, Watt CL. Palliative care at any stage of amyotrophic lateral sclerosis: a prospective feasibility study. Front Med (Lausanne) 2023; 10:1204816. [PMID: 37780560 PMCID: PMC10533918 DOI: 10.3389/fmed.2023.1204816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 08/23/2023] [Indexed: 10/03/2023] Open
Abstract
Introduction Many patients with amyotrophic lateral sclerosis (ALS) receive palliative care (PC) very late or not at all. The impact of PC on patients with ALS and caregivers has not been quantified. Study goals included (1) measuring the impact of early PC on quality of life and mood of patients/caregivers and (2) describing patient/caregiver satisfaction with PC. Methods The study was a non-randomized, prospective feasibility study of patients with ALS being treated at The Ottawa Hospital ALS Clinic and their caregivers. Exclusion criteria were age < 18 years, inability to complete questionnaires, and prior receipt of PC. The ALS Specific Quality of Life-Revised (ALSSQOL-R) questionnaire (patients only) and Hospital Anxiety and Depression Scale (HADS) were completed at regular intervals for up to 2 years. Patients accepting a PC consultation completed a post-PC satisfaction survey. Primary outcome measures included ALSSQOL-R and HADS scores compared before and after PC consultation, and between groups receiving and not receiving a PC consultation. Secondary outcome measures included responses on the post-PC satisfaction survey (1 = strongly disagree, 5 = strongly agree). Results 39 patients with ALS (age 66 ± 10 years, median time from diagnosis = 6 months) and 22 caregivers were enrolled. 32 patients had a PC consultation (30 were virtual). Patients and caregivers agreed with statements that the PC consult was helpful (mean ± SD = 4.54 ± 0.60, range = 3-5) and they would recommend PC to others with ALS (4.59 ± 0.59, range = 3-5). Participants disagreed with statements that the consult would have been better later in disease course (1.87 ± 0.80, range = 1-4) and that it took too much time/energy (1.44 ± 0.85, range = 1-4). Average ALSSQOL-R scores worsened significantly over time. HADS and ALSSQOL-R scores did not significantly differ between groups receiving and not receiving PC. Conclusion Patients with ALS and their caregivers found virtual PC consultations beneficial irrespective of disease duration or severity. Offering routine PC to all patients with ALS is feasible and should be considered as part of standard care. Clinical trial registration https://clinicaltrials.gov/ct2/show/NCT04257760, identifier NCT04257760.
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Affiliation(s)
- Jocelyn Zwicker
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Department of Medicine, The Ottawa Hospital, Ottawa, ON, Canada
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Ian C. Smith
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Jill Rice
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Department of Medicine, The Ottawa Hospital, Ottawa, ON, Canada
- Bruyère Research Institute, Ottawa, ON, Canada
- Bruyère Continuing Care, Ottawa, ON, Canada
| | - Rebekah Murphy
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Department of Medicine, The Ottawa Hospital, Ottawa, ON, Canada
- Bruyère Continuing Care, Ottawa, ON, Canada
- Queensway Carleton Hospital, Ottawa, ON, Canada
| | - Ari Breiner
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Department of Medicine, The Ottawa Hospital, Ottawa, ON, Canada
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Susan McNeely
- Department of Medicine, The Ottawa Hospital, Ottawa, ON, Canada
| | - Maria Duff
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Usha Buenger
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- The Rehabilitation Centre, Ottawa, ON, Canada
| | - Belinda Zehrt
- Department of Medicine, The Ottawa Hospital, Ottawa, ON, Canada
| | - Danica Nogo
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Christine L. Watt
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Department of Medicine, The Ottawa Hospital, Ottawa, ON, Canada
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Bruyère Research Institute, Ottawa, ON, Canada
- Bruyère Continuing Care, Ottawa, ON, Canada
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Genuis SK, Luth W, Bubela T, Johnston WS. What do people affected by amyotrophic lateral sclerosis want from health communications? Evidence from the ALS Talk Project. Muscle Nerve 2023; 68:286-295. [PMID: 37462337 DOI: 10.1002/mus.27935] [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: 03/28/2023] [Revised: 06/22/2023] [Accepted: 06/23/2023] [Indexed: 08/22/2023]
Abstract
INTRODUCTION/AIMS Health communication is central to effective, supportive amyotrophic lateral sclerosis (ALS) clinical care. Guidance for ALS communication is limited, focuses on diagnosis disclosure, and frequently relies on expert consensus and/or reviews. Patient-based evidence is needed to guide ALS health communication. We investigated how the experiences of ALS patients and family caregivers can inform effective communication practices from diagnosis to end-of-life. METHODS Data were drawn from the ALS Talk Project, an asynchronous, online focus group study. Seven focus groups and five interviews (105 participants) were conducted. Data were qualitatively analyzed using directed content analysis and the constant-comparative approach. RESULTS We found four primary themes: communication content, communication circumstances, information sufficiency, and communication manner. Data indicate participants relied on clinicians for medical information but also wanted practical information; health communication should attend to the circumstances within which conversations occur; information must be sufficient for individual needs, without overwhelming; and an empathetic, direct, and honest manner facilitated trust. Participants identified communication challenges and strategies to improve communication across major themes, including stepwise approaches and conversations tailored to individuals and their heterogeneous disease experiences. DISCUSSION Healthcare professionals should discuss patient/caregiver communication preferences early in the therapeutic relationship, co-develop a communication agreement, and update the agreement in response to changing needs and disease progression. This will foster regular discussion of information needs and promote timely discussions of challenging topics, including advance care, while giving patients and families a sense of control. Findings may have implications for other neuromuscular disease and/or seriously ill populations.
