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Aslam S, Manfredsson F, Stokes A, Shill H. "Advanced" Parkinson's disease: A review. Parkinsonism Relat Disord 2024; 123:106065. [PMID: 38418318 DOI: 10.1016/j.parkreldis.2024.106065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 02/05/2024] [Accepted: 02/21/2024] [Indexed: 03/01/2024]
Abstract
There is no consensus driven definition of "advanced" Parkinson's disease (APD) currently. APD has been described in terms of emergence of specific clinical features and clinical milestones of the disease e.g., motor fluctuations, time to increasing falls, emergence of cognitive decline, etc. The pathological burden of disease has been used to characterize various stages of the disease. Imaging markers have been associated with various motor and nonmotor symptoms of advancing disease. In this review, we present an overview of clinical, pathologic, and imaging markers of APD. We also propose a model of disease definition involving longitudinal assessments of these markers as well as quality of life metrics to better understand and predict disease progression in those with Parkinson's disease.
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Affiliation(s)
- Sana Aslam
- Barrow Neurological Institute, Phoenix, AZ, United States.
| | | | - Ashley Stokes
- Barrow Neurological Institute, Phoenix, AZ, United States
| | - Holly Shill
- Barrow Neurological Institute, Phoenix, AZ, United States
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Pedrosa AJ, Feldmann S, Klippel J, Volberg C, Weck C, Lorenzl S, Pedrosa DJ. Factors Associated with Preferred Place of Care and Death in Patients with Parkinson's Disease: A Cross-Sectional Study. JOURNAL OF PARKINSON'S DISEASE 2024; 14:589-599. [PMID: 38457148 DOI: 10.3233/jpd-230311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
Background A significant proportion of people with Parkinson's disease (PwPD) die in hospital settings. Although one could presume that most PwPD would favor being cared for and die at home, there is currently no evidence to support this assumption. Objective We aimed at exploring PwPD's preferences for place of end-of-life care and place of death, along with associated factors. Methods A cross-sectional study was conducted to investigate PwPD's end-of life wishes regarding their preferred place of care and preferred place of death. Using different approaches within a generalized linear model framework, we additionally explored factors possibly associated with preferences for home care and home death. Results Although most PwPD wished to be cared for and die at home, about one-third reported feeling indifferent about their place of death. Preferred home care was associated with the preference for home death. Furthermore, a preference for dying at home was more likely among PwPD's with informal care support and spiritual/religious affiliation, but less likely if they preferred institutional care towards the end of life. Conclusions The variation in responses regarding the preferred place of care and place of death highlights the need to distinguish between the concepts when discussing end-of-life care. However, it is worth noting that the majority of PwPD preferred care and death at home. The factors identified in relation to preferred place of care and death provide an initial understanding of PwPD decision-making, but call for further research to confirm our findings, explore causality and identify additional influencing factors.
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Affiliation(s)
- Anna J Pedrosa
- Department of Neurology, Philipps University Marburg, University Hospital Giessen and Marburg, Marburg, Germany
| | - Sarah Feldmann
- Department of Neurology, Philipps University Marburg, University Hospital Giessen and Marburg, Marburg, Germany
| | - Jan Klippel
- Department of Neurology, Philipps University Marburg, University Hospital Giessen and Marburg, Marburg, Germany
| | - Christian Volberg
- Department of Anaesthesiology and Intensive Care Medicine, Philipps University Marburg, University Hospital Giessen and Marburg, Marburg, Germany
- Research Group Medical Ethics, Philipps University Marburg, Marburg, Germany
| | - Christiane Weck
- Department of Neurology, Hospital Agatharied, Agatharied, Germany
- Institute of Palliative Care, Paracelsus Medical University, Salzburg, Austria
| | - Stefan Lorenzl
- Department of Neurology, Hospital Agatharied, Agatharied, Germany
- Institute of Palliative Care, Paracelsus Medical University, Salzburg, Austria
| | - David J Pedrosa
