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Doherty M, Chukwusa E, McQuillan R, Cranfield F, Gao W. The Palliative Care Needs of Patients with Multiple Sclerosis, Parkinson's Related Diseases, and Motor Neurone Disease: A Secondary Analysis of the OPTCARE Neuro Trial Data. J Palliat Med 2024; 27:622-629. [PMID: 38597932 DOI: 10.1089/jpm.2023.0437] [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] [Indexed: 04/11/2024] Open
Abstract
Background: Long-term neurological conditions include multiple sclerosis, Parkinson's-related diseases, and motor neurone disease. National and international guidelines recommend a palliative approach for advancing neurological disease, but there is little research describing and comparing the palliative care needs of these patients side by side. Objective: The aim of this study was to describe and compare the symptom burden and psychological distress of patients with multiple sclerosis, Parkinson's-related diseases, and motor neurone disease. Design: A cross-sectional secondary analysis of the OPTCARE Neuro trial data was performed. Setting/Subjects: Recruitment was from seven sites across the United Kingdom. Patients aged 18 years or older, severely affected by advanced stages of multiple sclerosis or Parkinson's-related diseases or any stage of motor neurone disease, with an unresolved symptom, and one other issue despite usual care were eligible. Measurements: Baseline demographics, Integrated Palliative care Outcome Scale (IPOS) Neuro, and Hospital Anxiety and Depression Scale (HADS) results were analyzed. Results: Data from 348 participants were analyzed. The mean IPOS Neuro-S24 score was 27, with no statistical difference found between groups (p = 0.341). The most common symptoms were poor mobility (68.5%), problems using legs (63%), and fatigue (34.8%). The HADS revealed that a quarter of participants met the criteria for a diagnosis of anxiety and depression. Conclusions: Multiple sclerosis, Parkinson's-related disease, and motor neurone disease patients who were eligible for the OPTCARE Neuro trial have unmet needs in the form of distressing physical and psychological symptoms. It is unclear how to address these needs. The answer likely lies in a collaborative approach between neurology, palliative care, psychology, and specialized allied health professionals. Future work should focus on investigating this.
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Affiliation(s)
| | - Emeka Chukwusa
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, United Kingdom
| | | | | | - Wei Gao
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, United Kingdom
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McClung JA, Frishman WH, Aronow WS. The Role of Palliative Care in Cardiovascular Disease. Cardiol Rev 2024:00045415-990000000-00182. [PMID: 38169299 DOI: 10.1097/crd.0000000000000634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
The American Heart Association has recommended that palliative care be integrated into the care of all patients with advanced cardiac illnesses. Notwithstanding, the number of patients receiving specialist palliative intervention worldwide remains extremely small. This review examines the nature of palliative care and what is known about its delivery to patients with cardiac illness. Most of the published literature on the subject concern advanced heart failure; however, some data also exist regarding patients with heart transplantation, pulmonary hypertension, valvular disease, congenital heart disease, indwelling devices, mechanical circulatory support, and advanced coronary disease. In addition, outcome data, certification requirements, workforce challenges, barriers to implementation, and a potential caveat about palliative care will also be examined. Further work is required regarding appropriate means of implementation, quality control, and timing of intervention.
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Affiliation(s)
- John Arthur McClung
- From the Departments of Cardiology and Medicine, Westchester Medical Center, New York Medical College, Valhalla, NY
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Ramanathan U, Besbris JM, Kramer NM, Yu AW, Solomon AJ, Jones CA, Mehta AK. Top Ten Tips Palliative Care Clinicians Should Know about Multiple Sclerosis. J Palliat Med 2023; 26:1555-1561. [PMID: 37074065 DOI: 10.1089/jpm.2023.0179] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023] Open
Abstract
Multiple sclerosis (MS) is a chronic, immune-mediated, neurodegenerative condition of the central nervous system, with distinct challenges due to its heterogeneous presentation, prognostic uncertainty, and variable clinical course of neurological and non-neurological symptoms and disability. Although there have been significant advances in management of MS, many patients experience disability progression. Despite MS being a frequent cause of neurological disability, particularly in young persons, involvement of palliative care physicians in the care of patients with MS has been limited. This article provides ten tips for palliative clinicians for caring for patients with MS and their care partners.
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Affiliation(s)
- Usha Ramanathan
- Department of Medicine and University of Toronto, Toronto, Ontario, Canada
- Department of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Jessica M Besbris
- Department of Internal Medicine and Cedars-Sinai Medical Center, Los Angeles, California, USA
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Neha M Kramer
- Department of Neurology and Rush University Medical Center, Chicago, Illinois, USA
- Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Amy W Yu
- Division of Neuroimmunology, Department of Neurology, Columbia University Irving Medical Center, New York, New York, USA
| | - Andrew J Solomon
- Department of Neurological Sciences, Larner College of Medicine at the University of Vermont, Burlington, Vermont, USA
| | - Christopher A Jones
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Ambereen K Mehta
- Department of Internal Medicine and Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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Runacres F, Mathers S, Lee SC, Hearn R, Gregory S, Bear N, Aoun S. Motor neurone disease: A point-prevalence study of patient reported symptom prevalence, severity and palliative care needs. Palliat Med 2023; 37:1402-1412. [PMID: 37553906 DOI: 10.1177/02692163231191545] [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] [Indexed: 08/10/2023]
Abstract
BACKGROUND Motor neurone disease is a rare but debilitating illness with incomplete evidence regarding patients' symptom burden. Palliative care and generalist clinicians are often in-experienced in caring for these patients and assessing their needs. AIM To identify the symptom prevalence and severity experienced by patients with motor neurone disease. Secondary objectives were to examine differences in symptom burden and clusters according to phenotype, functional status, palliative care provision and those in their last months of life. DESIGN A point prevalence study assessing patient-reported symptoms using a modified IPOS-Neuro assessment tool, incorporating 41 symptom items. SETTING/PARTICIPANTS Patients with motor neurone disease attending the State-wide Progressive Neurological Disease Service or inpatient unit at Calvary Health Care Bethlehem, Melbourne Australia, from March to December 2021. RESULTS A total of 102 patients participated, the majority diagnosed with lumber-onset (30.4%), bulbar-onset (28.4%) and cervical-onset (25.5%) phenotypes. Patients experienced a median of 17 symptoms (range 2-32) with a median of 3 symptoms rated as severe/overwhelming (range 0-13). Motor and functional symptoms predominated, with differences in symptom clusters present according to phenotype. Patients had a higher number of severe/overwhelming symptoms if they were accessing palliative care services (p = 0.005), in their last 6 months of life (p = 0.003) and experiencing moderate or severe functional impairment (p < 0.001). CONCLUSIONS Patients with motor neurone disease report high symptom burden. A validated motor neurone disease-specific symptom assessment tool is needed to accurately assess patients, including important variations in symptom clusters according to phenotype. Further research must focus on evidence-based treatment guidelines for symptoms experienced commonly and severely.
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Affiliation(s)
- Fiona Runacres
- Calvary Health Care Bethlehem, Caulfield South, VIC, Australia
- Monash Health, Supportive & Palliative Care Department, Clayton, VIC, Australia
- Monash University, School of Clinical Sciences, Clayton, VIC, Australia
- The University of Notre Dame, Darlinghurst, NSW, Australia
| | - Susan Mathers
- Calvary Health Care Bethlehem, Caulfield South, VIC, Australia
- Monash Health, Department of Neurology, Clayton, VIC, Australia
| | - Sarah Cm Lee
- Calvary Health Care Bethlehem, Caulfield South, VIC, Australia
- Monash University, School of Clinical Sciences, Clayton, VIC, Australia
| | - Rowan Hearn
- Calvary Health Care Bethlehem, Caulfield South, VIC, Australia
| | | | - Natasha Bear
- Bear Statistics, Perth, WA, Australia
- The University of Notre Dame, Institute for Health Research, Perth, WA, Australia
| | - Samar Aoun
- Perron Institute for Neurological and Translational Science, Nedlands, WA, Australia
- The University of Western Australia, Perth, WA, Australia
- La Trobe University, Melbourne, VIC, Australia
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Müller A, Dillen K, Dojan T, Ungeheuer S, Goereci Y, Dunkl V, Voltz R, Löcherbach P, Warnke C, Golla H. Development of a Long-Term Cross-Sectoral Case and Care Management Manual for Patients With Severe Multiple Sclerosis and Their Caregivers. Prof Case Manag 2023; 28:183-193. [PMID: 36518082 DOI: 10.1097/ncm.0000000000000608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE/OBJECTIVES Care and case management (CCM) aims to provide optimal care for patients and their caregivers on an individual and superordinate level of health care providers and authorities. To facilitate a clear and systematic CCM process as part of a clinical study intervention, a semistructured manual is the prerequisite. PRIMARY PRACTICE SETTINGS The ongoing COCOS-MS (Communication, Coordination and Security for People with Multiple Sclerosis) study is a randomized controlled Phase II clinical intervention study. The CCM manual is being tested on the intervention group consisting of severely affected individuals with multiple sclerosis (MS; Expanded Disability Status Scale [EDSS] >5) and their caregivers receiving CCM for 12 months in addition to standard care. The intervention comprises monthly personal visits and weekly telephone calls during which the CCM manual is applied. FINDINGS/CONCLUSIONS The CCM manual has been developed on the basis of previous literature and well-established questionnaires following theoretical aspects and prior scientific work covering individual domains of life of people with MS. Within the COCOS-MS study, its feasibility is being tested meticulously. It allows for a standardized assessment while being tailored to the individual. At the end of the intervention period, it will be analyzed statistically and qualitatively. Consequently, conclusions can be drawn as to whether the CCM manual is feasible or has to be adapted for use in standard care after analyzation. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE The CCM manual serves as a tool for the continuous, long-term, cross-sectoral care for patients suffering from severe MS and their caregivers. The manual provides guidance in adequately addressing patients' complex symptoms, problems, and needs, as well as assessing existing resources both at the individual patient level and at a superordinate level.
