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Maksymowicz S, Libura M, Malarkiewicz P. Overcoming therapeutic nihilism. Breaking bad news of amyotrophic lateral sclerosis—a patient-centred perspective in rare diseases. Neurol Sci 2022; 43:4257-4265. [PMID: 35149928 PMCID: PMC9213364 DOI: 10.1007/s10072-022-05931-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 02/03/2022] [Indexed: 11/24/2022]
Abstract
Amyotrophic lateral sclerosis (ALS) is a rare, incurable, and fatal neurodegenerative disease with median survival time from onset to death ranging from 20 to 48 months. Breaking bad news about ALS diagnosis is a challenging task for physicians and a life-changing experience for patients. Several protocols for delivering difficult information are available, including SPIKES and EMPATHY. Our goal was to assess to what extent these guidelines are followed in Polish ALS patients’ experience as well as to identify any other patients’ preferences not addressed by the guidelines. Participants of our study were recruited via a neurology clinic. Twenty-four patients with confirmed ALS diagnosis were interviewed using in-depth interview and a self-constructed questionnaire: 9 females, 15 males in age ranging from 30–39 to 60–69. The analysis showed a pattern of shortcomings and fundamental violations of available protocols reported by ALS patients. Patients also had to deal with therapeutic nihilism, as they were perceived as “hopeless cases”; unlike in oncological setting, their end-of-life needs were not accommodated by some standard schemes. As a conclusion, we recommend using extended breaking bad news protocols with special emphasis on preparing a treatment plan, giving the patient hope and sense of purpose, offering psychological support and counselling directed to patients and caregivers, and providing the patient with meaningful information about the disease, social support, treatment options, and referral to appropriate health care centres.
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Affiliation(s)
- Stanisław Maksymowicz
- Department of Psychology and Sociology of Health and Public Health, School of Public Health, Collegium Medicum of the University of Warmia and Mazury, Olsztyn, Poland
- Instytut Terapii Komórkowych S.A., Olsztyn, Poland
| | - Maria Libura
- Medical Education and Simulation Department, School of Medicine, Collegium Medicum of the University of Warmia and Mazury, Olsztyn, Poland
| | - Paulina Malarkiewicz
- Department of Obstetrics and Gynaecology, School of Medicine, Collegium Medicum of the University of Warmia and Mazury, Olsztyn, Poland
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Genuis SK, Luth W, Campbell S, Bubela T, Johnston WS. Communication About End of Life for Patients Living With Amyotrophic Lateral Sclerosis: A Scoping Review of the Empirical Evidence. Front Neurol 2021; 12:683197. [PMID: 34421792 PMCID: PMC8371472 DOI: 10.3389/fneur.2021.683197] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 07/09/2021] [Indexed: 12/03/2022] Open
Abstract
Background: Communication about end of life, including advance care planning, life-sustaining therapies, palliative care, and end-of-life options, is critical for the clinical management of amyotrophic lateral sclerosis patients. The empirical evidence base for this communication has not been systematically examined. Objective: To support evidence-based communication guidance by (1) analyzing the scope and nature of research on health communication about end of life for amyotrophic lateral sclerosis; and (2) summarizing resultant recommendations. Methods: A scoping review of empirical literature was conducted following recommended practices. Fifteen health-related and three legal databases were searched; 296 articles were screened for inclusion/exclusion criteria; and quantitative data extraction and analysis was conducted on 211 articles with qualitative analysis on a subset of 110 articles that focused primarily on health communication. Analyses summarized article characteristics, themes, and recommendations. Results: Analysis indicated a multidisciplinary but limited evidence base. Most reviewed articles addressed end-of-life communication as a peripheral focus of investigation. Generic communication skills are important; however, substantive and sufficient disease-related information, including symptom management and assistive devices, is critical to discussions about end of life. Few articles discussed communication about specific end-of-life options. Communication recommendations in analyzed articles draw attention to communication processes, style and content but lack the systematized guidance needed for clinical practice. Conclusions: This review of primary research articles highlights the limited evidence-base and consequent need for systematic, empirical investigation to inform effective communication about end of life for those with amyotrophic lateral sclerosis. This will provide a foundation for actionable, evidence-based communication guidelines about end of life. Implications for research, policy, and practice are discussed.
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Affiliation(s)
- Shelagh K. Genuis
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Westerly Luth
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Sandra Campbell
- John W. Scott Health Sciences Library, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Tania Bubela
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Wendy S. Johnston
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
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McMullan J, Crowe AL, Bailie C, Moore K, McMullan LS, Shamandi N, McAneney H, McKnight AJ. Improvements needed to support people living and working with a rare disease in Northern Ireland: current rare disease support perceived as inadequate. Orphanet J Rare Dis 2020; 15:315. [PMID: 33168042 PMCID: PMC7649905 DOI: 10.1186/s13023-020-01559-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 09/24/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Many people living and working with rare diseases describe consistent difficulties accessing appropriate information and support. In this study an evaluation of the awareness of rare diseases, alongside related information and educational resources available for patients, their families and healthcare professionals, was conducted in 2018-2019 using an online survey and semi-structured interviews with rare disease collaborative groups (charities, voluntary and community groups) active across Northern Ireland (NI). METHODS This study had 2 stages. Stage 1 was an online survey and stage 2 involved semi-structured interviews both with rare disease collaborative groups in Northern Ireland. The surveys and interviews were used to locate existing resources as well as identify gaps where the development of further resources would be appropriate. RESULTS Ninety-nine rare disease collaborative groups engaged with the survey with 31 providing detailed answers. Resources such as information, communication, 'registries', online services, training and improvements to support services were queried. Excellent communication is an important factor in delivering good rare disease support. Training for health professionals was also highlighted as an essential element of improving support for those with a rare disease to ensure they approach people with these unique and challenging diseases in an appropriate way. Carers were mentioned several times throughout the study; it is often felt they are overlooked in rare disease research and more support should be in place for them. Current care/support for those with a rare disease was highlighted as inadequate. Nine semi-structured interviews were conducted with rare disease collaborative groups. Reoccurring themes included a need for more effective information and communication, training for health professionals, online presence, support for carers, and involvement in research. CONCLUSIONS All rare disease collaborative groups agreed that current services for people living and working with a rare disease are not adequate. An important finding to consider in future research within the rare disease field is the inclusion of carers perceptions and experiences in studies. This research provides insight into the support available for rare diseases across Northern Ireland, highlights unmet needs, and suggests approaches to improve rare disease support.