- Department of Neurology, Philipps University Marburg, University Hospital Giessen and Marburg, Marburg, Germany
- Centre for Mind, Brain and Behaviour, Philipps University Marburg, Marburg, Germany
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3
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Seshadri S, Dini M, Macchi Z, Auinger P, Norton SA, Holtrop JS, Kluger BM. Reach of Palliative Care for Parkinson Disease: Results From a Large National Survey of Patients and Care Partners. Neurol Clin Pract 2023; 13:e200214. [PMID: 37854173 PMCID: PMC10581080 DOI: 10.1212/cpj.0000000000200214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 09/15/2023] [Indexed: 10/20/2023]
Abstract
Background and Objectives People with Parkinson disease (PWP) and their care partners have high palliative care needs resulting from disabling motor and nonmotor symptoms. There is growing support for palliative care (PC) approaches to Parkinson disease. However, little is known regarding the extent to which the palliative needs of PWP and care partners are currently being met. This study's primary objective is to describe PWP's and care partners' perceptions of the extent to which their PC needs are being met. Secondary objectives are to describe their perceptions of the quality of clinical communication and their knowledge of PC. Methods PWPs and care partners (n = 12,995) who had consented to receiving surveys from the Parkinson's Foundation were emailed an electronic survey. PC was operationalized as comprising 5 key components: systematic assessment and management of (1) nonmotor symptoms, (2) PWPs' emotional and spiritual needs, (3) care partners' needs, (4) the completion of annual advance care planning, and (5) timely referrals to specialist palliative care and hospice when appropriate. Results A total 1,882 individuals (1,266 PWP and 616 care partners) responded to the survey (response rate 14.5%). Few PWP (22%) reported that their neurologists never asked regarding bothersome nonmotor symptoms or did so or only if they brought it up. Fifty percent of PWP reported that pain as a specific nonmotor symptom was never managed or managed only if they brought it up. Similarly, PWPs' emotional and spiritual needs (55%), care partners' well-being (57%), and completion of advance care planning documentation (79%) were never addressed or only addressed if PWP brought it up. The quality of clinical communication was generally rated as open and honest (64% PWP). Fewer PWP (30%) reported that doctors helped them deal with the uncertainties of Parkinson disease. Most PWP (85%) reported being knowledgeable regarding PC, and 68% reported that the goal of PC was to help friends and family cope with the illness. Discussion Although some elements of PC are currently being addressed in routine care for PWP, there are many gaps and opportunities for improvement. These data may facilitate focused attention and development of resources to improve the quality and availability of PC for Parkinson disease.
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Affiliation(s)
- Sandhya Seshadri
- Department of Neurology (SS, PA, BMK), University of Rochester; Parkinson's Foundation (MD), New York; Department of Neurology (ZM), University of Colorado Anschutz Medical Campus; Center for Health & Technology (PA), University of Rochester; University of Rochester School of Nursing (SAN), NY; and Department of Family Medicine at the University of Colorado School of Medicine (JSH), Anschutz Medical Campus
| | - Megan Dini
- Department of Neurology (SS, PA, BMK), University of Rochester; Parkinson's Foundation (MD), New York; Department of Neurology (ZM), University of Colorado Anschutz Medical Campus; Center for Health & Technology (PA), University of Rochester; University of Rochester School of Nursing (SAN), NY; and Department of Family Medicine at the University of Colorado School of Medicine (JSH), Anschutz Medical Campus
| | - Zachary Macchi
- Department of Neurology (SS, PA, BMK), University of Rochester; Parkinson's Foundation (MD), New York; Department of Neurology (ZM), University of Colorado Anschutz Medical Campus; Center for Health & Technology (PA), University of Rochester; University of Rochester School of Nursing (SAN), NY; and Department of Family Medicine at the University of Colorado School of Medicine (JSH), Anschutz Medical Campus
| | - Peggy Auinger