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Affiliation(s)
- Anne Müller
- KOKOS-MS trial group: Anne Müller, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Beatrix Münzberg, is from the Department of Neurology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Clemens Warnke, is from the Department of Neurology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Dirk Müller, is from the Faculty of Medicine and University Hospital, Institute for Health Economics and Clinical Epidemiology (IGKE), University of Cologne, Cologne, Germany. Dorthe Hobus, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Gundula Palmbach, is from the Faculty of Medicine and University Hospital, Clinical Trials Centre Cologne (CTCC), University of Cologne, Cologne, Germany. Heidrun Golla, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Isabel Franke, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Kim Dillen, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Martin Hellmich, is from the Faculty of Medicine and University Hospital, Institute of Medical Statistics and Computational Biology (IMSB), University of Cologne, Cologne, Germany. Monika Höveler, is from the Department of Neurology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Solveig Ungeheuer, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Sophia Kochs, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Veronika Dunkl, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Yasemin Göreci, is from the Department of Neurology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
- Anne Müller, MA , studied social work (BA) and rehabilitation sciences (MA). She is currently working as a researcher and case manager in the COCOS-MS study at the Department of Palliative Medicine of the University Hospital Cologne and perusing her PhD studies in health sciences at the University of Cologne
- Kim Dillen, PhD, is a postdoctoral researcher at the Department of Palliative Medicine of the University Hospital Cologne. She has published research carried out in various patient populations and has many years of research as well as clinical experience as neuropsychologist in both Canada and Germany
- Thomas Dojan, MSc, studied psychology (MSc) and philosophy (BA). He is a licensed psycho-oncologist (Deutsche Krebsgesellschaft), currently working as a researcher at the Department of Palliative Medicine of the University Hospital Cologne as well as perusing PhD studies in philosophy at the University of Cologne and The Polish Academy of Sciences
- Solveig Ungeheuer, BA, worked as a palliative care nurse and studied social work (BA). She is currently working as a certified case manager in the COCOS-MS study at the Department of Palliative Medicine of the University Hospital Cologne
- Yasemin Göreci, MD, is a neurology resident working in the department of neurology at the University Hospital of Cologne. She is a clinical scientist and study physician at the COCOS-MS research project. Her main research focus is neuroimmunology and clinical studies regarding patients with multiple sclerosis
- Veronika Dunkl, MD, studied medicine and is a specialist for neurology and palliative care medicine. She did her doctorate in medicine in 2015. She is currently working as a physician and project manager in the COCOS-MS study at the Department of Palliative Medicine of the University Hospital Cologne
- Raymond Voltz, MD, is professor and since 2004, he is chair for palliative medicine at the University Hospital Cologne, and currently, he is the chair of its research ethics committee. One of his research focuses is the improvement of care of severely affected patients in the palliative context
- Peter Loecherbach, PhD , is professor of social work at the Catholic University of Applied Sciences in Mainz, where he served as rector for 7 years. He studied social work and pedagogy. He is case management instructor and chairman of the German Society for Care and Case Management (DGCC)
- Warnke, MD, is professor, consultant of neurology at the University Hospital Cologne since 2017. At his current affiliation, he is cohead of the MS center including an outpatient MS clinic. Focus of his research is clinical neuroimmunology, including clinical MS research and neurovirology with focus on progressive multifocal leukoencephalopathy (PML)
- Heidrun Golla, MD, professor, is neurologist, psychotherapist, pychoanalyst (DGIP), and palliative care physician. After her training as a neurologist at the University Clinic of Tübingen, she has been working at the Department of Palliative Medicine of the University Hospital Cologne since 2006
| | - Kim Dillen
- KOKOS-MS trial group: Anne Müller, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Beatrix Münzberg, is from the Department of Neurology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Clemens Warnke, is from the Department of Neurology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Dirk Müller, is from the Faculty of Medicine and University Hospital, Institute for Health Economics and Clinical Epidemiology (IGKE), University of Cologne, Cologne, Germany. Dorthe Hobus, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Gundula Palmbach, is from the Faculty of Medicine and University Hospital, Clinical Trials Centre Cologne (CTCC), University of Cologne, Cologne, Germany. Heidrun Golla, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Isabel Franke, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Kim Dillen, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Martin Hellmich, is from the Faculty of Medicine and University Hospital, Institute of Medical Statistics and Computational Biology (IMSB), University of Cologne, Cologne, Germany. Monika Höveler, is from the Department of Neurology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Solveig Ungeheuer, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Sophia Kochs, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Veronika Dunkl, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Yasemin Göreci, is from the Department of Neurology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
- Anne Müller, MA , studied social work (BA) and rehabilitation sciences (MA). She is currently working as a researcher and case manager in the COCOS-MS study at the Department of Palliative Medicine of the University Hospital Cologne and perusing her PhD studies in health sciences at the University of Cologne
- Kim Dillen, PhD, is a postdoctoral researcher at the Department of Palliative Medicine of the University Hospital Cologne. She has published research carried out in various patient populations and has many years of research as well as clinical experience as neuropsychologist in both Canada and Germany
- Thomas Dojan, MSc, studied psychology (MSc) and philosophy (BA). He is a licensed psycho-oncologist (Deutsche Krebsgesellschaft), currently working as a researcher at the Department of Palliative Medicine of the University Hospital Cologne as well as perusing PhD studies in philosophy at the University of Cologne and The Polish Academy of Sciences
- Solveig Ungeheuer, BA, worked as a palliative care nurse and studied social work (BA). She is currently working as a certified case manager in the COCOS-MS study at the Department of Palliative Medicine of the University Hospital Cologne
- Yasemin Göreci, MD, is a neurology resident working in the department of neurology at the University Hospital of Cologne. She is a clinical scientist and study physician at the COCOS-MS research project. Her main research focus is neuroimmunology and clinical studies regarding patients with multiple sclerosis
- Veronika Dunkl, MD, studied medicine and is a specialist for neurology and palliative care medicine. She did her doctorate in medicine in 2015. She is currently working as a physician and project manager in the COCOS-MS study at the Department of Palliative Medicine of the University Hospital Cologne
- Raymond Voltz, MD, is professor and since 2004, he is chair for palliative medicine at the University Hospital Cologne, and currently, he is the chair of its research ethics committee. One of his research focuses is the improvement of care of severely affected patients in the palliative context
- Peter Loecherbach, PhD , is professor of social work at the Catholic University of Applied Sciences in Mainz, where he served as rector for 7 years. He studied social work and pedagogy. He is case management instructor and chairman of the German Society for Care and Case Management (DGCC)
- Warnke, MD, is professor, consultant of neurology at the University Hospital Cologne since 2017. At his current affiliation, he is cohead of the MS center including an outpatient MS clinic. Focus of his research is clinical neuroimmunology, including clinical MS research and neurovirology with focus on progressive multifocal leukoencephalopathy (PML)
- Heidrun Golla, MD, professor, is neurologist, psychotherapist, pychoanalyst (DGIP), and palliative care physician. After her training as a neurologist at the University Clinic of Tübingen, she has been working at the Department of Palliative Medicine of the University Hospital Cologne since 2006
| | - Thomas Dojan
- KOKOS-MS trial group: Anne Müller, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Beatrix Münzberg, is from the Department of Neurology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Clemens Warnke, is from the Department of Neurology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Dirk Müller, is from the Faculty of Medicine and University Hospital, Institute for Health Economics and Clinical Epidemiology (IGKE), University of Cologne, Cologne, Germany. Dorthe Hobus, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Gundula Palmbach, is from the Faculty of Medicine and University Hospital, Clinical Trials Centre Cologne (CTCC), University of Cologne, Cologne, Germany. Heidrun Golla, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Isabel Franke, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Kim Dillen, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Martin Hellmich, is from the Faculty of Medicine and University Hospital, Institute of Medical Statistics and Computational Biology (IMSB), University of Cologne, Cologne, Germany. Monika Höveler, is from the Department of Neurology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Solveig Ungeheuer, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Sophia Kochs, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Veronika Dunkl, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Yasemin Göreci, is from the Department of Neurology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
- Anne Müller, MA , studied social work (BA) and rehabilitation sciences (MA). She is currently working as a researcher and case manager in the COCOS-MS study at the Department of Palliative Medicine of the University Hospital Cologne and perusing her PhD studies in health sciences at the University of Cologne
- Kim Dillen, PhD, is a postdoctoral researcher at the Department of Palliative Medicine of the University Hospital Cologne. She has published research carried out in various patient populations and has many years of research as well as clinical experience as neuropsychologist in both Canada and Germany
- Thomas Dojan, MSc, studied psychology (MSc) and philosophy (BA). He is a licensed psycho-oncologist (Deutsche Krebsgesellschaft), currently working as a researcher at the Department of Palliative Medicine of the University Hospital Cologne as well as perusing PhD studies in philosophy at the University of Cologne and The Polish Academy of Sciences
- Solveig Ungeheuer, BA, worked as a palliative care nurse and studied social work (BA). She is currently working as a certified case manager in the COCOS-MS study at the Department of Palliative Medicine of the University Hospital Cologne
- Yasemin Göreci, MD, is a neurology resident working in the department of neurology at the University Hospital of Cologne. She is a clinical scientist and study physician at the COCOS-MS research project. Her main research focus is neuroimmunology and clinical studies regarding patients with multiple sclerosis
- Veronika Dunkl, MD, studied medicine and is a specialist for neurology and palliative care medicine. She did her doctorate in medicine in 2015. She is currently working as a physician and project manager in the COCOS-MS study at the Department of Palliative Medicine of the University Hospital Cologne
- Raymond Voltz, MD, is professor and since 2004, he is chair for palliative medicine at the University Hospital Cologne, and currently, he is the chair of its research ethics committee. One of his research focuses is the improvement of care of severely affected patients in the palliative context
- Peter Loecherbach, PhD , is professor of social work at the Catholic University of Applied Sciences in Mainz, where he served as rector for 7 years. He studied social work and pedagogy. He is case management instructor and chairman of the German Society for Care and Case Management (DGCC)
- Warnke, MD, is professor, consultant of neurology at the University Hospital Cologne since 2017. At his current affiliation, he is cohead of the MS center including an outpatient MS clinic. Focus of his research is clinical neuroimmunology, including clinical MS research and neurovirology with focus on progressive multifocal leukoencephalopathy (PML)
- Heidrun Golla, MD, professor, is neurologist, psychotherapist, pychoanalyst (DGIP), and palliative care physician. After her training as a neurologist at the University Clinic of Tübingen, she has been working at the Department of Palliative Medicine of the University Hospital Cologne since 2006
| | - Solveig Ungeheuer
- KOKOS-MS trial group: Anne Müller, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Beatrix Münzberg, is from the Department of Neurology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Clemens Warnke, is from the Department of Neurology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Dirk Müller, is from the Faculty of Medicine and University Hospital, Institute for Health Economics and Clinical Epidemiology (IGKE), University of Cologne, Cologne, Germany. Dorthe Hobus, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Gundula Palmbach, is from the Faculty of Medicine and University Hospital, Clinical Trials Centre Cologne (CTCC), University of Cologne, Cologne, Germany. Heidrun Golla, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Isabel Franke, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Kim Dillen, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Martin Hellmich, is from the Faculty of Medicine and University Hospital, Institute of Medical Statistics and Computational Biology (IMSB), University of Cologne, Cologne, Germany. Monika Höveler, is from the Department of Neurology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Solveig Ungeheuer, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Sophia Kochs, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Veronika Dunkl, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Yasemin Göreci, is from the Department of Neurology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
- Anne Müller, MA , studied social work (BA) and rehabilitation sciences (MA). She is currently working as a researcher and case manager in the COCOS-MS study at the Department of Palliative Medicine of the University Hospital Cologne and perusing her PhD studies in health sciences at the University of Cologne
- Kim Dillen, PhD, is a postdoctoral researcher at the Department of Palliative Medicine of the University Hospital Cologne. She has published research carried out in various patient populations and has many years of research as well as clinical experience as neuropsychologist in both Canada and Germany
- Thomas Dojan, MSc, studied psychology (MSc) and philosophy (BA). He is a licensed psycho-oncologist (Deutsche Krebsgesellschaft), currently working as a researcher at the Department of Palliative Medicine of the University Hospital Cologne as well as perusing PhD studies in philosophy at the University of Cologne and The Polish Academy of Sciences
- Solveig Ungeheuer, BA, worked as a palliative care nurse and studied social work (BA). She is currently working as a certified case manager in the COCOS-MS study at the Department of Palliative Medicine of the University Hospital Cologne
- Yasemin Göreci, MD, is a neurology resident working in the department of neurology at the University Hospital of Cologne. She is a clinical scientist and study physician at the COCOS-MS research project. Her main research focus is neuroimmunology and clinical studies regarding patients with multiple sclerosis
- Veronika Dunkl, MD, studied medicine and is a specialist for neurology and palliative care medicine. She did her doctorate in medicine in 2015. She is currently working as a physician and project manager in the COCOS-MS study at the Department of Palliative Medicine of the University Hospital Cologne
- Raymond Voltz, MD, is professor and since 2004, he is chair for palliative medicine at the University Hospital Cologne, and currently, he is the chair of its research ethics committee. One of his research focuses is the improvement of care of severely affected patients in the palliative context
- Peter Loecherbach, PhD , is professor of social work at the Catholic University of Applied Sciences in Mainz, where he served as rector for 7 years. He studied social work and pedagogy. He is case management instructor and chairman of the German Society for Care and Case Management (DGCC)
- Warnke, MD, is professor, consultant of neurology at the University Hospital Cologne since 2017. At his current affiliation, he is cohead of the MS center including an outpatient MS clinic. Focus of his research is clinical neuroimmunology, including clinical MS research and neurovirology with focus on progressive multifocal leukoencephalopathy (PML)
- Heidrun Golla, MD, professor, is neurologist, psychotherapist, pychoanalyst (DGIP), and palliative care physician. After her training as a neurologist at the University Clinic of Tübingen, she has been working at the Department of Palliative Medicine of the University Hospital Cologne since 2006
| | - Yasemin Goereci