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Affiliation(s)
- Shelagh K Genuis
- Division of Neurology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Westerly Luth
- Division of Neurology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Tania Bubela
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Wendy S Johnston
- Division of Neurology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
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Brizzi K. Outpatient neuropalliative care. HANDBOOK OF CLINICAL NEUROLOGY 2023; 191:29-48. [PMID: 36599513 DOI: 10.1016/b978-0-12-824535-4.00002-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Palliative care is an approach to patient care that focuses on enhancing quality of life through relief of physical, emotional, and spiritual sources of distress and patient-tailored discussions about goals of care. The palliative care approach can be delivered by any provider, and can occur alongside disease-modifying therapies. For patients with a serious neurologic illness or a neurodegenerative disease, neuropalliative care is a growing field focused on providing high-quality palliative care to neurology patients. There are three models of neuropalliative care delivery in the outpatient setting: a consultative model with a palliative care specialist, an integrated model with an embedded palliative care provider, and a primary palliative care model with the patient's neurology provider. The main components of an outpatient palliative care visit include symptom assessment and treatment, communication about serious illness, advance care planning, and assessment of caregiver needs. For patients with advanced illness, palliative care can help facilitate timely referral to hospice. Through a palliative care approach, outpatient care for patients with serious neurologic disease or neurodegenerative disease can focus on the issues most important to the patient, promote improved illness understanding and planning, and can improve the overall quality of care.
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Affiliation(s)
- Kate Brizzi
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States; Department of Medicine, Massachusetts General Hospital, Boston, MA, United States.
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8
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Jensen S, Hafer J, Wiedau-Pazos M, Mehta AK. Longitudinal specialty palliative care for people with amyotrophic lateral sclerosis using a universal referral method. Muscle Nerve 2022; 66:E5-E6. [PMID: 35470443 DOI: 10.1002/mus.27562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 04/11/2022] [Accepted: 04/17/2022] [Indexed: 11/10/2022]
Affiliation(s)
- Sarah Jensen
- David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Julia Hafer
- David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Martina Wiedau-Pazos
- Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Ambereen K Mehta
- Palliative Care Program, Division of Medicine, Johns Hopkins School of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, Maryland, USA.,Division of Medicine, Johns Hopkins School of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, Maryland, USA
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9
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Wang Y, Yang X, Han Q, Liu M, Zhou C. Prevalence of Sialorrhea Among Amyotrophic Lateral Sclerosis Patients: A Systematic Review and Meta-Analysis. J Pain Symptom Manage 2022; 63:e387-e396. [PMID: 34920148 DOI: 10.1016/j.jpainsymman.2021.12.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 12/07/2021] [Accepted: 12/09/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND OBJECTIVES Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative motor neuron disease (MND), and sialorrhea is a known symptom in patients with ALS, which may cause a social embarrassment and discomfort. However, people do not pay attention to sialorrhea up to now. This study is aimed at conducting a systematic review and meta-analysis of the pooled prevalence of sialorrhea in ALS patients all around the world and raising awareness of salivation. METHODS We searched PubMed and EMBASE databases to obtain the comprehensive literatures which reported the prevalence of sialorrhea. We used AHRQ and NOS to evaluate the literature quality. Subgroup analyses were performed based on screening instruments and severity of sialorrhea. At the meantime, sensitivity analyses was also conducted to identify the source of heterogeneity. RESULTS A total of 17 eligible studies which included 21 groups of data reported prevalence of sialorrhea. The pooled prevalence of sialorrhea among ALS patients was 30.8% (95% CI: 20.0%-44.2%). For studies using ALSFRS-R, direct questioning, postal survey, and ALSSoL average and ALSFRS-R, the pooled prevalence of sialorrhea was 22.7%, 25.8%, 29.8% and 52.0% respectively. According to the severity of sialorrhea, the prevalence of mild, moderate, and severe sialorrhea were 25.1%, 11.2%, and 10.5%, respectively. And none of the studies alone had a significant effect on the overall prevalence of sialorrhea after we eliminated each study separately in sensitivity analyses. CONCLUSIONS Sialorrhea is a relatively common symptom in ALS patients with a comparatively high prevalence. In our study, we found that the prevalence of sialorrhea in ALS patients is relatively higher than the results based on direct questioning or postal survey. Therefore, we deduced that sialorrhea should be evaluated by more complex professional assessment scales to improve the quality of life and improve early prognosis of disease.
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Affiliation(s)
- Yao Wang
- Department of Neurology, (Y.W., X.Y., M.L.) The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China.
| | - Xiaoyu Yang
- Department of Neurology, (Y.W., X.Y., M.L.) The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
| | - Qun Han
- Department of Orthopedics, (Q.H.) Xianggong Central Health Center, Linyi, Shandong Province, China
| | - Min Liu
- Department of Neurology, (Y.W., X.Y., M.L.) The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
| | - Chang Zhou
- Department of Neurology, (Y.W., X.Y., M.L.) The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China.