- Department of Neurology (SS, PA, BMK), University of Rochester; Parkinson's Foundation (MD), New York; Department of Neurology (ZM), University of Colorado Anschutz Medical Campus; Center for Health & Technology (PA), University of Rochester; University of Rochester School of Nursing (SAN), NY; and Department of Family Medicine at the University of Colorado School of Medicine (JSH), Anschutz Medical Campus
| | - Sally A Norton
- Department of Neurology (SS, PA, BMK), University of Rochester; Parkinson's Foundation (MD), New York; Department of Neurology (ZM), University of Colorado Anschutz Medical Campus; Center for Health & Technology (PA), University of Rochester; University of Rochester School of Nursing (SAN), NY; and Department of Family Medicine at the University of Colorado School of Medicine (JSH), Anschutz Medical Campus
| | - Jodi S Holtrop
- Department of Neurology (SS, PA, BMK), University of Rochester; Parkinson's Foundation (MD), New York; Department of Neurology (ZM), University of Colorado Anschutz Medical Campus; Center for Health & Technology (PA), University of Rochester; University of Rochester School of Nursing (SAN), NY; and Department of Family Medicine at the University of Colorado School of Medicine (JSH), Anschutz Medical Campus
| | - Benzi M Kluger
- Department of Neurology (SS, PA, BMK), University of Rochester; Parkinson's Foundation (MD), New York; Department of Neurology (ZM), University of Colorado Anschutz Medical Campus; Center for Health & Technology (PA), University of Rochester; University of Rochester School of Nursing (SAN), NY; and Department of Family Medicine at the University of Colorado School of Medicine (JSH), Anschutz Medical Campus
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4
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Trahair ED, Mantri S. Examining the Role of Narrative in Palliative Care for Parkinson Disease: Changing the Story. Neurol Clin Pract 2023; 13:e200150. [PMID: 37081942 PMCID: PMC10112858 DOI: 10.1212/cpj.0000000000200150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 02/10/2023] [Indexed: 04/22/2023]
Abstract
Recent years have seen growing interest in neuropalliative care as a subspecialty. Simultaneously, the rise of narrative medicine in patient support groups and clinician training programs offers a way to listen deeply to the stories of those living with chronic illness and may inform corresponding health interventions. This commentary examines the ways in which an understanding of illness narrative schemata, particularly the so-called "chaos narrative," can contribute to patient and care partner distress, which in turn can be alleviated by a palliative care approach. Through examples of stories of people with Parkinson disease and their care partners, the article emphasizes the intersections between narrative medicine, neurology, and palliative care. Specific opportunities for bringing narrative medicine into the clinic are discussed.
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Affiliation(s)
- Esme D Trahair
- Department of Neurology (EDT, SM); and Trent Center for Bioethics, Humanities, and History of Medicine (EDT, SM), Duke University School of Medicine, Durham, NC
| | - Sneha Mantri
- Department of Neurology (EDT, SM); and Trent Center for Bioethics, Humanities, and History of Medicine (EDT, SM), Duke University School of Medicine, Durham, NC
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O'Shea N, Lyons S, Higgins S, O'Dowd S. Neurological update: the palliative care landscape for atypical parkinsonian syndromes. J Neurol 2023; 270:2333-2341. [PMID: 36688987 DOI: 10.1007/s00415-023-11574-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 01/12/2023] [Indexed: 01/24/2023]
Abstract
Atypical parkinsonian syndromes are neurodegenerative conditions, characterised by rapid disease progression and shorter life expectancy compared to idiopathic Parkinson's disease. These conditions inflict substantial physical and psychosocial burden on patients and their families; hence, there is a clear rationale for a palliative care approach from diagnosis. An interdisciplinary care model has been shown to improve symptom burden, quality of life and engagement with advance care planning, in a heterogeneous group of neurodegenerative conditions. In this update, we summarise how the landscape for treating these patients has changed and the questions that still need to be resolved.
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Affiliation(s)
- Noreen O'Shea
- Department of Neurology, Tallaght University Hospital, Tallaght, Dublin 24, D24NR0A, Ireland.
- Department of Palliative Medicine, Tallaght University Hospital, Tallaght, Dublin 24, D24NR0A, Ireland.