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Affiliation(s)
- Julie McMullan
- Centre for Public Health, School of Medicine Dentistry and Biomedical Sciences, Institute of Clinical Science, Block A, Grosvenor Road, Belfast, BT12 6BA, UK.
| | - Ashleen L Crowe
- Centre for Public Health, School of Medicine Dentistry and Biomedical Sciences, Institute of Clinical Science, Block A, Grosvenor Road, Belfast, BT12 6BA, UK
| | - Caitlin Bailie
- Centre for Public Health, School of Medicine Dentistry and Biomedical Sciences, Institute of Clinical Science, Block A, Grosvenor Road, Belfast, BT12 6BA, UK
| | - Kerry Moore
- Northern Ireland Rare Disease Partnership, 2 William Street, Newtownards, BT23 4AH, UK
| | - Lauren S McMullan
- Centre for Public Health, School of Medicine Dentistry and Biomedical Sciences, Institute of Clinical Science, Block A, Grosvenor Road, Belfast, BT12 6BA, UK
| | - Nahid Shamandi
- Centre for Public Health, School of Medicine Dentistry and Biomedical Sciences, Institute of Clinical Science, Block A, Grosvenor Road, Belfast, BT12 6BA, UK
| | - Helen McAneney
- Centre for Public Health, School of Medicine Dentistry and Biomedical Sciences, Institute of Clinical Science, Block A, Grosvenor Road, Belfast, BT12 6BA, UK
| | - Amy Jayne McKnight
- Centre for Public Health, School of Medicine Dentistry and Biomedical Sciences, Institute of Clinical Science, Block A, Grosvenor Road, Belfast, BT12 6BA, UK
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Crowe AL, McKnight AJ, McAneney H. Communication Needs for Individuals With Rare Diseases Within and Around the Healthcare System of Northern Ireland. Front Public Health 2019; 7:236. [PMID: 31497589 PMCID: PMC6712370 DOI: 10.3389/fpubh.2019.00236] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 08/06/2019] [Indexed: 12/15/2022] Open
Abstract
Objective: By definition a rare disease affects fewer than 1 in 2,000 people but collectively 1 in 17 people are affected at some time in their lives. Rare disease patients often describe feeling isolated and unsupported. The needs of individuals living with rare disease(s) are not well met globally and have not been specifically explored in Northern Ireland. Methods: An online survey was conducted in spring of 2017, focused on information and communication needs, to identify overarching themes. Databases were searched to place responses in an international context. Results: There were 240 survey respondents with four overarching themes identified: sources of information; medical care; rare disease community; and public awareness. Thirty relevant papers resulted from the literature search. A coordinated and transparent approach for improved medical care is needed where researchers, practitioners, and policy makers work with patients, carers, and rare disease advocates to ensure a fully considered rare disease strategy is implemented. In line with that developed by many other countries, a physical or virtual Northern Ireland reference network or center of excellence for rare diseases would provide an important strategic link. Sustainable funding, resources for rare disease charities, and more cross-border working would help build a local rare disease community. Major challenges highlighted include finding the right health and social care information. The internet was the most regularly accessed, and perceived as the easiest way, to source information on rare disease. Improved signposting to accredited information, ideally by the creation of a locally relevant online information hub, a local rare disease registry that can integrate with international systems, a local rare disease coordinator, and improving public awareness are urgent needs. Conclusions: Aligned to internationally reported outcomes, practical issues for future development based on the voices of individuals living, and working with a rare condition are described. It is essential that ongoing research evaluates changes to ensure that the best possible structures and mechanisms are put in place to improve communication and information systems for those affected by a rare condition(s).
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Affiliation(s)
- Ashleen L Crowe
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, United Kingdom
| | - Amy Jayne McKnight
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, United Kingdom
| | - Helen McAneney
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, United Kingdom
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Madsen LS, Jeppesen J, Handberg C. “Understanding my ALS”. Experiences and reflections of persons with amyotrophic lateral sclerosis and relatives on participation in peer group rehabilitation. Disabil Rehabil 2018; 41:1410-1418. [DOI: 10.1080/09638288.2018.1429499] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Louise Sofia Madsen
- Department of Public Health, Faculty of Health, Section for Clinical Social Medicine and Rehabilitation, Aarhus University, Aarhus, Denmark
- DEFACTUM, Central Denmark Region, Denmark
| | - Jørgen Jeppesen
- The National Rehabilitation Centre for Neuromuscular Diseases, Aarhus, Denmark
| | - Charlotte Handberg
- Department of Public Health, Faculty of Health, Section for Clinical Social Medicine and Rehabilitation, Aarhus University, Aarhus, Denmark
- DEFACTUM, Central Denmark Region, Denmark
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Facey K, Hansen HP. The imperative for patient-centred research to develop better quality services in rare diseases. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2016; 8:1-3. [PMID: 25616560 DOI: 10.1007/s40271-015-0113-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Karen Facey
- Evidence Based Health Policy Consultant, Woodlands Lodge, Buchanan Castle Estate, Drymen, G63 0HX, UK,
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