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10
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Erdmann A, Spoden C, Hirschberg I, Neitzke G. Talking about the end of life: communication patterns in amyotrophic lateral sclerosis – a scoping review. Palliat Care Soc Pract 2022; 16:26323524221083676. [PMID: 35309870 PMCID: PMC8928370 DOI: 10.1177/26323524221083676] [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: 09/21/2021] [Accepted: 02/04/2022] [Indexed: 11/26/2022] Open
Abstract
Amyotrophic lateral sclerosis (ALS) leads to death on average 2–4 years after the onset of symptoms. Although many people with the disease decide in favour of life-sustaining measures, some consider hastening death. The objectives of this review are to provide an insight into the following questions: (1) How do people with amyotrophic lateral sclerosis (PALS), their families and health care professionals (HCPs) communicate about life-sustaining and life-shortening options? (2) What are the challenges for all involved in decision making and communication about this topic? To answer these questions, we searched eight databases for publications in English and German on end-of-life issues of PALS. We included texts published between 2008 and 2018, and updated our search to May 2020. Sources were analysed in MAXQDA using deductively and inductively generated codes. After the final analysis, 123 full texts were included in this review. We identified a wide range of communicative challenges and six different and, in part, opposite communication patterns: avoiding or delaying communication on end-of-life issues, openly considering dying and actively seeking assistance, ignoring or disregarding patients’ wishes, discussing and respecting the patients’ wishes, engaging in advance care planning and avoiding or delaying advance care planning. The literature reveals a very heterogeneous response to end-of-life issues in ALS, despite several good-practice suggestions, examples and guidelines. We derive a strong need for harmonization and quality assurance concerning communication with PALS. Avoiding or delaying communication, decision making and planning, as well as ignoring or disregarding the patient’s will by HCP can be judged as a violation of the ethical principles of autonomy and non-maleficence.
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Affiliation(s)
- Anke Erdmann
- Institute for Experimental Medicine, Medical Ethics Working Group, Kiel University, 24105 Kiel, Germany
- Institute for Ethics, History and Philosophy of Medicine, Hannover Medical School, Hannover, Germany
| | - Celia Spoden
- German Institute for Japanese Studies, Tokyo, Japan
- Institute for Ethics, History and Philosophy of Medicine, Hannover Medical School, Hannover, Germany
| | - Irene Hirschberg
- Institute for Ethics, History and Philosophy of Medicine, Hannover Medical School, Hannover, Germany
| | - Gerald Neitzke
- Institute for Ethics, History and Philosophy of Medicine, Hannover Medical School, Hannover, Germany
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11
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McConvey K, Kazazian K, Iansavichene AE, Jenkins ME, Gofton TE. Triggers for Referral to Specialized Palliative Care in Advanced Neurologic and Neurosurgical Conditions: A Systematic Review. Neurol Clin Pract 2022; 12:190-202. [DOI: 10.1212/cpj.0000000000001159] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 01/10/2022] [Indexed: 11/15/2022]
Abstract
AbstractBackground:To systematically review the literature for the most suitable trigger criteria for referral to specialist palliative care services in life-limiting and life-threatening neurologic and neurosurgical conditions.Methods:Literature searches were conducted in Ovid MEDLINE and EMBASE (1990 – December 2020). To be included, studies must have trigger/referral criteria clearly outlined, a >75% non-oncology neurosciences population, and consensus or guidelines documents regarding palliative neurosciences or trigger/referral criteria. We excluded studies that had an oncological or non-neurosciences population as the main focus of study, trigger and referral criteria not clearly outlined, and no primary or duplicative data. The protocol was registered with PROSPERO (CRD4202013579), and PRISMA guidelines were followed. The American Academy of Neurology Clinical practice guidelines process manual was used to assess for risk of bias.Results:Our search identified 1748 publications, of which 22 articles met the eligibility criteria. Studies were considered in two main groups: A) studies designed specifically to identify trigger criteria for referral to specialised neuropalliative care services (n=9), and B) studies that retrospectively reported the reason for referral to specialised palliative care or reflected a consensus statement amongst people with advanced neurologic illness (n=13). Overall, the results suggest that several published referral triggers for specialized neuropalliative care are based on expert consensus. However, there is a growing body of literature providing evidence-based condition-specific triggers for multiple sclerosis, parkinsonism, ALS and dementia.Discussion:There is a growing body of research that outlines evidence-based referral triggers for neuropalliative care. The ambiguity of nomenclature surrounding referral triggers in the current literature and field of neuropalliative care was a limitation to this study. We suggest that condition-specific triggers are likely to be the most effective for identifying the appropriate patients and timing for referral to specialist palliative care.
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12
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Caregivers' View of Socio-Medical Care in the Terminal Phase of Amyotrophic Lateral Sclerosis-How Can We Improve Holistic Care in ALS? J Clin Med 2022; 11:jcm11010254. [PMID: 35011995 PMCID: PMC8745628 DOI: 10.3390/jcm11010254] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 12/28/2021] [Accepted: 12/30/2021] [Indexed: 11/18/2022] Open
Abstract
Multidimensional socio-medical care with an early integration of palliative principles is strongly recommended in amyotrophic lateral sclerosis (ALS), but provided inconsistently. We conducted telephone interviews with 49 former caregivers of deceased ALS patients to examine their experience of care in the terminal phase including caregiver burden. Patients who received specialized palliative care (45% of patients) were more likely to die at home (p = 0.004) and without burdening symptoms (p = 0.021). The majority of caregivers (86%) reported deficits in socio-medical care. Most frequently mentioned were problems receiving medical aids (45%) and a lack of caregiver support (35%). A higher level of deficits experienced by caregivers was associated with negative health outcomes on the side of the caregivers (reported by 57% of them; p = 0.002) and stronger caregiver burden (p = 0.004). To provide good quality of dying to patients and reduce the burden on caregivers, multidimensional—including palliative—care in ALS urgently needs to be strengthened in the healthcare structures.