| | - Shane Lyons
- Department of Neurology, Tallaght University Hospital, Tallaght, Dublin 24, D24NR0A, Ireland
| | - Stephen Higgins
- Department of Palliative Medicine, Tallaght University Hospital, Tallaght, Dublin 24, D24NR0A, Ireland
- Our Lady's Hospice & Care Services, Harold's Cross, Dublin, D6WRY72, Ireland
| | - Sean O'Dowd
- Department of Neurology, Tallaght University Hospital, Tallaght, Dublin 24, D24NR0A, Ireland
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Effects of Palliative Care for Progressive Neurologic Diseases: A Systematic Review and Meta-Analysis. J Am Med Dir Assoc 2023; 24:171-184. [PMID: 36481217 DOI: 10.1016/j.jamda.2022.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 10/30/2022] [Accepted: 11/01/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To determine the association of palliative care for progressive neurologic diseases with patient- and caregiver-centered outcomes. DESIGN Systematic review and meta-analysis of randomized controlled trials and quasi-experimental studies, including pilot studies. SETTING AND PARTICIPANTS Adults with progressive neurologic diseases (dementia, multiple sclerosis, Parkinson's disease, motor neuron disease, multiple system atrophy, and progressive supranuclear palsy) and their caregivers. METHODS MEDLINE, EMBASE, CINAHL PLUS, Cochrane CENTRAL, and PubMed were searched from inception to September 2021. Two reviewers independently screened studies, extracted data, and assessed risk of bias using the Cochrane risk of bias tools. Narrative synthesis was conducted. Patient quality of life (QoL), symptom burden, caregiver burden, and satisfaction with care were meta-analyzed using a random-effects model. RESULTS Fifteen trials provided data on 3431 patients (mean age, 73.9 years). Compared with usual care, palliative care was statistically significantly associated with lower symptom burden [standardized mean difference (SMD), -0.34 (95% Cl, -0.59 to -0.09)] and higher caregiver satisfaction [SMD, 0.41 (95% Cl, 0.12 to 0.71)] and patient satisfaction [SMD, 0.43 (95% Cl, -0.01 to 0.87)]. However, the associations were not significant after excluding studies with high risk of bias. Insignificant associations of palliative care with caregiver burden [SMD, -0.09 (95% Cl, -0.21 to 0.03)] and patient QoL [SMD, 0.19 (95% Cl, -0.07 to 0.44)] were observed. CONCLUSIONS AND IMPLICATIONS Palliative care is likely to improve symptom burden and satisfaction with care among patients with progressive neurologic diseases and their caregivers, while its effects on QoL and caregiver burden remains inconclusive. Specific intervention components including interdisciplinary team, palliative care physicians, home visits, and spiritual care appeared to be associated with increased effects on improving palliative outcomes. More rigorous designed studies are warranted to examine the effects of neuropalliative care, effective intervention components, optimal timing, and symptom triggers of palliative care referrals.
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Chen Y, Hou L, Li W, Wang Q, Zhou W, Yang H. Referral criteria to palliative care for patients with Parkinson's disease: a systematic review. Curr Med Res Opin 2023; 39:267-279. [PMID: 36369847 DOI: 10.1080/03007995.2022.2146405] [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: 11/14/2022]
Abstract
OBJECTIVE This systematic review aimed to identify the referral criteria for palliative care in patients with Parkinson's disease. METHODS We conducted an electronic search for publications on referral criteria for palliative care in patients with Parkinson's disease in six electronic databases. The articles were thoroughly reviewed by two independent reviewers for inclusion using a predefined data extraction list. The referral criteria were thematically classified using a coding methodology. RESULTS This systematic review included 36 publications. We identified 14 referral criteria themes. The most common referral indicators were functional decline (n = 11 [31%]), needs assessment tools (n = 11 [31%]), physical or emotional symptoms (n = 10[28%]), need for palliative care (n = 10 [28%]), decision support (n = 9 [25%]), advanced Parkinson's disease (n = 7[19%]), and diagnosis of Parkinson's disease (n = 7 [19%]). However, there was a lack of consensus on symptom assessment tools. In addition, there were no agreed cut-offs or defined time for palliative care referral for patients with Parkinson's disease. CONCLUSIONS The 14 themes identified in this systematic review were categorized into disease- and needs-based criteria. These themes show the wide range of referral timing and procedures. Further studies should be conducted to reveal standardized referral criteria.