- KOKOS-MS trial group: Anne Müller, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Beatrix Münzberg, is from the Department of Neurology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Clemens Warnke, is from the Department of Neurology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Dirk Müller, is from the Faculty of Medicine and University Hospital, Institute for Health Economics and Clinical Epidemiology (IGKE), University of Cologne, Cologne, Germany. Dorthe Hobus, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Gundula Palmbach, is from the Faculty of Medicine and University Hospital, Clinical Trials Centre Cologne (CTCC), University of Cologne, Cologne, Germany. Heidrun Golla, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Isabel Franke, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Kim Dillen, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Martin Hellmich, is from the Faculty of Medicine and University Hospital, Institute of Medical Statistics and Computational Biology (IMSB), University of Cologne, Cologne, Germany. Monika Höveler, is from the Department of Neurology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Solveig Ungeheuer, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Sophia Kochs, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Veronika Dunkl, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Yasemin Göreci, is from the Department of Neurology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
- Anne Müller, MA , studied social work (BA) and rehabilitation sciences (MA). She is currently working as a researcher and case manager in the COCOS-MS study at the Department of Palliative Medicine of the University Hospital Cologne and perusing her PhD studies in health sciences at the University of Cologne
- Kim Dillen, PhD, is a postdoctoral researcher at the Department of Palliative Medicine of the University Hospital Cologne. She has published research carried out in various patient populations and has many years of research as well as clinical experience as neuropsychologist in both Canada and Germany
- Thomas Dojan, MSc, studied psychology (MSc) and philosophy (BA). He is a licensed psycho-oncologist (Deutsche Krebsgesellschaft), currently working as a researcher at the Department of Palliative Medicine of the University Hospital Cologne as well as perusing PhD studies in philosophy at the University of Cologne and The Polish Academy of Sciences
- Solveig Ungeheuer, BA, worked as a palliative care nurse and studied social work (BA). She is currently working as a certified case manager in the COCOS-MS study at the Department of Palliative Medicine of the University Hospital Cologne
- Yasemin Göreci, MD, is a neurology resident working in the department of neurology at the University Hospital of Cologne. She is a clinical scientist and study physician at the COCOS-MS research project. Her main research focus is neuroimmunology and clinical studies regarding patients with multiple sclerosis
- Veronika Dunkl, MD, studied medicine and is a specialist for neurology and palliative care medicine. She did her doctorate in medicine in 2015. She is currently working as a physician and project manager in the COCOS-MS study at the Department of Palliative Medicine of the University Hospital Cologne
- Raymond Voltz, MD, is professor and since 2004, he is chair for palliative medicine at the University Hospital Cologne, and currently, he is the chair of its research ethics committee. One of his research focuses is the improvement of care of severely affected patients in the palliative context
- Peter Loecherbach, PhD , is professor of social work at the Catholic University of Applied Sciences in Mainz, where he served as rector for 7 years. He studied social work and pedagogy. He is case management instructor and chairman of the German Society for Care and Case Management (DGCC)
- Warnke, MD, is professor, consultant of neurology at the University Hospital Cologne since 2017. At his current affiliation, he is cohead of the MS center including an outpatient MS clinic. Focus of his research is clinical neuroimmunology, including clinical MS research and neurovirology with focus on progressive multifocal leukoencephalopathy (PML)
- Heidrun Golla, MD, professor, is neurologist, psychotherapist, pychoanalyst (DGIP), and palliative care physician. After her training as a neurologist at the University Clinic of Tübingen, she has been working at the Department of Palliative Medicine of the University Hospital Cologne since 2006
| | - Veronika Dunkl
- KOKOS-MS trial group: Anne Müller, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Beatrix Münzberg, is from the Department of Neurology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Clemens Warnke, is from the Department of Neurology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Dirk Müller, is from the Faculty of Medicine and University Hospital, Institute for Health Economics and Clinical Epidemiology (IGKE), University of Cologne, Cologne, Germany. Dorthe Hobus, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Gundula Palmbach, is from the Faculty of Medicine and University Hospital, Clinical Trials Centre Cologne (CTCC), University of Cologne, Cologne, Germany. Heidrun Golla, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Isabel Franke, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Kim Dillen, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Martin Hellmich, is from the Faculty of Medicine and University Hospital, Institute of Medical Statistics and Computational Biology (IMSB), University of Cologne, Cologne, Germany. Monika Höveler, is from the Department of Neurology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Solveig Ungeheuer, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Sophia Kochs, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Veronika Dunkl, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Yasemin Göreci, is from the Department of Neurology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
- Anne Müller, MA , studied social work (BA) and rehabilitation sciences (MA). She is currently working as a researcher and case manager in the COCOS-MS study at the Department of Palliative Medicine of the University Hospital Cologne and perusing her PhD studies in health sciences at the University of Cologne
- Kim Dillen, PhD, is a postdoctoral researcher at the Department of Palliative Medicine of the University Hospital Cologne. She has published research carried out in various patient populations and has many years of research as well as clinical experience as neuropsychologist in both Canada and Germany
- Thomas Dojan, MSc, studied psychology (MSc) and philosophy (BA). He is a licensed psycho-oncologist (Deutsche Krebsgesellschaft), currently working as a researcher at the Department of Palliative Medicine of the University Hospital Cologne as well as perusing PhD studies in philosophy at the University of Cologne and The Polish Academy of Sciences
- Solveig Ungeheuer, BA, worked as a palliative care nurse and studied social work (BA). She is currently working as a certified case manager in the COCOS-MS study at the Department of Palliative Medicine of the University Hospital Cologne
- Yasemin Göreci, MD, is a neurology resident working in the department of neurology at the University Hospital of Cologne. She is a clinical scientist and study physician at the COCOS-MS research project. Her main research focus is neuroimmunology and clinical studies regarding patients with multiple sclerosis
- Veronika Dunkl, MD, studied medicine and is a specialist for neurology and palliative care medicine. She did her doctorate in medicine in 2015. She is currently working as a physician and project manager in the COCOS-MS study at the Department of Palliative Medicine of the University Hospital Cologne
- Raymond Voltz, MD, is professor and since 2004, he is chair for palliative medicine at the University Hospital Cologne, and currently, he is the chair of its research ethics committee. One of his research focuses is the improvement of care of severely affected patients in the palliative context
- Peter Loecherbach, PhD , is professor of social work at the Catholic University of Applied Sciences in Mainz, where he served as rector for 7 years. He studied social work and pedagogy. He is case management instructor and chairman of the German Society for Care and Case Management (DGCC)
- Warnke, MD, is professor, consultant of neurology at the University Hospital Cologne since 2017. At his current affiliation, he is cohead of the MS center including an outpatient MS clinic. Focus of his research is clinical neuroimmunology, including clinical MS research and neurovirology with focus on progressive multifocal leukoencephalopathy (PML)
- Heidrun Golla, MD, professor, is neurologist, psychotherapist, pychoanalyst (DGIP), and palliative care physician. After her training as a neurologist at the University Clinic of Tübingen, she has been working at the Department of Palliative Medicine of the University Hospital Cologne since 2006
| | - Raymond Voltz
- KOKOS-MS trial group: Anne Müller, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Beatrix Münzberg, is from the Department of Neurology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Clemens Warnke, is from the Department of Neurology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Dirk Müller, is from the Faculty of Medicine and University Hospital, Institute for Health Economics and Clinical Epidemiology (IGKE), University of Cologne, Cologne, Germany. Dorthe Hobus, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Gundula Palmbach, is from the Faculty of Medicine and University Hospital, Clinical Trials Centre Cologne (CTCC), University of Cologne, Cologne, Germany. Heidrun Golla, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Isabel Franke, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Kim Dillen, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Martin Hellmich, is from the Faculty of Medicine and University Hospital, Institute of Medical Statistics and Computational Biology (IMSB), University of Cologne, Cologne, Germany. Monika Höveler, is from the Department of Neurology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Solveig Ungeheuer, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Sophia Kochs, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Veronika Dunkl, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Yasemin Göreci, is from the Department of Neurology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
- Anne Müller, MA , studied social work (BA) and rehabilitation sciences (MA). She is currently working as a researcher and case manager in the COCOS-MS study at the Department of Palliative Medicine of the University Hospital Cologne and perusing her PhD studies in health sciences at the University of Cologne
- Kim Dillen, PhD, is a postdoctoral researcher at the Department of Palliative Medicine of the University Hospital Cologne. She has published research carried out in various patient populations and has many years of research as well as clinical experience as neuropsychologist in both Canada and Germany
- Thomas Dojan, MSc, studied psychology (MSc) and philosophy (BA). He is a licensed psycho-oncologist (Deutsche Krebsgesellschaft), currently working as a researcher at the Department of Palliative Medicine of the University Hospital Cologne as well as perusing PhD studies in philosophy at the University of Cologne and The Polish Academy of Sciences
- Solveig Ungeheuer, BA, worked as a palliative care nurse and studied social work (BA). She is currently working as a certified case manager in the COCOS-MS study at the Department of Palliative Medicine of the University Hospital Cologne
- Yasemin Göreci, MD, is a neurology resident working in the department of neurology at the University Hospital of Cologne. She is a clinical scientist and study physician at the COCOS-MS research project. Her main research focus is neuroimmunology and clinical studies regarding patients with multiple sclerosis
- Veronika Dunkl, MD, studied medicine and is a specialist for neurology and palliative care medicine. She did her doctorate in medicine in 2015. She is currently working as a physician and project manager in the COCOS-MS study at the Department of Palliative Medicine of the University Hospital Cologne
- Raymond Voltz, MD, is professor and since 2004, he is chair for palliative medicine at the University Hospital Cologne, and currently, he is the chair of its research ethics committee. One of his research focuses is the improvement of care of severely affected patients in the palliative context
- Peter Loecherbach, PhD , is professor of social work at the Catholic University of Applied Sciences in Mainz, where he served as rector for 7 years. He studied social work and pedagogy. He is case management instructor and chairman of the German Society for Care and Case Management (DGCC)
- Warnke, MD, is professor, consultant of neurology at the University Hospital Cologne since 2017. At his current affiliation, he is cohead of the MS center including an outpatient MS clinic. Focus of his research is clinical neuroimmunology, including clinical MS research and neurovirology with focus on progressive multifocal leukoencephalopathy (PML)
- Heidrun Golla, MD, professor, is neurologist, psychotherapist, pychoanalyst (DGIP), and palliative care physician. After her training as a neurologist at the University Clinic of Tübingen, she has been working at the Department of Palliative Medicine of the University Hospital Cologne since 2006
| | - Peter Löcherbach
- KOKOS-MS trial group: Anne Müller, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Beatrix Münzberg, is from the Department of Neurology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Clemens Warnke, is from the Department of Neurology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Dirk Müller, is from the Faculty of Medicine and University Hospital, Institute for Health Economics and Clinical Epidemiology (IGKE), University of Cologne, Cologne, Germany. Dorthe Hobus, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Gundula Palmbach, is from the Faculty of Medicine and University Hospital, Clinical Trials Centre Cologne (CTCC), University of Cologne, Cologne, Germany. Heidrun Golla, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Isabel Franke, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Kim Dillen, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Martin Hellmich, is from the Faculty of Medicine and University Hospital, Institute of Medical Statistics and Computational Biology (IMSB), University of Cologne, Cologne, Germany. Monika Höveler, is from the Department of Neurology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Solveig Ungeheuer, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Sophia Kochs, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Veronika Dunkl, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Yasemin Göreci, is from the Department of Neurology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
- Anne Müller, MA , studied social work (BA) and rehabilitation sciences (MA). She is currently working as a researcher and case manager in the COCOS-MS study at the Department of Palliative Medicine of the University Hospital Cologne and perusing her PhD studies in health sciences at the University of Cologne
- Kim Dillen, PhD, is a postdoctoral researcher at the Department of Palliative Medicine of the University Hospital Cologne. She has published research carried out in various patient populations and has many years of research as well as clinical experience as neuropsychologist in both Canada and Germany
- Thomas Dojan, MSc, studied psychology (MSc) and philosophy (BA). He is a licensed psycho-oncologist (Deutsche Krebsgesellschaft), currently working as a researcher at the Department of Palliative Medicine of the University Hospital Cologne as well as perusing PhD studies in philosophy at the University of Cologne and The Polish Academy of Sciences
- Solveig Ungeheuer, BA, worked as a palliative care nurse and studied social work (BA). She is currently working as a certified case manager in the COCOS-MS study at the Department of Palliative Medicine of the University Hospital Cologne
- Yasemin Göreci, MD, is a neurology resident working in the department of neurology at the University Hospital of Cologne. She is a clinical scientist and study physician at the COCOS-MS research project. Her main research focus is neuroimmunology and clinical studies regarding patients with multiple sclerosis
- Veronika Dunkl, MD, studied medicine and is a specialist for neurology and palliative care medicine. She did her doctorate in medicine in 2015. She is currently working as a physician and project manager in the COCOS-MS study at the Department of Palliative Medicine of the University Hospital Cologne
- Raymond Voltz, MD, is professor and since 2004, he is chair for palliative medicine at the University Hospital Cologne, and currently, he is the chair of its research ethics committee. One of his research focuses is the improvement of care of severely affected patients in the palliative context
- Peter Loecherbach, PhD , is professor of social work at the Catholic University of Applied Sciences in Mainz, where he served as rector for 7 years. He studied social work and pedagogy. He is case management instructor and chairman of the German Society for Care and Case Management (DGCC)
- Warnke, MD, is professor, consultant of neurology at the University Hospital Cologne since 2017. At his current affiliation, he is cohead of the MS center including an outpatient MS clinic. Focus of his research is clinical neuroimmunology, including clinical MS research and neurovirology with focus on progressive multifocal leukoencephalopathy (PML)
- Heidrun Golla, MD, professor, is neurologist, psychotherapist, pychoanalyst (DGIP), and palliative care physician. After her training as a neurologist at the University Clinic of Tübingen, she has been working at the Department of Palliative Medicine of the University Hospital Cologne since 2006
| | - Clemens Warnke
- KOKOS-MS trial group: Anne Müller, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Beatrix Münzberg, is from the Department of Neurology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Clemens Warnke, is from the Department of Neurology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Dirk Müller, is from the Faculty of Medicine and University Hospital, Institute for Health Economics and Clinical Epidemiology (IGKE), University of Cologne, Cologne, Germany. Dorthe Hobus, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Gundula Palmbach, is from the Faculty of Medicine and University Hospital, Clinical Trials Centre Cologne (CTCC), University of Cologne, Cologne, Germany. Heidrun Golla, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Isabel Franke, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Kim Dillen, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Martin Hellmich, is from the Faculty of Medicine and University Hospital, Institute of Medical Statistics and Computational Biology (IMSB), University of Cologne, Cologne, Germany. Monika Höveler, is from the Department of Neurology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Solveig Ungeheuer, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Sophia Kochs, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Veronika Dunkl, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Yasemin Göreci, is from the Department of Neurology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