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13
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Dawson B, McConvey K, Gofton TE. When to initiate palliative care in neurology. HANDBOOK OF CLINICAL NEUROLOGY 2022; 190:105-125. [PMID: 36055710 DOI: 10.1016/b978-0-323-85029-2.00011-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Life-limiting and life-threatening neurologic conditions often progress slowly. Patients live with a substantial symptom burden over a long period of time, and there is often a high degree of functional and cognitive impairment. Because of this, the most appropriate time to initiate neuropalliative care is often difficult to identify. Further challenges to the incorporation of neuropalliative care include communication barriers, such as profound dysarthria or language impairments, and loss of cognitive function and decision-making capacity that prevent shared decision making and threaten patient autonomy. As a result, earlier initiation of at least some components of palliative care is paramount to ensuring patient-centered care while the patient is still able to communicate effectively and participate as fully as possible in their medical care. For these reasons, neuropalliative care is also distinct from palliative care in oncology, and there is a growing evidence base to guide timely initiation and integration of neuropalliative care. In this chapter, we will focus on when to initiate palliative care in patients with life-limiting, life-threatening, and advanced neurologic conditions. We will address three main questions, which patients with neurologic conditions will benefit from initiation of palliative care, what aspects of neurologic illness are most amenable to neuropalliative care, and when to initiate neuropalliative care?
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Affiliation(s)
- Benjamin Dawson
- Department of Clinical Neurologic Sciences, Western University, London, ON, Canada
| | - Kayla McConvey
- Department of Clinical Neurologic Sciences, Western University, London, ON, Canada
| | - Teneille E Gofton
- Department of Clinical Neurologic Sciences, Western University, London, ON, Canada.
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14
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Margolius AJ, Samala RV. Delivery models of neuropalliative care. HANDBOOK OF CLINICAL NEUROLOGY 2022; 190:61-71. [PMID: 36055720 DOI: 10.1016/b978-0-323-85029-2.00007-5] [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
Drawing its beginnings from end-of-life care, palliative care has developed into a specialized interdisciplinary effort aiming to alleviate distress in all its form, and spanning the whole serious illness trajectory. With this evolution came the inevitable expansion to different sites and modes of care delivery. This section discusses the various models of bringing palliative care to patients with neurologic illness. It begins by distinguishing primary from specialist palliative care, then examines various models of inpatient and outpatient care. Hospital-based models include consultation service and dedicated inpatient units, while outpatient care mainly consists of palliative care specialists embedded in disease-specific clinics. Home-based palliative care and services provided through telemedicine are discussed. Hospice, a model of care often associated with end-of-life palliative care is detailed, together with suggestions on when to consider transitioning to hospice care. It is worth noting that there is not a single best model of palliative care delivery for persons living with neurologic illness. The models discussed in this chapter are complementary not competing and should be adopted by clinicians to fit the needs of patients and caregivers, the resources available in the healthcare system, and based on where patients are in the spectrum of their illness.
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Affiliation(s)
- Adam J Margolius
- Palliative Care Program, Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, Cleveland, OH, United States.
| | - Renato V Samala
- Department of Palliative and Supportive Care, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, United States
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15
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Tolchin DW. Rehabilitation in Neuromuscular Disorders. Neuromuscul Disord 2022. [DOI: 10.1016/b978-0-323-71317-7.00008-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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16
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Takacs SM, Comer AR. Documentation of advance care planning forms in patients with amyotrophic lateral sclerosis. Muscle Nerve 2021; 65:187-192. [PMID: 34787317 DOI: 10.1002/mus.27462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 11/11/2021] [Accepted: 11/12/2021] [Indexed: 11/11/2022]
Abstract
INTRODUCTION/AIMS Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disorder characterized by progressive weakness. Survival is typically only a few years from symptom onset. The often-predictable disease course creates opportunities to complete advance care planning (ACP) forms. The Physician Orders for Life-Sustaining Treatment (POLST) is a broadly used ACP paradigm to communicate end-of-life wishes but has not been well-studied in the ALS population. METHODS In this retrospective chart review study, patients diagnosed with ALS seen between 2014 and 2018 at an academic ALS center were identified. Demographic information, clinical characteristics, and ACP data were collected. RESULTS Of 513 patients identified, 30% had an ACP document. POLST forms were competed in 16.6% of patients with 73.8% of forms signed by a neurologist. Only 5.1% of patients saw a palliative care physician. Palliative care consultation was associated with having an POLST on file (P < .001). Patients with completed POLST forms were significantly more likely to have been seen in clinic more frequently (P < .001) and have a lower ALS Functional Rating Scale-Revised score on last visit (P = .005). DISCUSSION Less than one third of patients with ALS completed an ACP document, and only a small percentage completed POLST forms. The data suggest a need for greater documentation of goals of care in the ALS population.