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Affiliation(s)
- Yiping Chen
- School of Nursing, Shanxi Medical University, Taiyuan, Shanxi Province, China
- Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi Province, China
| | - Liyuan Hou
- School of Nursing, Shanxi Medical University, Taiyuan, Shanxi Province, China
- Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi Province, China
| | - Wei Li
- International Medical Department, Peking Union Medical College Hospital, Beijing, China
| | - Qiaohong Wang
- School of Nursing, Shanxi Medical University, Taiyuan, Shanxi Province, China
- Department of Nursing, First Hospital of Shanxi Medical University, Taiyuan, Shanxi Province, China
| | - Wentao Zhou
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- National Neuroscience Institute, Singapore
| | - Hui Yang
- School of Nursing, Shanxi Medical University, Taiyuan, Shanxi Province, China
- Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi Province, China
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8
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Brizzi K. Outpatient neuropalliative care. HANDBOOK OF CLINICAL NEUROLOGY 2023; 191:29-48. [PMID: 36599513 DOI: 10.1016/b978-0-12-824535-4.00002-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Palliative care is an approach to patient care that focuses on enhancing quality of life through relief of physical, emotional, and spiritual sources of distress and patient-tailored discussions about goals of care. The palliative care approach can be delivered by any provider, and can occur alongside disease-modifying therapies. For patients with a serious neurologic illness or a neurodegenerative disease, neuropalliative care is a growing field focused on providing high-quality palliative care to neurology patients. There are three models of neuropalliative care delivery in the outpatient setting: a consultative model with a palliative care specialist, an integrated model with an embedded palliative care provider, and a primary palliative care model with the patient's neurology provider. The main components of an outpatient palliative care visit include symptom assessment and treatment, communication about serious illness, advance care planning, and assessment of caregiver needs. For patients with advanced illness, palliative care can help facilitate timely referral to hospice. Through a palliative care approach, outpatient care for patients with serious neurologic disease or neurodegenerative disease can focus on the issues most important to the patient, promote improved illness understanding and planning, and can improve the overall quality of care.
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Affiliation(s)
- Kate Brizzi
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States; Department of Medicine, Massachusetts General Hospital, Boston, MA, United States.
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9
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Corcoran J, Huang AH, Miyasaki JM, Tarolli CG. Palliative care in Parkinson disease and related disorders. HANDBOOK OF CLINICAL NEUROLOGY 2023; 191:107-128. [PMID: 36599503 DOI: 10.1016/b978-0-12-824535-4.00017-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Although neuropalliative care is a relatively new field, there is increasing evidence for its use among the degenerative parkinsonian syndromes, including idiopathic Parkinson disease, progressive supranuclear palsy, multiple system atrophy, dementia with Lewy bodies, and corticobasal syndrome. This chapter outlines the current state of evidence for palliative care among individuals with the degenerative parkinsonian syndromes with discussion surrounding: (1) disease burden and needs across the conditions; (2) utility, timing, and methods for advance care planning; (3) novel care models for the provision of palliative care; and 4) end-of-life care issues. We also discuss currently unmet needs and unanswered questions in the field, proposing priorities for research and the assessment of implemented care models.
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Affiliation(s)
- Jennifer Corcoran
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, United States
| | - Andrew H Huang
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, United States
| | - Janis M Miyasaki
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Christopher G Tarolli
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, United States.
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Lennaerts-Kats H, Ebenau A, Kanters S, Bloem BR, Vissers KC, Dijkstra BW, Meinders MJ, Groot MM. The Effect of a Multidisciplinary Blended Learning Program on Palliative Care Knowledge for Health Care Professionals Involved in the Care for People with Parkinson's Disease. JOURNAL OF PARKINSON'S DISEASE 2022; 12:2575-2584. [PMID: 36442209 PMCID: PMC9837679 DOI: 10.3233/jpd-223539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Parkinson's disease (PD) is an increasingly prevalent and progressive degenerative disease. Palliative care for PD should be integrated into the routine care for people with PD. However, PD health care professionals typically lack knowledge of palliative care, highlighting the necessity of educational programs in this field. OBJECTIVE To determine the effectiveness of a multidisciplinary blended learning program for health care professionals specialized in PD in the Netherlands. METHODS We used a pre-posttest intervention design. The intervention consisted of an e-learning in combination with an online network meeting in which the participating health care professionals discussed palliative care for PD with specialists from the field of palliative care. Outcome variables included self-rated level of knowledge (scale 1-10), familiarity with specialized palliative care services (5-point Likert scale) and the validated End-of-Life Professional Caregiver Survey (EPCS). RESULTS A total of 1029 participants from sixteen different disciplines, all active in the care for people with PD, with a mean age of 45 years and 13 years of working experience, followed the blended learning program. Self-rated level of knowledge improved from 4.75 to 5.72 (0.96; p < 0.001; 95% CI change = [0.85 . . . 1.08]. Familiarity with palliative care services also increased by 1.06 (from 1.85 to 2.90; p=<0.001; 95% CI change = [1.00 . . . 1.12]). CONCLUSION A blended learning program can improve self-rated knowledge about palliative care and its services. Such programs might be a first step towards optimal integration of palliative care expertise and services within PD-care.