- Anne Müller, MA , studied social work (BA) and rehabilitation sciences (MA). She is currently working as a researcher and case manager in the COCOS-MS study at the Department of Palliative Medicine of the University Hospital Cologne and perusing her PhD studies in health sciences at the University of Cologne
- Kim Dillen, PhD, is a postdoctoral researcher at the Department of Palliative Medicine of the University Hospital Cologne. She has published research carried out in various patient populations and has many years of research as well as clinical experience as neuropsychologist in both Canada and Germany
- Thomas Dojan, MSc, studied psychology (MSc) and philosophy (BA). He is a licensed psycho-oncologist (Deutsche Krebsgesellschaft), currently working as a researcher at the Department of Palliative Medicine of the University Hospital Cologne as well as perusing PhD studies in philosophy at the University of Cologne and The Polish Academy of Sciences
- Solveig Ungeheuer, BA, worked as a palliative care nurse and studied social work (BA). She is currently working as a certified case manager in the COCOS-MS study at the Department of Palliative Medicine of the University Hospital Cologne
- Yasemin Göreci, MD, is a neurology resident working in the department of neurology at the University Hospital of Cologne. She is a clinical scientist and study physician at the COCOS-MS research project. Her main research focus is neuroimmunology and clinical studies regarding patients with multiple sclerosis
- Veronika Dunkl, MD, studied medicine and is a specialist for neurology and palliative care medicine. She did her doctorate in medicine in 2015. She is currently working as a physician and project manager in the COCOS-MS study at the Department of Palliative Medicine of the University Hospital Cologne
- Raymond Voltz, MD, is professor and since 2004, he is chair for palliative medicine at the University Hospital Cologne, and currently, he is the chair of its research ethics committee. One of his research focuses is the improvement of care of severely affected patients in the palliative context
- Peter Loecherbach, PhD , is professor of social work at the Catholic University of Applied Sciences in Mainz, where he served as rector for 7 years. He studied social work and pedagogy. He is case management instructor and chairman of the German Society for Care and Case Management (DGCC)
- Warnke, MD, is professor, consultant of neurology at the University Hospital Cologne since 2017. At his current affiliation, he is cohead of the MS center including an outpatient MS clinic. Focus of his research is clinical neuroimmunology, including clinical MS research and neurovirology with focus on progressive multifocal leukoencephalopathy (PML)
- Heidrun Golla, MD, professor, is neurologist, psychotherapist, pychoanalyst (DGIP), and palliative care physician. After her training as a neurologist at the University Clinic of Tübingen, she has been working at the Department of Palliative Medicine of the University Hospital Cologne since 2006
| | - Heidrun Golla
- KOKOS-MS trial group: Anne Müller, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Beatrix Münzberg, is from the Department of Neurology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Clemens Warnke, is from the Department of Neurology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Dirk Müller, is from the Faculty of Medicine and University Hospital, Institute for Health Economics and Clinical Epidemiology (IGKE), University of Cologne, Cologne, Germany. Dorthe Hobus, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Gundula Palmbach, is from the Faculty of Medicine and University Hospital, Clinical Trials Centre Cologne (CTCC), University of Cologne, Cologne, Germany. Heidrun Golla, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Isabel Franke, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Kim Dillen, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Martin Hellmich, is from the Faculty of Medicine and University Hospital, Institute of Medical Statistics and Computational Biology (IMSB), University of Cologne, Cologne, Germany. Monika Höveler, is from the Department of Neurology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Solveig Ungeheuer, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Sophia Kochs, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Veronika Dunkl, is from the Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany. Yasemin Göreci, is from the Department of Neurology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
- Anne Müller, MA , studied social work (BA) and rehabilitation sciences (MA). She is currently working as a researcher and case manager in the COCOS-MS study at the Department of Palliative Medicine of the University Hospital Cologne and perusing her PhD studies in health sciences at the University of Cologne
- Kim Dillen, PhD, is a postdoctoral researcher at the Department of Palliative Medicine of the University Hospital Cologne. She has published research carried out in various patient populations and has many years of research as well as clinical experience as neuropsychologist in both Canada and Germany
- Thomas Dojan, MSc, studied psychology (MSc) and philosophy (BA). He is a licensed psycho-oncologist (Deutsche Krebsgesellschaft), currently working as a researcher at the Department of Palliative Medicine of the University Hospital Cologne as well as perusing PhD studies in philosophy at the University of Cologne and The Polish Academy of Sciences
- Solveig Ungeheuer, BA, worked as a palliative care nurse and studied social work (BA). She is currently working as a certified case manager in the COCOS-MS study at the Department of Palliative Medicine of the University Hospital Cologne
- Yasemin Göreci, MD, is a neurology resident working in the department of neurology at the University Hospital of Cologne. She is a clinical scientist and study physician at the COCOS-MS research project. Her main research focus is neuroimmunology and clinical studies regarding patients with multiple sclerosis
- Veronika Dunkl, MD, studied medicine and is a specialist for neurology and palliative care medicine. She did her doctorate in medicine in 2015. She is currently working as a physician and project manager in the COCOS-MS study at the Department of Palliative Medicine of the University Hospital Cologne
- Raymond Voltz, MD, is professor and since 2004, he is chair for palliative medicine at the University Hospital Cologne, and currently, he is the chair of its research ethics committee. One of his research focuses is the improvement of care of severely affected patients in the palliative context
- Peter Loecherbach, PhD , is professor of social work at the Catholic University of Applied Sciences in Mainz, where he served as rector for 7 years. He studied social work and pedagogy. He is case management instructor and chairman of the German Society for Care and Case Management (DGCC)
- Warnke, MD, is professor, consultant of neurology at the University Hospital Cologne since 2017. At his current affiliation, he is cohead of the MS center including an outpatient MS clinic. Focus of his research is clinical neuroimmunology, including clinical MS research and neurovirology with focus on progressive multifocal leukoencephalopathy (PML)
- Heidrun Golla, MD, professor, is neurologist, psychotherapist, pychoanalyst (DGIP), and palliative care physician. After her training as a neurologist at the University Clinic of Tübingen, she has been working at the Department of Palliative Medicine of the University Hospital Cologne since 2006
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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. [PMID: 35747549 PMCID: PMC9208418 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
Background and Objectives 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% nononcology neurosciences population, and consensus or guidelines documents regarding palliative neurosciences or trigger/referral criteria. We excluded studies that had an oncologic 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 Preferred Reporting Items for Systematic Reviews and Meta-Analyses 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 1,748 publications, of which 22 articles met the eligibility criteria. Studies were considered in 2 main groups: (A) studies designed specifically to identify trigger criteria for referral to specialized neuropalliative care services (n = 9) and (B) studies that retrospectively reported the reason for referral to specialized palliative care or reflected a consensus statement among 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, amyotrophic lateral sclerosis, 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. (PROSPERO registration number: CRD42020135791, crd.york.ac.uk/prospero).
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Affiliation(s)
- Kayla McConvey
- Department of Clinical Neurological Sciences (KM, KK, MEJ, TEG), Western University, London, Ontario, Canada; and Library Services (AEI), London Health Sciences Centre, Ontario, Canada
| | - Karnig Kazazian
- Department of Clinical Neurological Sciences (KM, KK, MEJ, TEG), Western University, London, Ontario, Canada; and Library Services (AEI), London Health Sciences Centre, Ontario, Canada
| | - Alla E Iansavichene
- Department of Clinical Neurological Sciences (KM, KK, MEJ, TEG), Western University, London, Ontario, Canada; and Library Services (AEI), London Health Sciences Centre, Ontario, Canada
| | - Mary E Jenkins
- Department of Clinical Neurological Sciences (KM, KK, MEJ, TEG), Western University, London, Ontario, Canada; and Library Services (AEI), London Health Sciences Centre, Ontario, Canada
| | - Teneille Emma Gofton
- Department of Clinical Neurological Sciences (KM, KK, MEJ, TEG), Western University, London, Ontario, Canada; and Library Services (AEI), London Health Sciences Centre, Ontario, Canada
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Golla H, Dillen K, Hellmich M, Dojan T, Ungeheuer S, Schmalz P, Staß A, Mildenberger V, Goereci Y, Dunkl V, Strupp J, Fink GR, Voltz R, Stock S, Cornely O, Stahmann A, Müller A, Löcherbach P, Burghaus L, Limmroth V, Bonmann E, Gerbershagen K, Nelles G, Joist T, Haas J, Temmes H, Warnke C. Communication, Coordination, and Security for People with Multiple Sclerosis (COCOS-MS): a randomised phase II clinical trial protocol. BMJ Open 2022; 12:e049300. [PMID: 35078833 PMCID: PMC8796263 DOI: 10.1136/bmjopen-2021-049300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 10/29/2021] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Patients with multiple sclerosis (MS) have complex needs that range from organising one's everyday life to measures of disease-specific therapy monitoring to palliative care. Patients with MS are likely to depend on multiple healthcare providers and various authorities, which are often difficult to coordinate. Thus, they will probably benefit from comprehensive cross-sectoral coordination of services provided by care and case management (CCM). Though studies have shown that case management improves quality of life (QoL), functional status and reduces service use, such benefits have not yet been investigated in severely affected patients with MS. In this explorative phase ll clinical trial, we evaluated a CCM with long-term, cross-sectoral and outreaching services and, in addition, considered the unit of care (patients and caregivers). METHODS AND ANALYSIS Eighty patients with MS and their caregivers will be randomly assigned to either the control (standard care) or the intervention group (standard care plus CCM (for 12 months)). Regular data assessments will be done at baseline and then at 3-month intervals. As primary outcome, we will evaluate patients' QoL. Secondary outcomes are patients' treatment-related risk perception, palliative care needs, anxiety/depression, use of healthcare services, caregivers' burden and QoL, meeting patients' and caregivers' needs, and evaluating the CCM intervention. We will also evaluate CCM through individual interviews and focus groups. The sample size calculation is based on a standardised effect of 0.5, and one baseline and four follow-up assessments (with correlation 0.5). Linear mixed models for repeated measures will be applied to analyse changes in quantitative outcomes over time. Multiple imputation approaches are taken to assess the robustness of the results. The explorative approach (phase ll clinical trial) with embedded qualitative research will allow for the development of a final design for a confirmative phase lll trial. ETHICS AND DISSEMINATION The trial will be conducted under the Declaration of Helsinki and has been approved by the Ethics Commission of Cologne University's Faculty of Medicine. Trial results will be published in an open-access scientific journal and presented at conferences. TRIAL REGISTRATION NUMBER German Register for Clinical Studies (DRKS) (DRKS00022771).
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Affiliation(s)
- Heidrun Golla
- Department of Palliative Medicine, University of Cologne, Cologne, Germany
| | - Kim Dillen
- Department of Palliative Medicine, University of Cologne, Cologne, Germany
| | - Martin Hellmich
- Institute of Medical Statistics and Computational Biology (IMSB), University of Cologne, Cologne, Germany
| | - Thomas Dojan
- Department of Palliative Medicine, University of Cologne, Cologne, Germany
| | - Solveig Ungeheuer
- Department of Palliative Medicine, University of Cologne, Cologne, Germany
| | - Petra Schmalz
- Clinical Trials Centre Cologne (CTCC), University of Cologne, Cologne, Germany
| | - Angelika Staß
- Clinical Trials Centre Cologne (CTCC), University of Cologne, Cologne, Germany
| | - Vanessa Mildenberger
- Institute for Health Economics and Clinical Epidemiology (IGKE), University of Cologne, Cologne, Germany
| | - Yasemin Goereci
- Department of Neurology, University of Cologne, Cologne, Nordrhein-Westfalen, Germany
| | - Veronika Dunkl
- Department of Palliative Medicine, University of Cologne, Cologne, Germany
| | - Julia Strupp
- Department of Palliative Medicine, University of Cologne, Cologne, Germany
| | - Gereon R Fink
- Department of Neurology, University of Cologne, Cologne, Nordrhein-Westfalen, Germany
- Cognitive Neuroscience, Institute of Neurosciences and Medicine, Jülich, Germany
| | - Raymond Voltz
- Department of Palliative Medicine, University of Cologne, Cologne, Germany
- Clinical Trials Centre Cologne (CTCC), University of Cologne, Cologne, Germany
- Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), University of Cologne, Cologne, Germany
- Center for Health Services Research (ZVFK), University of Cologne, Cologne, Germany
| | - Stephanie Stock
- Institute for Health Economics and Clinical Epidemiology (IGKE), University of Cologne, Cologne, Germany
| | - Oliver Cornely
- Clinical Trials Centre Cologne (CTCC), University of Cologne, Cologne, Germany
| | - Alexander Stahmann
- MS-Registry by the German MS-Society, MS Forschungs- und Projektentwicklungs-gGmbH, Hannover, Germany
| | - Anne Müller
- Department of Palliative Medicine, University of Cologne, Cologne, Germany
| | - Peter Löcherbach
- German Society for Care and Case Management (DGCC), Mainz, Germany
| | - Lothar Burghaus
- Department of Neurology, Heilig Geist-Krankenhaus Köln, Cologne, Germany
| | | | | | | | - Gereon Nelles
- NeuroMed Campus, MedCampus Hohenlind, Cologne, Germany
| | - Thomas Joist
- Academic Teaching Practice, University of Cologne, Cologne, Germany
| | - Judith Haas
- German Multiple Sclerosis Society Federal Association (DMSG), Hannover, Germany
| | - Herbert Temmes
- German Multiple Sclerosis Society Federal Association (DMSG), Hannover, Germany
| | - Clemens Warnke
- Department of Neurology, University of Cologne, Cologne, Nordrhein-Westfalen, Germany
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8
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Leeper H, Cooper D, Armstrong T. Palliative Care Intervention Trials for Adults Living With Progressive Central Nervous System Diseases and Their Caregivers: A Systematic Review. J Pain Symptom Manage 2022; 63:e88-e110. [PMID: 34147576 PMCID: PMC8683574 DOI: 10.1016/j.jpainsymman.2021.06.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 06/06/2021] [Accepted: 06/07/2021] [Indexed: 11/23/2022]
Abstract
CONTEXT Interest in implementing palliative care for adults living with progressive central nervous system diseases (PCNSD) and their caregivers is increasing. OBJECTIVES To inform evidence-based practice and future research by critically evaluating randomized clinical trials (RCTs) investigating palliative care interventions (PCIs) for adults living with PCNSD and their caregivers using self-reported outcomes and the patient- and caregiver-reported outcome measures employed. METHODS A systematic search using PRISMA methods of EMBASE, PubMed, Scopus, Web of Science databases using index and keyword methods for articles published from inception through February 28, 2021 was performed. RCTs investigating PCI as their primary aim using patient- and/or caregiver-reported outcomes to assess PCI effectiveness in adults living with PCNSD and their caregivers were included for qualitative synthesis. RESULTS Five RCTs met criteria and used 21 unique outcome measures. Pooled patient diagnoses included multiple sclerosis, motor neuron disease and movement disorders, primarily Parkinson's Disease. All five RCTs assessed PCI effectiveness on patient symptom burden and caregiver burden, and three RCTs used patient QOL as a primary outcome. Overall risk of bias was low. Pooled positive findings were limited to very modest changes in patient QOL, specific physical symptoms and caregiver burden. Most outcome measures lacked clinimetric responsiveness to detect change whether caused by disease or an intervention to the patient or caregiver. CONCLUSION Sparse, low-certainty evidence for PCI impact on patient QOL, symptom burden and caregiver burden indicate future research should consider refining study populations, interventions, outcomes assessed and outcome measures to detect any change due to PCI.