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Affiliation(s)
- Sara M Takacs
- Department of Neurology, Indiana University School of Medicine, Indiana University Health, Indianapolis, Indiana, USA
| | - Amber R Comer
- Department of Health Sciences, Indiana University School of Health and Human Sciences, Indianapolis, Indiana, USA
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17
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Gillespie J, Przybylak-Brouillard A, Watt CL. The Palliative Care Information Needs of Patients with Amyotrophic Lateral Sclerosis and their Informal Caregivers: A Scoping Review. J Pain Symptom Manage 2021; 62:848-862. [PMID: 33757892 DOI: 10.1016/j.jpainsymman.2021.03.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/10/2021] [Accepted: 03/11/2021] [Indexed: 12/12/2022]
Abstract
CONTEXT Amyotrophic Lateral Sclerosis (ALS) is a fatal neurodegenerative disease, associated with impaired quality of life for patients and caregivers. As treatment is largely supportive, early involvement of palliative care (PC) is recommended as standard of care. Despite this, literature surrounding PC information needs is limited. OBJECTIVES To explore the PC information needs of patients with ALS and their caregivers and identify gaps in the literature. METHODS A scoping review using MEDLINE, EMBASE, CINAHL and PsycINFO databases (2000-2019) was conducted. Articles examining PC information needs as stated by ALS patients and/or current/bereaved caregivers were included. Studies examining other diagnoses and those focused on healthcare workers were excluded. Thematic synthesis was used to summarize and identify prevalent domains and themes in the literature. RESULTS 581 articles underwent primary screening, with thirty-two ultimately included (26 original articles, six reviews). Fourteen examined information needs of both patients and caregivers, 13 caregivers only, 5 patients only. The most common PC information needs were as follows: for patients, disease course/prognosis (n = 10), general disease information (n = 9), decision-making (n = 7) and symptoms (n = 6); for caregivers, services and resources (n = 15), disease course/prognosis (n = 14), general disease information (n = 13) and skills (n = 10). There was substantial variability in information needs, both between patients and caregivers and among members of the same group. CONCLUSION ALS patients and caregivers have unique and varying PC information needs. Future research should better characterize these needs to improve patient and caregiver quality of life. The delivery of information must be tailored to individual patient or caregiver preferences.
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Affiliation(s)
- Jacqueline Gillespie
- Division of Palliative Care, Trillium Health Partners, Mississauga, Ontario, Canada
| | | | - Christine L Watt
- Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Bruyere Research Institute, Ottawa, Ontario, Canada.
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18
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Chaudhary U, Chander BS, Ohry A, Jaramillo-Gonzalez A, Lulé D, Birbaumer N. Brain Computer Interfaces for Assisted Communication in Paralysis and Quality of Life. Int J Neural Syst 2021; 31:2130003. [PMID: 34587854 DOI: 10.1142/s0129065721300035] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The rapid evolution of Brain-Computer Interface (BCI) technology and the exponential growth of BCI literature during the past 20 years is a consequence of increasing computational power and the achievements of statistical learning theory and machine learning since the 1960s. Despite this rapid scientific progress, the range of successful clinical and societal applications remained limited, with some notable exceptions in the rehabilitation of chronic stroke and first steps towards BCI-based assisted verbal communication in paralysis. In this contribution, we focus on the effects of noninvasive and invasive BCI-based verbal communication on the quality of life (QoL) of patients with amyotrophic lateral sclerosis (ALS) in the locked-in state (LIS) and the completely locked-in state (CLIS). Despite a substantial lack of replicated scientific data, this paper complements the existing methodological knowledge and focuses future investigators' attention on (1) Social determinants of QoL and (2) Brain reorganization and behavior. While it is not documented in controlled studies that the good QoL in these patients is a consequence of BCI-based neurorehabilitation, the proposed determinants of QoL might become the theoretical background needed to develop clinically more useful BCI systems and to evaluate the effects of BCI-based communication on QoL for advanced ALS patients and other forms of severe paralysis.