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Affiliation(s)
- Herma Lennaerts-Kats
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Center of Expertise for Parkinson & Movement Disorders, Nijmegen, The Netherlands,Department of Anesthesiology, Radboud University Medical Center, Pain and Palliative Care, Nijmegen, The Netherlands,Correspondence to: Herma Lennaerts-Kats, Radboudumc, Reinier
Postlaan 4, 6525 GC Nijmegen, Netherlands. Tel.: +003124 3614701; E-mail:
| | - Anne Ebenau
- Department of Anesthesiology, Radboud University Medical Center, Pain and Palliative Care, Nijmegen, The Netherlands
| | - Silvia Kanters
- Department of Anesthesiology, Radboud University Medical Center, Pain and Palliative Care, Nijmegen, The Netherlands
| | - Bastiaan R. Bloem
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Center of Expertise for Parkinson & Movement Disorders, Nijmegen, The Netherlands
| | - Kris C.P. Vissers
- Department of Anesthesiology, Radboud University Medical Center, Pain and Palliative Care, Nijmegen, The Netherlands
| | - Bauke W. Dijkstra
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Center of Expertise for Parkinson & Movement Disorders, Nijmegen, The Netherlands
| | - Marjan J. Meinders
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Center of Expertise for Parkinson & Movement Disorders, Nijmegen, The Netherlands,Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare, Nijmegen, the Netherlands
| | - Marieke M. Groot
- Department of Anesthesiology, Radboud University Medical Center, Pain and Palliative Care, Nijmegen, The Netherlands
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11
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Harrison MB, Morrissey DL, Dalrymple WA, D'Abreu A, Daly FN. Primary Palliative Care in Huntington's Disease. Mov Disord Clin Pract 2022; 10:55-63. [PMID: 36698999 PMCID: PMC9847290 DOI: 10.1002/mdc3.13589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 09/12/2022] [Accepted: 09/23/2022] [Indexed: 01/28/2023] Open
Abstract
Background Palliative care practices, including communication about patient-centered goals of care and advance care planning (ACP), have the potential to enhance care throughout the course of Huntington's disease (HD) and related disorders. The goal of our project was to develop a pilot program that integrates primary palliative care practices with interdisciplinary care for HD. Objectives (1) To train HD team members to facilitate goals of care and ACP conversations at all stages of HD; (2) To create materials for care planning in HD focused on patient-centered goals of care and health-related quality of life; and (3) To modify clinic workflow to include goals of care and ACP discussions. Methods We defined planning domains to expand care planning beyond end-of-life concerns. We created a patient and family guide to advance care planning in HD. We conducted VitalTalk communications training with the HD team. We modified the interdisciplinary clinic workflow to include ACP and developed an EMR template for documentation. Results After communication training, more team members felt well prepared to discuss serious news (12.5% to 50%) and manage difficult conversations (25% to 62.5%). The proportion of clinic visits including advance care planning discussions increased from 12.5% to 30.6% during the pilot phase. Conclusions Provision of primary palliative care for HD in an interdisciplinary clinic is feasible. Integration of palliative care practices into HD specialty care requires additional training and modification of clinic operations.