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Affiliation(s)
- HeatherE Leeper
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland; Office of Research Services, Division of Library Services, National Institutes of Health, Bethesda, Maryland.
| | - Diane Cooper
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland; Office of Research Services, Division of Library Services, National Institutes of Health, Bethesda, Maryland
| | - TerriS Armstrong
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland; Office of Research Services, Division of Library Services, National Institutes of Health, Bethesda, Maryland
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The PCOC Symptom Assessment Scale (SAS): A valid measure for daily use at point of care and in palliative care programs. PLoS One 2021; 16:e0247250. [PMID: 33765077 PMCID: PMC7993777 DOI: 10.1371/journal.pone.0247250] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 02/03/2021] [Indexed: 11/19/2022] Open
Abstract
Background Very few measures are used successfully as part of routine care within national palliative care outcome programs. Only a handful of studies examine these measures. The aim of this study is to evaluate the validity of a measure used in a national outcomes program: the Palliative Care Outcomes Collaboration Symptom Assessment Scale (PCOC SAS). Methods A retrospective multi-site cohort study with secondary analysis of routinely collected patient-level data to assess PCOC SAS’s internal consistency, construct validity, reliability, interpretability, acceptability and sensitivity. The analyses used two sets, with data collected by inpatient and community palliative care services registered with the Australian national PCOC. Results Dataset one included 1,117 patients receiving palliative care from 21 services. Dataset two included 5,294 patients receiving palliative care from 119 PCOC services. PCOC SAS demonstrated the ability to detect and discriminate distress by palliative care phase, functional status and diagnosis. Excellent and good convergent and discriminant validity were demonstrated. Fair through to substantial inter-rater and intra-rater reliability levels were evidenced. Sufficient interpretability resulted along with necessary levels of acceptability and sensitivity. Conclusion PCOC SAS is a valid and reliable patient-reported outcome measure suitable for use in routine clinical care with patients requiring palliative and or end-of-life care, including in national outcomes programs.
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Koffman J, Yorganci E, Murtagh F, Yi D, Gao W, Barclay S, Pickles A, Higginson I, Johnson H, Wilson R, Bailey S, Ewart C, Evans C. The AMBER care bundle for hospital inpatients with uncertain recovery nearing the end of life: the ImproveCare feasibility cluster RCT. Health Technol Assess 2020; 23:1-150. [PMID: 31594555 DOI: 10.3310/hta23550] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Patients admitted to hospital with a terminal illness and uncertain recovery often receive inconsistent care and do not have the opportunity to die in their preferred place of death. Previous end-of-life care packages, such as the Liverpool Care Pathway for the Dying Patient, have sometimes been badly implemented. The AMBER (Assessment; Management; Best practice; Engagement; Recovery uncertain) care bundle was developed to remedy this. It has not been evaluated in a randomised trial, but a definitive trial would face many hurdles. OBJECTIVE To optimise the design of and determine the feasibility of a pragmatic, multicentre, cluster randomised controlled trial of the AMBER care bundle compared with best standard care. DESIGN A feasibility cluster randomised controlled trial including semistructured interviews with patients and relatives, focus groups with health-care professionals, non-participant observations of multidisciplinary team meetings, a standard care survey, heat maps and case note reviews. Retrospective data were collected from the family or close friends of deceased patients via a bereavement survey. SETTING Four general medical wards at district general hospitals in England. PARTICIPANTS There were 65 participants (control, n = 36; intervention, n = 29). There were 24 interviews, four focus groups, 15 non-participant meeting observations, six case note reviews and three heat maps, and 15 of out 23 bereavement, standard care surveys were completed. INTERVENTION The AMBER care bundle is implemented by a nurse facilitator. It includes the development and documentation of a medical plan, consideration of outcomes, resuscitation and escalation status and daily plan revisiting. The AMBER care bundle encourages staff, patients and families to talk openly about their preferences and priorities should the worst happen. MAIN OUTCOME MEASURES Two 'candidate' primary outcomes were selected to be evaluated for a future definitive trial: Integrated Palliative care Outcome Scale patient/family anxiety and communication subscale and 'howRwe'. The secondary outcome measures were Integrated Palliative care Outcome Scale symptoms, Australian-modified Karnofsky Performance Status scale, EuroQol-5 Dimensions, five-level version, Client Service Receipt Inventory, recruitment rate, intervention fidelity and intervention acceptability. RESULTS Data were collected for 65 patients. This trial was not powered to measure clinical effectiveness, but variance and changes observed in the Integrated Palliative care Outcome Scale subscale indicated that this measure would probably detect differences within a definitive trial. It was feasible to collect data on health, social and informal care service use and on quality of life at two time points. The AMBER care bundle was broadly acceptable to all stakeholders and was delivered as planned. The emphasis on 'clinical uncertainty' prompted health-care professional awareness of often-overlooked patients. Reviewing patients' AMBER care bundle status was integrated into routine practice. Refinements included simplifying the inclusion criteria and improving health-care professional communication training. Improvements to trial procedures included extending the time devoted to recruitment and simplifying consent procedures. There was also a recommendation to reduce data collected from patients and relatives to minimise burden. LIMITATIONS The recruitment rate was lower than anticipated. The inclusion criteria for the trial were difficult to interpret. Information sheets and consent procedures were too detailed and lengthy for the target population. Health-care professionals' enthusiasm and specialty were not considered while picking trial wards. Participant recruitment took place later during hospital admission and the majority of participants were lost to follow-up because they had been discharged. Those who participated may have different characteristics from those who did not. CONCLUSIONS This feasibility trial has demonstrated that an evaluation of the AMBER care bundle among an acutely unwell patient population, although technically possible, is not practical or feasible. The intervention requires optimisation. TRIAL REGISTRATION Current Controlled Trials ISRCTN36040085. National Institute for Health Research (NIHR) Portfolio registration number 32682. FUNDING This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 55. See the NIHR Journals Library website for further project information.
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Affiliation(s)
| | - Emel Yorganci
- Cicely Saunders Institute, King's College London, London, UK
| | - Fliss Murtagh
- Wolfson Palliative Care Research Centre, University of Hull, Hull, UK
| | - Deokhee Yi
- Cicely Saunders Institute, King's College London, London, UK
| | - Wei Gao
- Cicely Saunders Institute, King's College London, London, UK
| | - Stephen Barclay
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | | | - Irene Higginson
- Cicely Saunders Institute, King's College London, London, UK
| | - Halle Johnson
- Cicely Saunders Institute, King's College London, London, UK
| | - Rebecca Wilson
- Cicely Saunders Institute, King's College London, London, UK
| | | | | | - Catherine Evans
- Cicely Saunders Institute, King's College London, London, UK.,Sussex Community NHS Foundation Trust, Brighton, UK
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11
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Jiang B, Wang H, Xu H. Steroid receptor RNA activator affects the development of poststroke depression by regulating the peroxisome proliferator-activated receptor γ signaling pathway. Neuroreport 2020; 31:48-56. [PMID: 31714481 PMCID: PMC6903361 DOI: 10.1097/wnr.0000000000001367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 08/22/2019] [Indexed: 11/06/2022]
Abstract
The long noncoding RNA, steroid receptor RNA activator (SRA), has been reported to be involved in the development of many types of disease in humans. The aim of this study was to evaluate whether SRA was associated with poststroke depression (PSD). A PSD rat model was established, and depression-like behaviors and sucrose consumption in rats with PSD were analyzed. Reverse transcription-quantitative PCR (RT-PCR), western blot and luciferase dual reporter assay analyses were performed to detect the expression of peroxisome proliferator-activated receptor γ (PPARγ) expression following SRA small interfering RNA (siRNA) treatment. Compared with the control, the horizontal and vertical movement scores and consumption of sucrose solution were decreased in the PSD, PSD + LV-SRA and PSD + pioglitazone groups at 7 days post-SRA-siRNA treatment, while they were increased in the PSD + LV-SRA and PSD + pioglitazone groups. Furthermore, SRA expression in the PSD, PSD + LV-SRA and PSD + pioglitazone groups was lowered compared with the control group at 7 days postinjection. SRA increased the reported luciferase activity, but pioglitazone had no effect on the luciferase activity induced by SRA. SRA upregulated PPARγ mRNA and protein expression, whereas SRA siRNA significantly downregulated its expression. No significant differences in characteristics were identified between rats with and without PSD. SRA was more highly expressed in rats with PSD than rats without PSD. Collectively, this study suggests that SRA is associated with PSD through PPARγ signaling, indicating a potential therapeutic target of SRA for controlling PSD.
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Affiliation(s)
| | | | - Houchi Xu
- Neurosurgery, Rizhao People’s Hospital, Rizhao, Shandong, China
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12
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Latorraca COC, Martimbianco ALC, Pachito DV, Torloni MR, Pacheco RL, Pereira JG, Riera R. Palliative care interventions for people with multiple sclerosis. Cochrane Database Syst Rev 2019; 10:CD012936. [PMID: 31637711 PMCID: PMC6803560 DOI: 10.1002/14651858.cd012936.pub2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND People with multiple sclerosis (MS) have complex symptoms and different types of needs. These demands include how to manage the burden of physical disability as well as how to organise daily life, restructure social roles in the family and at work, preserve personal identity and community roles, keep self-sufficiency in personal care, and how to be part of an integrated care network. Palliative care teams are trained to keep open full and competent lines of communication about symptoms and disease progression, advanced care planning, and end-of-life issues and wishes. Teams create a treatment plan for the total management of symptoms, supporting people and families on decision-making. Despite advances in research and the existence of many interventions to reduce disease activity or to slow the progression of MS, this condition remains a life-limiting disease with symptoms that impact negatively the lives of people with it and their families. OBJECTIVES To assess the effects (benefits and harms) of palliative care interventions compared to usual care for people with any form of multiple sclerosis: relapsing-remitting MS (RRMS), secondary-progressive MS (SPMS), primary-progressive MS (PPMS), and progressive-relapsing MS (PRMS) We also aimed to compare the effects of different palliative care interventions. SEARCH METHODS On 31 October 2018, we conducted a literature search in the specialised register of the Cochrane MS and Rare Diseases of the Central Nervous System Review Group, which contains trials from CENTRAL, MEDLINE, Embase, CINAHL, LILACS, Clinical trials.gov and the World Health Organization International Clinical Trials Registry Platform. We also searched PsycINFO, PEDro and Opengrey. We also handsearched relevant journals and screened the reference lists of published reviews. We contacted researchers in palliative care and multiple sclerosis. SELECTION CRITERIA Randomised controlled trials (RCTs) and cluster randomised trials were eligible for inclusion, as well as the first phase of cross-over trials. We included studies that compared palliative care interventions versus usual care. We also included studies that compared palliative care interventions versus another type of palliative interventions. DATA COLLECTION AND ANALYSIS We used standard Cochrane methodological procedures. We summarised key results and certainty of evidence in a 'Summary of Finding' table that reported outcomes at six or more months of post-intervention. MAIN RESULTS Three studies (146 participants) met our selection criteria. Two studies compared multidisciplinary, fast-track palliative care versus multidisciplinary standard care while on a waiting-list control, and one study compared a multidisciplinary palliative approach versus multidisciplinary standard care at different time points (12, 16, and 24 weeks). Two were RCTs with parallel design (total 94 participants) and one was a cross-over design (52 participants). The three studies assessed palliative care as a home-based intervention. One of the three studies included participants with 'neurodegenerative diseases', with MS people being a subset of the randomised population. We assessed the risk of bias of included studies using Cochrane's 'Risk of Bias' tool.We found no evidence of differences between intervention and control groups in long-time follow-up (> six months post-intervention) for the following outcomes: mean change in health-related quality of life (SEIQoL - higher scores mean better quality of life; MD 4.80, 95% CI -12.32 to 21.92; participants = 62; studies = 1; very low-certainty evidence), serious adverse events (RR 0.97, 95% CI 0.44 to 2.12; participants = 76; studies = 1, 22 events, low-certainty evidence) and hospital admission (RR 0.78, 95% CI 0.24 to 2.52; participants = 76; studies = 1, 10 events, low-certainty evidence).The three included studies did not assess the following outcomes at long term follow-up (> six months post intervention): fatigue, anxiety, depression, disability, cognitive function, relapse-free survival, and sustained progression-free survival.We did not find any trial that compared different types of palliative care with each other. AUTHORS' CONCLUSIONS Based on the findings of the RCTs included in this review, we are uncertain whether palliative care interventions are beneficial for people with MS. There is low- or very low-certainty evidence regarding the difference between palliative care interventions versus usual care for long-term health-related quality of life, adverse events, and hospital admission in patients with MS. For intermediate-term follow-up, we are also uncertain about the effects of palliative care for the outcomes: health-related quality of life (measured by different assessments: SEIQoL or MSIS), disability, anxiety, and depression.