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Affiliation(s)
- Ujwal Chaudhary
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen 72076, Germany.,ALSVOICE gGmbH, Mössingen 72116, Germany
| | - Bankim Subhash Chander
- ALSVOICE gGmbH, Mössingen 72116, Germany.,Department of Psychiatry and Psychotherapy, Center for Innovative Psychiatric and Psychotherapeutic Research, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim 68159, Germany
| | - Avi Ohry
- Sackler Faculty of Medicine, Tel Aviv University & Reuth Medical & Rehabilitation Center, Tel Aviv, Israel
| | - Andres Jaramillo-Gonzalez
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen 72076, Germany
| | | | - Niels Birbaumer
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen 72076, Germany.,ALSVOICE gGmbH, Mössingen 72116, Germany
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19
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Takahashi K, Murakami F, Komai K, Ishida C, Kato-Motozaki Y. Difference in the Care of Patients with Amyotrophic Lateral Sclerosis With and Without Intervention from the Palliative Care Team: Observations from a Center in Japan. Palliat Med Rep 2021; 2:201-206. [PMID: 34318298 PMCID: PMC8310746 DOI: 10.1089/pmr.2020.0084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2021] [Indexed: 12/02/2022] Open
Abstract
Background: Despite the significant palliative care needs for people living with amyotrophic lateral sclerosis (ALS), palliative medicine in Japan is mainly focused on oncologic disease. Objective: To compare the care provided to patients with ALS with and without intervention from the palliative care team (PCT and non-PCT groups, respectively). Design: This is a retrospective case–control study. Setting: One ALS center in Japan. Participants: Sixty patients with clinically definite ALS treated until death from January 2012 to December 2019. Measurements: We compared the two groups based on the presence of advance directives, patient age, use of noninvasive and invasive ventilation, maximum opioid dosage, and use of nonopioid palliative medications such as antidepressants and anxiolytics. We also compared the prescribing practices of the attending physicians. Results: There was no difference in the rate of advance directive completion between the PCT and non-PCT groups. Although all but one patient in the PCT group used opioids, only half of the patients in the non-PCT group used opioids (p < 0.001). The mean maximum opioid dosage was higher in the PCT group than in the non-PCT group (p = 0.003). Moreover, 79.2% and 41.7% of the PCT and non-PCT groups, respectively, received antidepressants or antianxiety agents (p = 0.004). Maximum opioid dosages were not different on the basis of attending physician's experience level. Conclusions: Opioid and nonopioid medications intended for symptom management were more likely to be prescribed to patients with ALS who received intervention from a PCT.
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Affiliation(s)
- Kazuya Takahashi
- Department of Neurology, Hokuriku Brain and Neuromuscular Disease Center, National Hospital Organization Iou National Hospital, Kanazawa, Japan.,Palliative Care Team, Hokuriku Brain and Neuromuscular Disease Center, National Hospital Organization Iou National Hospital, Kanazawa, Japan
| | - Fumi Murakami
- Palliative Care Team, Hokuriku Brain and Neuromuscular Disease Center, National Hospital Organization Iou National Hospital, Kanazawa, Japan.,Nursing Unit, Hokuriku Brain and Neuromuscular Disease Center, National Hospital Organization Iou National Hospital, Kanazawa, Japan
| | - Kiyonobu Komai
- Department of Neurology, Hokuriku Brain and Neuromuscular Disease Center, National Hospital Organization Iou National Hospital, Kanazawa, Japan
| | - Chiho Ishida
- Department of Neurology, Hokuriku Brain and Neuromuscular Disease Center, National Hospital Organization Iou National Hospital, Kanazawa, Japan
| | - Yuko Kato-Motozaki
- Department of Neurology, Hokuriku Brain and Neuromuscular Disease Center, National Hospital Organization Iou National Hospital, Kanazawa, Japan.,Palliative Care Team, Hokuriku Brain and Neuromuscular Disease Center, National Hospital Organization Iou National Hospital, Kanazawa, Japan
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20
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Mehta TR, Bayat E, Govindarajan R. Palliative care in amyotrophic lateral sclerosis clinics: A survey of NEALS consortium membership. Muscle Nerve 2021; 63:769-774. [PMID: 33580524 DOI: 10.1002/mus.27203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 02/06/2021] [Accepted: 02/07/2021] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative condition managed with a multidisciplinary approach. Palliative care is important for this approach, but there is a lack of recommendations for the role and involvement of palliative medicine (PM) specialists in multidisciplinary ALS care. METHODS This questionnaire-based survey assessed the state of palliative care in selective sites that are a part of Northeast Amyotrophic Lateral Sclerosis Consortium (NEALS). RESULTS Twenty-seven percent of the sites included palliative care specialists as a part of their ALS clinics and they were introduced to the patients and family by ALS specialists (75.94%) usually at an advanced stage of ALS. DISCUSSION Our study when compared with other study results having a similar aim showed that there is a variability in the practice of palliative care specialists in ALS clinics. Having evidence-based guidelines will help in the management of ALS patients more effectively.
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Affiliation(s)
- Tejas R Mehta
- Department of Neurology, University of Missouri, Columbia, Missouri, USA
| | - Elham Bayat
- Department of Neurology, George Washington University, Washington, District of Columbia, USA
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21
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Hafer J, Jensen S, Wiedau-Pazos M, Mehta AK. Assessment of feasibility and utility of universal referral to specialty palliative care in a multidisciplinary amyotrophic lateral sclerosis clinic: A cohort study. Muscle Nerve 2021; 63:818-823. [PMID: 33533539 DOI: 10.1002/mus.27194] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 01/27/2021] [Accepted: 01/31/2021] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Although the value of palliative care integration in multidisciplinary amyotrophic lateral sclerosis (ALS) clinics has been increasingly recognized, limited data are available demonstrating the feasibility and utility of a palliative care specialist embedded in an ALS clinic. The purpose of this study is to describe the feasibility and utility of a universal outpatient referral model for specialty palliative care for patients with amyotrophic lateral sclerosis. METHODS This is a retrospective cohort study of initial patient visits with a palliative care physician in a multidisciplinary ALS clinic at an academic institution. All patients were referred to an embedded palliative care physician from January to December 2019. RESULTS Within the study period, 52 of 69 (75%) patients with a confirmed diagnosis of ALS were seen by the palliative care physician. The most common reason patients were not seen by palliative care was a lack of insurance authorization (n = 5). At the visit, 94% of patients discussed at least one advance care planning or goals of care topic. The most common advance care planning topic discussed was code status (40%). The most common goals of care topic discussed was meaning and values (57%). Symptom management was discussed with 40 patients (77%). The most common symptom addressed was pain and/or muscle spasms (33%). DISCUSSION These data support the feasibility and utility of universal, outpatient palliative care referral for patients with ALS. Further research is necessary to determine the long-term effect on outcomes for this population.