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Affiliation(s)
| | - Dana L. Morrissey
- Department of NeurologyUniversity of VirginiaCharlottesvilleVirginiaUSA
| | - W. Alex Dalrymple
- Department of NeurologyUniversity of VirginiaCharlottesvilleVirginiaUSA
| | - Anelyssa D'Abreu
- Department of NeurologyUniversity of VirginiaCharlottesvilleVirginiaUSA
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12
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Jensen I, Bretschneider A, Stiel S, Wegner F, Höglinger GU, Klietz M. Analysis of Parkinson's Disease Outpatient Counselling for Advance Directive Creation: A Cross-Sectional Questionnaire-Based Survey of German General Practitioners and Neurologists. Brain Sci 2022; 12:brainsci12060749. [PMID: 35741634 PMCID: PMC9221250 DOI: 10.3390/brainsci12060749] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/01/2022] [Accepted: 06/06/2022] [Indexed: 02/05/2023] Open
Abstract
A major proportion of people with Parkinson’s disease (PwP) in Germany has written an advance directive (AD). Unfortunately, these ADs are unclear for PD-specific endpoints. We previously established consensus-based recommendations for disease-specific content of an AD in PwP. However, the implementation of those recommendations and the consulting of AD creation and modification in PwP remains to be evaluated. This study aimed to investigate the practical use of PD-specific recommendations for ADs in outpatient settings. A total of 87 physicians (45 general practitioners (GPs) and 42 neurologists, 10% response rate) answered a self-constructed semiquantitative questionnaire. The participants were asked to evaluate the suggested PD-specific recommendations for ADs and the supply of palliative care in the outpatient setting. Overall, the vast majority of treating physicians agreed on the usefulness of the newly constructed PD-specific recommendations. Consultations to discuss information about PD-specific ADs were scarce with short durations. Only 24% of participating physicians implemented the PD-specific recommendations in their daily practice. GPs and neurologists agreed on the benefit of disease-specific recommendations for ADs. In future, a more general integration of these recommendations in routine care might improve specific AD creation of PwP and advanced care planning.
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Affiliation(s)
- Ida Jensen
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany; (A.B.); (F.W.); (G.U.H.); (M.K.)
- Correspondence:
| | - Almut Bretschneider
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany; (A.B.); (F.W.); (G.U.H.); (M.K.)
| | - Stephanie Stiel
- Institute for General Practice and Palliative Care, Hannover Medical School, 30625 Hannover, Germany;
| | - Florian Wegner
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany; (A.B.); (F.W.); (G.U.H.); (M.K.)
| | - Günter U. Höglinger
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany; (A.B.); (F.W.); (G.U.H.); (M.K.)
| | - Martin Klietz
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany; (A.B.); (F.W.); (G.U.H.); (M.K.)
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13
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Badwal K, Kiliaki SA, Dugani SB, Pagali SR. Psychosis Management in Lewy Body Dementia: A Comprehensive Clinical Approach. J Geriatr Psychiatry Neurol 2022; 35:255-261. [PMID: 33461372 DOI: 10.1177/0891988720988916] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Lewy body dementia (LBD) is asynucleinopathy that results in clinical manifestation of motor and neuropsychiatric symptoms. The disease burden associated with psychosis in LBD patients is significantly higher compared to other types of dementia or even to LBD without psychosis. Effective care management processes should include consideration of de-prescribing any offending agents including anticholinergics and dopaminergic agents, followed by nonpharmacological and low risk pharmacological approach. If addition of pharmacological agents is required, consideration should be given to acetylcholinesterase inhibitors, pimavanserin and atypical antipsychotics such as quetiapine or clozapine. Side effects of these medications should be considered prior to selection and initiation of a medication regimen. Goals of care and functional assessment are a crucial part of the optimized care plan, given overall guarded prognosis, in the context of numerous complications observed in this population. Palliative care consultation could facilitate symptom control and timely enrollment into hospice if consistent with patient's goals.
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Affiliation(s)
- Karun Badwal
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Shangwe A Kiliaki
- Division of Hospital Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Sagar B Dugani
- Division of Hospital Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Sandeep R Pagali
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Mayo Clinic, Rochester, MN, USA.,Division of Hospital Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
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14
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Halhouli O, Zhang Q, Aldridge GM. Caring for patients with cognitive dysfunction, fluctuations and dementia caused by Parkinson's disease. PROGRESS IN BRAIN RESEARCH 2022; 269:407-434. [PMID: 35248204 DOI: 10.1016/bs.pbr.2022.01.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Cognitive dysfunction is one of the most prevalent non-motor symptoms in patients with Parkinson's disease (PD). While it tends to worsen in the later stages of disease, it can occur at any time, with 15-20% of patients exhibiting cognitive deficits at diagnosis (Aarsland et al., 2010; Goldman and Sieg, 2020). The characteristic features of cognitive dysfunction include impairment in executive function, visuospatial abilities, and attention, which vary in severity from subtle impairment to overt dementia (Martinez-Horta and Kulisevsky, 2019). To complicate matters, cognitive dysfunction is prone to fluctuate in PD patients, impacting diagnosis and the ability to assess progression and decision-making capacity. The diagnosis of cognitive impairment or dementia has a huge impact on patient independence, quality of life, life expectancy and caregiver burden (Corallo et al., 2017; Lawson et al., 2016; Leroi et al., 2012). It is therefore essential that physicians caring for patients with PD provide education, screening and treatment for this aspect of the disease. In this chapter, we provide a practical guide for the assessment and management of various degrees of cognitive dysfunction in patients with PD by approaching the disease at different stages. We address risk factors for cognitive dysfunction, prevention strategies prior to making the diagnosis, available tools for screening. Lastly, we review aspects of care, management and considerations, including decision-making capacity, that occur after the patient has been diagnosed with cognitive dysfunction or dementia.