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Affiliation(s)
- Carolina OC Latorraca
- Centro de Estudos de Saúde Baseada em Evidências e Avaliação Tecnológica em SaúdeCochrane BrazilRua Borges Lagoa, 564 cj 63São PauloSPBrazil04038‐000
| | - Ana Luiza C Martimbianco
- Centro de Estudos de Saúde Baseada em Evidências e Avaliação Tecnológica em SaúdeCochrane BrazilRua Borges Lagoa, 564 cj 63São PauloSPBrazil04038‐000
| | - Daniela V Pachito
- Centro de Estudos de Saúde Baseada em Evidências e Avaliação Tecnológica em SaúdeCochrane BrazilRua Borges Lagoa, 564 cj 63São PauloSPBrazil04038‐000
| | - Maria Regina Torloni
- Centro de Estudos de Saúde Baseada em Evidências e Avaliação Tecnológica em SaúdeCochrane BrazilRua Borges Lagoa, 564 cj 63São PauloSPBrazil04038‐000
| | - Rafael L Pacheco
- Centro de Estudos de Saúde Baseada em Evidências e Avaliação Tecnológica em SaúdeCochrane BrazilRua Borges Lagoa, 564 cj 63São PauloSPBrazil04038‐000
| | | | - Rachel Riera
- Centro de Estudos de Saúde Baseada em Evidências e Avaliação Tecnológica em SaúdeCochrane BrazilRua Borges Lagoa, 564 cj 63São PauloSPBrazil04038‐000
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Murtagh FE, Ramsenthaler C, Firth A, Groeneveld EI, Lovell N, Simon ST, Denzel J, Guo P, Bernhardt F, Schildmann E, van Oorschot B, Hodiamont F, Streitwieser S, Higginson IJ, Bausewein C. A brief, patient- and proxy-reported outcome measure in advanced illness: Validity, reliability and responsiveness of the Integrated Palliative care Outcome Scale (IPOS). Palliat Med 2019; 33:1045-1057. [PMID: 31185804 PMCID: PMC6691591 DOI: 10.1177/0269216319854264] [Citation(s) in RCA: 183] [Impact Index Per Article: 36.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Few measures capture the complex symptoms and concerns of those receiving palliative care. AIM To validate the Integrated Palliative care Outcome Scale, a measure underpinned by extensive psychometric development, by evaluating its validity, reliability and responsiveness to change. DESIGN Concurrent, cross-cultural validation study of the Integrated Palliative care Outcome Scale - both (1) patient self-report and (2) staff proxy-report versions. We tested construct validity (factor analysis, known-group comparisons, and correlational analysis), reliability (internal consistency, agreement, and test-retest reliability), and responsiveness (through longitudinal evaluation of change). SETTING/PARTICIPANTS In all, 376 adults receiving palliative care, and 161 clinicians, from a range of settings in the United Kingdom and Germany. RESULTS We confirm a three-factor structure (Physical Symptoms, Emotional Symptoms and Communication/Practical Issues). Integrated Palliative care Outcome Scale shows strong ability to distinguish between clinically relevant groups; total Integrated Palliative care Outcome Scale and Integrated Palliative care Outcome Scale subscale scores were higher - reflecting more problems - in those patients with 'unstable' or 'deteriorating' versus 'stable' Phase of Illness (F = 15.1, p < 0.001). Good convergent and discriminant validity to hypothesised items and subscales of the Edmonton Symptom Assessment System and Functional Assessment of Cancer Therapy-General is demonstrated. The Integrated Palliative care Outcome Scale shows good internal consistency (α = 0.77) and acceptable to good test-retest reliability (60% of items kw > 0.60). Longitudinal validity in form of responsiveness to change is good. CONCLUSION The Integrated Palliative care Outcome Scale is a valid and reliable outcome measure, both in patient self-report and staff proxy-report versions. It can assess and monitor symptoms and concerns in advanced illness, determine the impact of healthcare interventions, and demonstrate quality of care. This represents a major step forward internationally for palliative care outcome measurement.
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Affiliation(s)
- Fliss Em Murtagh
- 1 Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK.,2 Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, London, UK
| | - Christina Ramsenthaler
- 2 Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, London, UK.,3 Department of Palliative Medicine, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Alice Firth
- 2 Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, London, UK
| | - Esther I Groeneveld
- 2 Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, London, UK
| | - Natasha Lovell
- 2 Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, London, UK
| | - Steffen T Simon
- 4 Center for Palliative Medicine, University of Cologne, Cologne, Germany
| | - Johannes Denzel
- 3 Department of Palliative Medicine, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Ping Guo
- 2 Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, London, UK
| | - Florian Bernhardt
- 3 Department of Palliative Medicine, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Eva Schildmann
- 3 Department of Palliative Medicine, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Birgitt van Oorschot
- 5 Interdisciplinary Centre for Palliative Medicine, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Farina Hodiamont
- 3 Department of Palliative Medicine, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Sabine Streitwieser
- 3 Department of Palliative Medicine, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Irene J Higginson
- 2 Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, London, UK
| | - Claudia Bausewein
- 3 Department of Palliative Medicine, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
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Reilly CC, Bausewein C, Garrod R, Jolley CJ, Moxham J, Higginson IJ. Breathlessness during daily activity: The psychometric properties of the London Chest Activity of Daily Living Scale in patients with advanced disease and refractory breathlessness. Palliat Med 2017; 31:868-875. [PMID: 27932629 PMCID: PMC5613804 DOI: 10.1177/0269216316680314] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The London Chest Activities of Daily Living Scale measures the impact of breathlessness on both activity and social functioning. However, the London Chest Activities of Daily Living Scale is not routinely used in patients with advanced disease. AIM To assess the psychometric properties of the London Chest Activities of Daily Living Scale in patients with refractory breathlessness due to advanced disease. DESIGN A cross-sectional secondary analysis of data from a randomised controlled parallel-group, pragmatic, single-blind fast-track trial (randomised controlled trial) investigating the effectiveness of an integrated palliative and respiratory care service for patients with advanced disease and refractory breathlessness, known as the Breathlessness Support Service (NCT01165034). All patients completed the following questionnaires: the London Chest Activities of Daily Living Scale, Chronic Respiratory Questionnaire, the Palliative care Outcome Scale, Palliative care Outcome Scale-symptoms, the Hospital Anxiety and Depression Scale and breathlessness measured on a numerical rating scale. Data quality, scaling assumptions, acceptability, internal consistency and construct validity of the London Chest Activities of Daily Living Scale were determined using standard psychometric approaches. SETTING/PARTICIPANTS Breathless patients with advanced malignant and non-malignant disease. RESULTS A total of 88 patients were studied, primary diagnosis included; chronic obstructive pulmonary disease = 53, interstitial lung disease = 17, cancer = 18. Median (range) London Chest Activities of Daily Living Scale total score was 46.5 (14-67). No floor or ceiling effect was observed for the London Chest Activities of Daily Living Scale total score. Internal consistency was good, and Cronbach's alpha for the London Chest Activities of Daily Living Scale total score was 0.90. Construct validity was good with 13 out of 15 a priori hypotheses met. CONCLUSION Psychometric analyses suggest that the London Chest Activities of Daily Living Scale is acceptable, reliable and valid in patients with advanced disease and refractory breathlessness.
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Affiliation(s)
- Charles C Reilly
- 1 Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, UK.,2 Physiotherapy, King's College Hospital NHS Foundation Trust, London, UK
| | - Claudia Bausewein
- 1 Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, UK.,3 Department of Palliative Medicine, Munich University Hospital, LMU Munich, Munich, Germany
| | - Rachel Garrod
- 4 Department of Respiratory Medicine, King's College London, London, UK
| | - Caroline J Jolley
- 5 Department of Asthma, Allergy and Respiratory Science, King's College London, London, UK.,6 Centre of Human & Aerospace Physiological Sciences, King's College London, London, UK
| | - John Moxham
- 5 Department of Asthma, Allergy and Respiratory Science, King's College London, London, UK
| | - Irene J Higginson
- 1 Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, UK
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15
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Solari A, Giordano A, Patti F, Grasso MG, Confalonieri P, Palmisano L, Ponzio M, Borreani C, Rosato R, Veronese S, Zaratin P, Battaglia MA. Randomized controlled trial of a home-based palliative approach for people with severe multiple sclerosis. Mult Scler 2017; 24:663-674. [PMID: 28381133 PMCID: PMC5946675 DOI: 10.1177/1352458517704078] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Evidence on the efficacy of palliative care in persons with severe multiple sclerosis (MS) is scarce. OBJECTIVE To assess the efficacy of a home-based palliative approach (HPA) for adults with severe MS and their carers. METHODS Adults with severe MS-carer dyads were assigned (2:1 ratio) to either HPA or usual care (UC). At each center, a multi-professional team delivered the 6-month intervention. A blind examiner assessed dyads at baseline, 3 months, and 6 months. Primary outcome measures were Palliative care Outcome Scale-Symptoms-MS (POS-S-MS) and Schedule for the Evaluation of Individual Quality of Life-Direct Weighting (SEIQoL-DW, not assessed in severely cognitively compromised patients). RESULTS Of 78 dyads randomized, 76 (50 HPA, 26 UC) were analyzed. Symptom burden (POS-S-MS) significantly reduced in HPA group compared to UC ( p = 0.047). Effect size was 0.20 at 3 months and 0.32 at 6 months, and statistical significance was borderline in per-protocol analysis ( p = 0.062). Changes in SEIQoL-DW index did not differ in the two groups, as changes in secondary patient and carer outcomes. CONCLUSION HPA slightly reduced symptoms burden. We found no evidence of HPA efficacy on patient quality of life and on secondary outcomes.
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Affiliation(s)
- Alessandra Solari
- Unit of Neuroepidemiology, Foundation IRCCS Neurological Institute C. Besta, Milan, Italy
| | - Andrea Giordano
- Unit of Neuroepidemiology, Foundation IRCCS Neurological Institute C. Besta, Milan, Italy
| | - Francesco Patti
- MS Centre, Neurology Clinic, University Hospital Policlinico Vittorio Emanuele, Catania, Italy
| | | | - Paolo Confalonieri
- Department of Neuroimmunology and Neuromuscular Diseases, Foundation IRCCS Neurological Institute C. Besta, Milan, Italy
| | - Lucia Palmisano
- National Center for Drug Evaluation and Research, Istituto Superiore di Sanità, Rome, Italy
| | - Michela Ponzio
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy
| | - Claudia Borreani
- Unit of Clinical Psychology, Foundation IRCCS Istituto Nazionale per la Cura dei Tumori, Milan, Italy
| | - Rosalba Rosato
- Department of Psychology, University of Turin, Turin, Italy
| | | | - Paola Zaratin
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy
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16
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Patient reported outcome measures of quality of end-of-life care: A systematic review. Maturitas 2016; 96:16-25. [PMID: 28041590 DOI: 10.1016/j.maturitas.2016.11.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 11/04/2016] [Indexed: 11/23/2022]
Abstract
End-of-life (EoL) care1 is increasingly used as a generic term in preference to palliative care or terminal care, particularly with reference to individuals with chronic disease, who are resident in community and long-term care (LTC) settings. This review evaluates studies based on patient reported outcome measures (PROMS) of quality of EoL care across all health-care settings. From 1041 citations, 12 studies were extracted by searches conducted in EBSCO, Scopus, Web of Science, PubMed, Cochrane, Open Grey and Google Scholar databases. At present, the evidence base for EoL care is founded on cancer care. This review highlights the paucity of studies that evaluate quality of EoL care for patients with chronic disease outside the established cancer-acute care paradigm, particularly in LTC. This review highlights the absence of any PROMs for the estimated 60% of patients in LTC with cognitive impairment. Patient-reported outcomes (PROs) are critical to understanding how EoL care services and practices affect patients' health and EoL experience. PROMs describe the quality of care from the patient's perspective and add balance to existing clinical or proxy-derived knowledge on the quality of care and services provided.