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Affiliation(s)
- Julia Hafer
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - Sarah Jensen
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - Martina Wiedau-Pazos
- Department of Neurology, University of California, Los Angeles, Los Angeles, California, USA
| | - Ambereen K Mehta
- Palliative Care Program, Department of Medicine, University of California, Los Angeles, Los Angeles, California, USA.,Palliative Care Program, Division of General Internal Medicine, Johns Hopkins Bayview Medical Center, Baltimore, Maryland, USA
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22
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Brassil M, Gallegos-Kearin V, Tolchin DW. Subspecialty Training: Hospice and Palliative Medicine. Am J Phys Med Rehabil 2021; 100:189-192. [PMID: 32541344 DOI: 10.1097/phm.0000000000001489] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
ABSTRACT Physiatrists care for patients and families with complex medical needs, and primary palliative care is an important part of the comprehensive rehabilitation care plan. Palliative care improves patient and family quality of life and reduces healthcare costs. Clinical care guidelines for several physiatry patient populations now include the provision of palliative care.Current Accreditation Council for Graduate Medical Education physiatry residency program requirements include foundational palliative care skills. Similarly, current clinical palliative care practice guidelines enumerate standards that apply to the rehabilitation setting. However, there is a dearth of literature on the current state of palliative care training within physiatry programs, and hospice and palliative medicine remains one of the least subscribed physiatry subspecialties.In this article, we describe palliative care, highlight existing literature on palliative care needs within physiatry patient populations, and identify a core physiatry-palliative care skillset. We look both within physiatry and across other specialties to guide recommendations for palliative care education within physiatry residency programs. We also describe opportunities for post-residency fellowship training in hospice and palliative medicine.
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Affiliation(s)
- Michelle Brassil
- From the University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania (MB); Vanderbilt University Medical Center, Nashville, Tennessee (VG-K); and Spaulding Rehabilitation Hospital/Harvard Medical School, Boston, Massachusetts (DWT)
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23
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Mehta AK, Jackson NJ, Wiedau-Pazos M. Palliative Care Consults in an Inpatient Setting for Patients With Amyotrophic Lateral Sclerosis. Am J Hosp Palliat Care 2020; 38:1091-1098. [DOI: 10.1177/1049909120969959] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background: Limited data about the frequency and outcomes of palliative care (PC) specialty consultations for patients with amyotrophic lateral sclerosis (ALS) are available. Methods: This study was a retrospective chart review. Patients with ALS admitted to 2 academic hospitals from 2013-2018 were included. We compared patients who were seen by an inpatient specialty PC service (PC group) with those who were not (NonPC group). Results: Twenty-four patients met inclusion criteria (9 PC group, 15 NonPC group). Patients in both groups were similar in age and had been diagnosed for a similar amount of time before admission. In the PC group, 6 patients were seen by more than 1 PC multidisciplinary team member (physician, social worker, spiritual care provider, clinical nurse specialist). PC consultations were requested for goals of care (GOC) (n = 7), pain (n = 4), hospice information/referral (n = 2), dyspnea (n = 1), and excessive oral secretions (n = 1). GOC topics addressed for both groups were code status, treatment preferences (tracheostomy placement, percutaneous endoscopic gastrostomy placement, change to comfort care), prognostication, and hospice information/referral. Patients in the PC group were significantly more likely to be discharged with GOC (89%, p = 0.02) and completed advance care planning (ACP) documents (89%, p = 0.04) than patients in the NonPC group (32%; 47%). Despite reason for consultation, at least 1 symptom was addressed for every patient seen by PC specialists. Conclusions: Inpatient specialty PC consultation for patients with ALS leads to greater documentation of GOC and ACP by discharge. PC consultants participate in symptom management in patients with ALS during hospitalization.
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Affiliation(s)
- Ambereen K. Mehta
- Department of Medicine, Palliative Care Program, University of California, Los Angeles Medical Center, Los Angeles, CA, USA
| | - Nicholas J. Jackson
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Martina Wiedau-Pazos
- Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
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24
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Abstract
BACKGROUND Amyotrophic lateral sclerosis (ALS) presents many transitions for persons/people with ALS (PwALS) and their caregivers. Transitions are passages from one life phase, condition, or status to another. We used qualitative methods to understand how PwALS and caregivers experience transitions throughout their ALS journey. METHODS PwALS and their caregivers were recruited from a multidisciplinary ALS clinic in Edmonton, Canada. We recruited patients at the stage of ALS that home mechanical ventilation, a feeding tube, and/or assistive communication technology had been offered. Semi-structured interviews were audio-recorded, transcribed, and analyzed using qualitative thematic analysis. RESULTS We interviewed 14 PwALS and 15 caregivers and identified 5 recurring themes. The importance of community was identified by many PwALS and caregivers who expressed feelings of loneliness and isolation. Most caregivers were spouses and couples navigated a change in their relationship roles as one spouse transitioned to becoming a caregiver while the other transitioned to dependency. The caregiver spouses reported a sense of "total responsibility" that encompassed continual vigilance for the PwALS's well-being, managing their household and finances. PwALS and caregivers reported transitioning to reliance on life-sustaining medical devices; early adoption and information on these devices increased their quality of life. Participants also wanted more and earlier information on advanced care planning. PwALS and caregivers identified adapting to new forms of communication as a necessity. CONCLUSION ALS presents many transitions for PwALS and caregivers. Understanding these transitions is important for ALS healthcare professionals who seek to implement best care practices.
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25
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Phillips JN, Besbris J, Foster LA, Kramer NM, Maiser S, Mehta AK. Models of outpatient neuropalliative care for patients with amyotrophic lateral sclerosis. Neurology 2020; 95:782-788. [DOI: 10.1212/wnl.0000000000010831] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 08/03/2020] [Indexed: 11/15/2022] Open
Abstract
ObjectiveTo describe some current models of outpatient neuropalliative care (NPC) available to patients with amyotrophic lateral sclerosis at different institutions within the United States.MethodsSix NPC physicians were asked to contribute written descriptions about the PC available in their ALS clinics. Descriptions were then compiled and assessed for similarities and differences.ResultsAll clinics are multidisciplinary, with regular appointments every 3 months and similar appointment times for new visits (60–120 minutes) and follow-up visits (20–45 minutes). Four clinics have an NPC specialist embedded within the ALS clinic, 1 institution has a separate clinic for NPC, and 1 institution has both. The NPC physician at 5 institutions is a neurologist with formal palliative care training and at 1 institution is an internist with formal palliative care training. NPC is part of routine care for all patients at 2 institutions, and the primary reasons for consultation are goals of care (GOC) and severe symptom management.ConclusionNPC is provided to patients with ALS heterogeneously throughout the United States with some variation in services and delivery, but all clinics are addressing similar core needs. Given the poor prognosis and high PC needs, those with ALS are the ideal patients to receive NPC. Future studies are necessary given the paucity of data available to determine best practices and to better define meaningful outcomes.
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26
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Brizzi KT, Bridges JFP, Yersak J, Balas C, Thakur N, Galvin M, Hardiman O, Heatwole C, Ravits J, Simmons Z, Bruijn L, Chan J, Bedlack R, Berry JD. Understanding the needs of people with ALS: a national survey of patients and caregivers. Amyotroph Lateral Scler Frontotemporal Degener 2020; 21:355-363. [DOI: 10.1080/21678421.2020.1760889] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Kate T. Brizzi
- Healey Center for ALS, Massachusetts General Hospital, Boston, MA, USA,
- Department of Medicine, Division of Palliative Care, Massachusetts General Hospital, Boston, MA, USA,
| | | | | | | | | | - Miriam Galvin
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College, Dublin, Ireland,
| | - Orla Hardiman
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College, Dublin, Ireland,
| | - Chad Heatwole
- Medical Center, University of Rochester, Rochester, NY, USA,
| | - John Ravits
- Department of Neurosciences, University of California, San Diego, CA, USA,
| | | | - Lucie Bruijn
- Translational Medicine, EMEA, AVeXis, London, UK,
| | - James Chan
- Center for Biostatistics, Massachusetts General Hospital, Boston, MA, USA,
| | - Richard Bedlack
- Department of Neurology, Duke University Medical Center, Durham, NC, USA
| | - James D. Berry
- Healey Center for ALS, Massachusetts General Hospital, Boston, MA, USA,
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27
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Washington KT, Kukulka K, Govindarjan R, Mehr DR. Engaging Specialist Palliative Care in the Management of Amyotrophic Lateral Sclerosis: A Patient-, Family-, and Provider-Based Approach. J Palliat Care 2020; 37:170-176. [PMID: 32066316 DOI: 10.1177/0825859719895827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To describe key stakeholders' perspectives on specialist palliative care and its integration into the management of amyotrophic lateral sclerosis (ALS). METHODS The study conducted was a qualitative, noninterventional, descriptive study. Data were collected via individual interviews of 42 stakeholders (n = 14 patients, n = 16 family caregivers, and n = 12 health-care providers). Transcribed interviews were analyzed using inductive thematic analysis techniques. RESULTS Stakeholders' general impressions of specialist palliative care were highly variable. Many expressed limited or inaccurate understandings of palliative care's definition and purpose. Perceptions of palliative care as hospice were common. Stakeholders generally supported the integration of specialist palliative care into ALS management, and many recognized the value of early integration of palliative services in both the community and the clinical setting. CONCLUSION Key stakeholders readily identified a meaningful role for specialist palliative care in ALS management. Integration of specialist palliative care into existing systems of support would be facilitated by a more comprehensive understanding of the service among patients, family caregivers, and health-care providers.
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Affiliation(s)
- Karla T Washington
- Department of Family and Community Medicine, School of Medicine, University of Missouri, Columbia, MO, USA
| | - Klaudia Kukulka
- Department of Family and Community Medicine, School of Medicine, University of Missouri, Columbia, MO, USA
| | - Raghav Govindarjan
- Department of Neurology, School of Medicine, University of Missouri, Columbia, MO, USA
| | - David R Mehr
- Department of Family and Community Medicine, School of Medicine, University of Missouri, Columbia, MO, USA
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