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17
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Gao W, Crosby V, Wilcock A, Burman R, Silber E, Hepgul N, Chaudhuri KR, Higginson IJ. Psychometric Properties of a Generic, Patient-Centred Palliative Care Outcome Measure of Symptom Burden for People with Progressive Long Term Neurological Conditions. PLoS One 2016; 11:e0165379. [PMID: 27780237 PMCID: PMC5079599 DOI: 10.1371/journal.pone.0165379] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 09/15/2016] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND There is no standard palliative care outcome measure for people with progressive long term neurological conditions (LTNC). This study aims to determine the psychometric properties of a new 8-item palliative care outcome scale of symptom burden (IPOS Neuro-S8) in this population. DATA AND METHODS Data were merged from a Phase II palliative care intervention study in multiple sclerosis (MS) and a longitudinal observational study in idiopathic Parkinson's disease (IPD), multiple system atrophy (MSA) and progressive supranuclear palsy (PSP). The IPOS Neuro-S8 was assessed for its data quality, score distribution, ceiling and floor effects, reliability, factor structure, convergent and discriminant validity, concurrent validity with generic (Palliative care Outcome Scale) and condition specific measures (Multiple Sclerosis Impact Scale; Non-motor Symptoms Questionnaire; Parkinson's Disease Questionnaire), responsiveness and minimally clinically important difference. RESULTS Of the 134 participants, MS patients had a mean Extended Disability Status Scale score 7.8 (SD = 1.0), patients with an IPD, MSA or PSP were in Hoehn & Yahr stage 3-5. The IPOS Neuro-S8 had high data quality (2% missing), mean score 8 (SD = 5; range 0-32), no ceiling effects, borderline floor effects, good internal consistency (Cronbach's α = 0.7) and moderate test-retest reliability (intraclass coefficient = 0.6). The results supported a moderately correlated two-factor structure (Pearson's r = 0.5). It was moderately correlated with generic and condition specific measures (Pearson's r: 0.5-0.6). There was some evidence for discriminant validity in IPD, MSA and PSP (p = 0.020), and for good responsiveness and longitudinal construct validity. CONCLUSIONS IPOS Neuro-S8 shows acceptable to promising psychometric properties in common forms of progressive LTNCs. Future work needs to confirm these findings with larger samples and its usefulness in wider disease groups.
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Affiliation(s)
- Wei Gao
- King's College London, Faculty of Life Sciences and Medicine, Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, London, United Kingdom
| | - Vincent Crosby
- Palliative Medicine, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Andrew Wilcock
- Palliative Medicine and Medical Oncology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Rachael Burman
- King's College London, Faculty of Life Sciences and Medicine, Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, London, United Kingdom
| | - Eli Silber
- Department of Neurology, Kings' College Hospital, London, United Kingdom
| | - Nilay Hepgul
- King's College London, Faculty of Life Sciences and Medicine, Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, London, United Kingdom
| | - K Ray Chaudhuri
- National Parkinson Foundation Centre of Excellence, Kings College Hospital and Kings College, London, United Kingdom
| | - Irene J. Higginson
- King's College London, Faculty of Life Sciences and Medicine, Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, London, United Kingdom
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18
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Kasser SL, Goldstein A, Wood PK, Sibold J. Symptom variability, affect and physical activity in ambulatory persons with multiple sclerosis: Understanding patterns and time-bound relationships. Disabil Health J 2016; 10:207-213. [PMID: 27814947 DOI: 10.1016/j.dhjo.2016.10.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 08/23/2016] [Accepted: 10/09/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Individuals with multiple sclerosis (MS) experience a clinical course that is highly variable with daily fluctuations in symptoms significantly affecting functional ability and quality of life. Yet, understanding how MS symptoms co-vary and associate with physical and psychological health is unclear. OBJECTIVE The purpose of the study was to explore variability patterns and time-bound relationships across symptoms, affect, and physical activity in individuals with MS. METHODS The study employed a multivariate, replicated, single-subject repeated-measures (MRSRM) design and involved four individuals with MS. Mood, fatigue, pain, balance confidence, and losses of balance were measured daily over 28 days by self-report. Physical activity was also measured daily over this same time period via accelerometry. Dynamic factor analysis (DFA) was used to determine the dimensionality and lagged relationships across the variables. RESULTS Person-specific models revealed considerable time-dependent co-variation patterns as well as pattern variation across subjects. Results also offered insight into distinct variability structures at varying levels of disability. CONCLUSION Modeling person-level variability may be beneficial for addressing the heterogeneity of experiences in individuals with MS and for understanding temporal and dynamic interrelationships among perceived symptoms, affect, and health outcomes in this group.
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Affiliation(s)
- Susan L Kasser
- Department of Rehabilitation and Movement Science, University of Vermont, Burlington, VT, USA.
| | - Amanda Goldstein
- Department of Rehabilitation and Movement Science, University of Vermont, Burlington, VT, USA
| | - Phillip K Wood
- Department of Psychological Sciences, University of Missouri, Columbia, MO, USA
| | - Jeremy Sibold
- Department of Rehabilitation and Movement Science, University of Vermont, Burlington, VT, USA
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19
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D'Amico E, Zanghì A, Patti F, Zappia M. Palliative care in progressive multiple sclerosis. Expert Rev Neurother 2016; 17:123-127. [PMID: 27718749 DOI: 10.1080/14737175.2017.1245615] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Multiple sclerosis (MS) is a progressive disease of the central nervous system with unknown etiology. It could be associated with severe disability and losses of physical, psychological and social role functioning over time. People with MS share experiences in common with people affected by diseases with a shorter and clearer terminal phase. Therefore, it is appropriate to offer a palliative care approach to people with severe MS and their caregivers. Areas covered: Benefits for severe MS patients and their caregivers were shown when palliative care was included in their care. However, many neurologists show no interest toward palliative care services for people with severe MS. Misunderstandings about the services of palliative care are still prevalent. Expert commentary: When all results are considered, they show that palliative care for severe MS patients may be beneficial. The five-year view will discuss the barriers of palliative care inclusion for people with severe MS.
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Affiliation(s)
- Emanuele D'Amico
- a Department of Medical and Surgical Sciences and Advanced Technologies G.F. Ingrassia , Policlinico G. Rodolico , Catania , Italy
| | - Aurora Zanghì
- a Department of Medical and Surgical Sciences and Advanced Technologies G.F. Ingrassia , Policlinico G. Rodolico , Catania , Italy
| | - Francesco Patti
- a Department of Medical and Surgical Sciences and Advanced Technologies G.F. Ingrassia , Policlinico G. Rodolico , Catania , Italy
| | - Mario Zappia
- a Department of Medical and Surgical Sciences and Advanced Technologies G.F. Ingrassia , Policlinico G. Rodolico , Catania , Italy
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20
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Adoni T. Multiple sclerosis, fatigue and sleep disorders: beyond the clinical relapses. ARQUIVOS DE NEURO-PSIQUIATRIA 2016; 74:431-432. [PMID: 27332065 DOI: 10.1590/0004-282x20160079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 05/11/2016] [Indexed: 06/06/2023]
Affiliation(s)
- Tarso Adoni
- Hospital Sírio-Libanês, Hospital Sírio Libanês, Centro de Esclerose Múltipla, São Paulo SP , Brasil, Hospital Sírio Libanês, Centro de Esclerose Múltipla, São Paulo SP, Brasil
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21
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Giordano A, Cimino V, Campanella A, Morone G, Fusco A, Farinotti M, Palmisano L, Confalonieri P, Lugaresi A, Grasso MG, Ponzio M, Veronese S, Patti F, Solari A. Low quality of life and psychological wellbeing contrast with moderate perceived burden in carers of people with severe multiple sclerosis. J Neurol Sci 2016; 366:139-145. [PMID: 27288793 DOI: 10.1016/j.jns.2016.05.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 05/10/2016] [Accepted: 05/10/2016] [Indexed: 11/24/2022]
Affiliation(s)
- Andrea Giordano
- Unit of Neuroepidemiology, Foundation IRCCS Neurological Institute C. Besta, via Celoria 11, 20133 Milan, Italy.
| | - Vincenzo Cimino
- MS Centre, Neurology Clinic, University Hospital Policlinico Vittorio Emanuele, via S. Sofia, 78, 95123 Catania, Italy.
| | - Angela Campanella
- Scientific Direction, Foundation IRCCS Neurological Institute C. Besta, via Celoria 11, 20133 Milan, Italy.
| | - Giovanni Morone
- Multiple Sclerosis Unit, IRCCS S. Lucia Foundation, Via Ardeatina 306, 00142 Rome, Italy.
| | - Augusto Fusco
- Multiple Sclerosis Unit, IRCCS S. Lucia Foundation, Via Ardeatina 306, 00142 Rome, Italy.
| | - Mariangela Farinotti
- Unit of Neuroepidemiology, Foundation IRCCS Neurological Institute C. Besta, via Celoria 11, 20133 Milan, Italy.
| | - Lucia Palmisano
- Department of Therapeutic Research and Medicine Evaluation, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy.
| | - Paolo Confalonieri
- Unit of Neuroimmunology, and Neuromuscular Diseases, Foundation IRCCS Neurological Institute C. Besta, via Celoria 11, 20133 Milan, Italy.
| | - Alessandra Lugaresi
- Department of Neuroscience, Imaging and Clinical Sciences, G. d'Annunzio University of Chieti-Pescara, Via dei Vestini 31, 66013 Chieti, Italy.
| | - Maria Grazia Grasso
- Multiple Sclerosis Unit, IRCCS S. Lucia Foundation, Via Ardeatina 306, 00142 Rome, Italy.
| | - Michela Ponzio
- Department of Research, Fondazione Italiana Sclerosi Multipla (FISM), Via Operai 40, 16149 Genoa, Italy.
| | - Simone Veronese
- FARO Charitable Foundation, Via Oddino Morgari 12, 10125 Turin, Italy.
| | - Francesco Patti
- MS Centre, Neurology Clinic, University Hospital Policlinico Vittorio Emanuele, via S. Sofia, 78, 95123 Catania, Italy.
| | - Alessandra Solari
- Unit of Neuroepidemiology, Foundation IRCCS Neurological Institute C. Besta, via Celoria 11, 20133 Milan, Italy.
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Kaur D, Kumar G, Billore N, Singh AK. Defining the Role of Physiotherapy in Palliative Care in Multiple Sclerosis. Indian J Palliat Care 2016; 22:176-9. [PMID: 27162430 PMCID: PMC4843558 DOI: 10.4103/0973-1075.179599] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
With increasing prevalence of multiple sclerosis worldwide, India too has transitioned from low to medium prevalence region. This increases the overall burden of a number of people suffering from a chronic progressive disorder. Such scenario underlines the need for an early comprehensive and holistic patient management plan, aiming to provide a better quality of life. The presented case is one such example of a patient-centered, and interdisciplinary team approach for better management of a patient suffering from an incurable, progressive disorder. As physiotherapists tend to spend a considerable amount of time with their patients on a regular basis, it becomes imperative to view all the patient related problems from a wider angle and endeavor to address each of them individually/collaboratively. In a palliative care setting, physiotherapy can no longer be considered as only physical symptom management approach but a patient care approach considering their entire physical, emotional, psychosocial, and spiritual needs. This novel case report shall serve as a guiding strategy for physiotherapists to work in the domain of palliative care.
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Affiliation(s)
- Darshpreet Kaur
- Departments of Neurology and Neurorehabilitaion, Bihar Neurodiagnostic Centre, Patna, India
| | - Gunjan Kumar
- Department of Neurology, NIMHANS, Bengaluru, Karnataka, India
| | - Nidhi Billore
- Departments of R.V. College of Physiotherapy, Bengaluru, Karnataka, India
| | - Ajay Kumar Singh
- Departments of Neurology and Neurorehabilitaion, Bihar Neurodiagnostic Centre, Patna, India
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23
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Individualized quality of life of severely affected multiple sclerosis patients: practicability and value in comparison with standard inventories. Qual Life Res 2016; 25:2755-2763. [PMID: 27125955 DOI: 10.1007/s11136-016-1303-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2016] [Indexed: 12/14/2022]
Abstract
PURPOSE Individualized quality of life (QoL) measures differ from traditional inventories in that QoL domains/weights are not predetermined, but identified by the individual. We assessed practicability of the Schedule for the Evaluation of Individual QoL-Direct Weighting (SEIQoL-DW) interview in severely affected multiple sclerosis (MS) patients; the key QoL dimensions identified; and the correlation of the SEIQoL-DW index score with standard patient-reported outcome measures (PROMs). METHODS Participants were people with severe MS who performed the baseline visit of the PeNSAMI trial (ISRCTN73082124). The SEIQoL-DW was administered at the patient's home by a trained examiner. Patients then received the following PROMs: the Core-Palliative care Outcome Scale (Core-POS), the Palliative care Outcome Scale-Symptoms-MS (POS-S-MS), the European Quality of Life Five Dimensions-3L (EQ-5D-3L), and the Hospital Anxiety and Depression Scale (HADS). RESULTS Of 59 enrolled patients, 11 (19 %) did not receive the SEIQoL-DW (and the other PROMs) because of severe cognitive compromise or inability to communicate. SEIQoL-DW administration was completed and deemed valid in all 48 cases (mean age 60 years, 58 % women, median Expanded Disability Status Scale score 8.5). Mean SEIQoL-DW index score was 59.1 (SD 25.5). The most commonly nominated SEIQoL-DW areas were family (94 % of the patients), relationships, and leisure activities (both 65 %). Core-POS and POS-S-MS contained 70 % of the SEIQoL-DW-nominated areas. Nevertheless, correlations between SEIQoL-DW index, Core-POS, and POS-S-MS (and the other PROMs) were negligible. CONCLUSIONS Individualized QoL can be assessed in severely affected MS patients, providing information that is not tracked by the standard inventories Core-POS, POS-S-MS, EQ-5D-3L, and HADS.
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24
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Collins ES, Witt J, Bausewein C, Daveson BA, Higginson IJ, Murtagh FEM. A Systematic Review of the Use of the Palliative Care Outcome Scale and the Support Team Assessment Schedule in Palliative Care. J Pain Symptom Manage 2015; 50:842-53.e19. [PMID: 26335764 DOI: 10.1016/j.jpainsymman.2015.07.015] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 06/24/2015] [Accepted: 07/13/2015] [Indexed: 11/28/2022]
Abstract
CONTEXT The Palliative care Outcome Scale (POS) and the Support Team Assessment Schedule (STAS) are two outcome measures used in palliative care settings to assess palliative concerns, needs, and quality of care. OBJECTIVES This systematic review builds on the findings of a previous review to appraise the use of the POS and STAS since 2010, particularly the context and nature of their use. METHODS MEDLINE, Embase, PsycINFO, British Nursing Index, and CINAHL were searched for studies published between February 2010 and June 2014. Relevant authors were contacted, and reference lists of included studies were searched. Studies reporting validation or the use of the POS or STAS were included, and data on sample population, how the outcome measure was being used, study design, study aim, and results of the study were extracted. RESULTS Forty-three studies were included (POS n = 35, STAS n = 8). There was an increase in the use of the POS and STAS in Europe and Africa with the publication of 13 new translations of the POS. Most studies focused on the use, rather than further validation, of the POS and STAS. There has been increasing use of these measures within non-cancer patient groups. CONCLUSION The POS and STAS are now used in a wide variety of settings and countries. These tools may be used in the future to compare palliative care needs and quality of care across diverse contexts and patient groups.
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Affiliation(s)
- Emily S Collins
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, United Kingdom; School of Medicine, Keele University, Keele, Staffordshire, United Kingdom
| | - Jana Witt
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, United Kingdom
| | - Claudia Bausewein
- Klinik und Poliklinik für Palliativmedizin, Klinikum der Universität München, Munich, Germany
| | - Barbara A Daveson
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, United Kingdom
| | - Irene J Higginson
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, United Kingdom
| | - Fliss E M Murtagh
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, United Kingdom.
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25
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Strupp J, Voltz R, Golla H. Opening locked doors: Integrating a palliative care approach into the management of patients with severe multiple sclerosis. Mult Scler 2015; 22:13-8. [DOI: 10.1177/1352458515608262] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 09/02/2015] [Indexed: 11/17/2022]
Abstract
Patients severely affected by multiple sclerosis (MS) have a large range of unmet needs. Although initially counterintuitive, specialized palliative care (PC) may be beneficial for these patients and their relatives. PC has advanced greatly in recent years, yet it is still predominantly tumour patients who profit from this. For MS, a first randomized phase II trial has already demonstrated significant benefits for patients and their caregivers when PC was included in their care. However, there are barriers: neurologists not convinced about PC, or PC not taking on MS patients. Studies have shown that misunderstandings and a lack of information among healthcare professionals about the roles and services of PC for MS are still prevalent. This topical review will give an overview of the unmet needs of patients as well as the possible benefits and barriers of PC for MS, and will describe models of services on how to “open locked doors”.
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Affiliation(s)
- J Strupp
- Department of Palliative Medicine, University Hospital, Cologne, Germany
| | - R Voltz
- Department of Palliative Medicine, University Hospital, Cologne, Germany/Center for Integrated Oncology Cologne / Bonn (CIO), Germany/Clinical Trials Center Cologne, Germany (ZKS)
| | - H Golla
- Department of Palliative Medicine, University Hospital, Cologne, Germany/Center for Integrated Oncology Cologne / Bonn (CIO), Germany/Clinical Trials Center Cologne, Germany (ZKS)
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26
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Solari A, Giordano A, Grasso MG, Confalonieri P, Patti F, Lugaresi A, Palmisano L, Amadeo R, Martino G, Ponzio M, Casale G, Borreani C, Causarano R, Veronese S, Zaratin P, Battaglia MA. Home-based palliative approach for people with severe multiple sclerosis and their carers: study protocol for a randomized controlled trial. Trials 2015; 16:184. [PMID: 25899519 PMCID: PMC4409986 DOI: 10.1186/s13063-015-0695-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 03/30/2015] [Indexed: 11/18/2022] Open
Abstract
Background Preliminary evidence suggests that palliative care may be useful for people with severe multiple sclerosis (MS). The aim of this study is to determine the effectiveness of a home-based palliative approach (HPA) for people with severe MS and their carers. Methods/design This is a single-blind randomized controlled trial with a nested qualitative study. Seventy-five severe MS-carer dyads are being randomized (at three centers, one in each area of Italy) to HPA or usual care (UC) in a 2:1 ratio. Each center has a specially trained team consisting of four professionals (physician, nurse, psychologist, social worker). The team makes a comprehensive assessment of the needs of the dyads. HPA content is then agreed on, discussed with the patient’s caring physician, and delivered over six months. The intervention is not intended to replace existing services. At later visits, the team checks the HPA delivery and reviews/modifies it as necessary. HPA and UC dyads are assessed at home by a blind examiner at baseline, and three and six months later; they also receive monthly telephone interviews. Dyads assigned to UC receive the examiner’s visits and telephone interviews, but not the team visits. Primary outcome measures are changes in symptoms (Palliative care Outcome Scale-Symptoms-MS, POS-S-MS), and quality of life (the Schedule for the Evaluation of Individual Quality of Life-Direct Weighting (SEIQoL-DW), not assessed in patients with severe cognitive compromise) at three and six months. Other outcomes are changes in patient functional status and mood; changes in carer quality of life, mood and caregiving burden; costs; incorporation with standard care; unplanned hospital admissions; referrals to hospice; and deaths. The experience of participants will be evaluated qualitatively by individual semi-structured interviews (HPA patients and carers) and focus group meetings (HPA patients’ caring physicians). Discussion The results of our study will show whether the HPA is feasible and beneficial to people with severe MS and their carers living in the three Italian geographic areas. The nested qualitative study will add to the understanding of the strengths and limitations of the intervention. Trial registration The trial was registered with Current Controlled Trials (identifier: ISRCTN73082124) on 19 June 2014.
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Affiliation(s)
- Alessandra Solari
- Unit of Neuroepidemiology, Foundation IRCCS Neurological Institute C. Besta, Via Celoria 11, 20133, Milan, Italy.
| | - Andrea Giordano
- Unit of Neuroepidemiology, Foundation IRCCS Neurological Institute C. Besta, Via Celoria 11, 20133, Milan, Italy.
| | - Maria Grazia Grasso
- Multiple Sclerosis Unit, Foundation IRCCS S. Lucia Rehabilitation Hospital, Via Ardeatina 306, 00179, Rome, Italy.
| | - Paolo Confalonieri
- Unit of Neuroimmunology, Foundation IRCCS Neurological Institute C. Besta, Via Celoria 11, 20133, Milan, Italy.
| | - Francesco Patti
- Department of Medical and Surgical Sciences and Advanced Technologies, University of Catania; MS Center, Neurology Clinic, University Hospital Policlinico Vittorio Emanuele, Via Santa Sofia 78, 95123, Catania, Italy.
| | - Alessandra Lugaresi
- Department of Neuroscience, Imaging and Clinical Sciences, G. d'Annunzio University of Chieti-Pescara, Via dei Vestini 31, 66100, Chieti, Italy.
| | - Lucia Palmisano
- Department of Therapeutic Research and Medicine Evaluation, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Rome, Italy.
| | - Roberta Amadeo
- Associazione Italiana Sclerosi Multipla, Via Operai 40, 16149, Genoa, Italy.
| | - Giovanni Martino
- Associazione Italiana Sclerosi Multipla, Via Operai 40, 16149, Genoa, Italy.
| | - Michela Ponzio
- Fondazione Italiana Sclerosi Multipla, Via Operai 40, 16149, Genoa, Italy.
| | - Giuseppe Casale
- Antea Charitable Association, Piazza Santa Maria della Pietà 5, 00135, Rome, Italy.
| | - Claudia Borreani
- Unit of Clinical Psychology, Foundation IRCCS Istituto Nazionale per la Cura dei Tumori, Via Venezian 1, 20133, Milan, Italy.
| | - Renzo Causarano
- Unit of Palliative Care-Hospice, Niguarda Ca' Granda Hospital, Piazza Ospedale Maggiore 3, 20162, Milan, Italy.
| | - Simone Veronese
- FARO Charitable Foundation, Via Morgari 12, 10125, Turin, Italy.
| | - Paola Zaratin
- Fondazione Italiana Sclerosi Multipla, Via Operai 40, 16149, Genoa, Italy.
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Borreani C, Bianchi E, Pietrolongo E, Rossi I, Cilia S, Giuntoli M, Giordano A, Confalonieri P, Lugaresi A, Patti F, Grasso MG, de Carvalho LL, Palmisano L, Zaratin P, Battaglia MA, Solari A. Unmet needs of people with severe multiple sclerosis and their carers: qualitative findings for a home-based intervention. PLoS One 2014; 9:e109679. [PMID: 25286321 PMCID: PMC4186842 DOI: 10.1371/journal.pone.0109679] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 09/10/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Few data on services for people with severe multiple sclerosis (MS) are available. The Palliative Network for Severely Affected Adults with MS in Italy (PeNSAMI) developed a home palliative care program for MS patients and carers, preceded by a literature review and qualitative study (here reported). OBJECTIVE To identify unmet needs of people with severe MS living at home by qualitative research involving key stakeholders, and theorize broad areas of intervention to meet those needs. METHOD Data were collected from: at least 10 personal interviews with adults with severe MS (primary/secondary progressive, EDSS≥8.0); three focus group meetings (FGs) of carers of people with severe MS; and two FGs of health professionals (HPs). Grounded theory guided the analysis of interview and FG transcripts, from which the areas of intervention were theorized. RESULTS Between October 2012 and May 2013, 22 MS patients, 30 carers and 18 HPs participated. Forty-eight needs themes were identified, grouped into 14 categories and four domains. Seven, highly interdependent intervention areas were theorized. Patients had difficulties expressing needs; experiences of burden and loneliness were prominent, chiefly in dysfunctional, less affluent families, and among parent carers. Needs differed across Italy with requirements for information and access to services highest in the South. All participants voiced a strong need for qualified personnel and care coordination in day-to-day home care. Personal hygiene emerged as crucial, as did the need for a supportive network and preservation of patient/carer roles within family and community. CONCLUSIONS Unmet needs transcended medical issues and embraced organizational and psychosocial themes, as well as health policies. The high interdependence of the seven intervention areas theorized is in line with the multifaceted approach of palliative care. At variance with typical palliative contexts, coping with disability rather than end-of-life was a major concern of patients and carers.
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Affiliation(s)
- Claudia Borreani
- Unit of Psychology, Foundation IRCCS Istituto Nazionale per la Cura dei Tumori, Milan, Italy
| | - Elisabetta Bianchi
- Unit of Psychology, Foundation IRCCS Istituto Nazionale per la Cura dei Tumori, Milan, Italy
| | - Erika Pietrolongo
- Department of Neuroscience, Imaging and Clinical Sciences, University “G. d'Annunzio” of Chieti-Pescara, Chieti, Italy
| | - Ilaria Rossi
- Multiple Sclerosis Unit, Foundation IRCCS S. Lucia Rehabilitation Hospital, Rome, Italy
| | - Sabina Cilia
- Neurology Clinic, MS Center, University Hospital Policlinico Vittorio Emanuele, Catania, Italy
| | | | - Andrea Giordano
- Unit of Neuroepidemiology, Foundation IRCCS Neurological Institute C. Besta, Milan, Italy
| | - Paolo Confalonieri
- Unit of Neuroimmunology, Foundation IRCCS Neurological Institute C. Besta, Milan, Italy
| | - Alessandra Lugaresi
- Department of Neuroscience, Imaging and Clinical Sciences, University “G. d'Annunzio” of Chieti-Pescara, Chieti, Italy
| | - Francesco Patti
- Neurology Clinic, MS Center, University Hospital Policlinico Vittorio Emanuele, Catania, Italy
| | - Maria Grazia Grasso
- Multiple Sclerosis Unit, Foundation IRCCS S. Lucia Rehabilitation Hospital, Rome, Italy
| | | | - Lucia Palmisano
- Dept. of Therapeutic Research and Medicine Evaluation, Istituto Superiore di Sanità, Rome, Italy
| | - Paola Zaratin
- Scientific Research Department, Italian Multiple Sclerosis Foundation, Genoa, Italy
| | | | - Alessandra Solari
- Unit of Neuroepidemiology, Foundation IRCCS Neurological Institute C. Besta, Milan, Italy
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