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Affiliation(s)
- Oday Halhouli
- University of Iowa, Department of Neurology, Iowa City, IA, United States
| | - Qiang Zhang
- University of Iowa, Department of Neurology, Iowa City, IA, United States
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15
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Dawson B, McConvey K, Gofton TE. When to initiate palliative care in neurology. HANDBOOK OF CLINICAL NEUROLOGY 2022; 190:105-125. [PMID: 36055710 DOI: 10.1016/b978-0-323-85029-2.00011-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Life-limiting and life-threatening neurologic conditions often progress slowly. Patients live with a substantial symptom burden over a long period of time, and there is often a high degree of functional and cognitive impairment. Because of this, the most appropriate time to initiate neuropalliative care is often difficult to identify. Further challenges to the incorporation of neuropalliative care include communication barriers, such as profound dysarthria or language impairments, and loss of cognitive function and decision-making capacity that prevent shared decision making and threaten patient autonomy. As a result, earlier initiation of at least some components of palliative care is paramount to ensuring patient-centered care while the patient is still able to communicate effectively and participate as fully as possible in their medical care. For these reasons, neuropalliative care is also distinct from palliative care in oncology, and there is a growing evidence base to guide timely initiation and integration of neuropalliative care. In this chapter, we will focus on when to initiate palliative care in patients with life-limiting, life-threatening, and advanced neurologic conditions. We will address three main questions, which patients with neurologic conditions will benefit from initiation of palliative care, what aspects of neurologic illness are most amenable to neuropalliative care, and when to initiate neuropalliative care?
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Affiliation(s)
- Benjamin Dawson
- Department of Clinical Neurologic Sciences, Western University, London, ON, Canada
| | - Kayla McConvey
- Department of Clinical Neurologic Sciences, Western University, London, ON, Canada
| | - Teneille E Gofton
- Department of Clinical Neurologic Sciences, Western University, London, ON, Canada.
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16
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Churm D, Dickinson C, Robinson L, Paes P, Cronin T, Walker R. How Do Patients With Parkinson's Disease Approach Advance Care Planning? A UK-Based Mixed Methods Study. J Geriatr Psychiatry Neurol 2022; 35:168-175. [PMID: 33461368 DOI: 10.1177/0891988720988917] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Advance Care Planning (ACP) allows people the opportunity to plan for a time when they may lose capacity. The aim of this study was to determine the extent people with Parkinson's disease (PD) were aware of ACP, existing plans they held and to explore their own views, as well as their relatives, on planning for the future. METHODS This was a sequential explanatory mixed methods study with a postal quantitative survey to establish awareness and engagement with planning for the future; and qualitative semi-structured interviews to explore the views of people with PD and their relatives on ACP and future plans. RESULTS 104 questionnaires were analyzed. 76% of respondents had not heard of ACP, while 69% expressed an interest in finding out more about ACP. 78% had a will, and 23% had appointed lasting power of attorneys. All interviewees acknowledged engaging in some aspect of planning. Plans were mostly practical as opposed to health-care related. Interviewees expressed a preference for ACP to be carried out by their PD team, at home, and at a time relevant to their condition. CONCLUSION The awareness and understanding of ACP in people with PD is low. While there is desire to be better informed about ACP, this did not translate into desire to engage in ACP. Health professionals should identify people for whom ACP may serve a positive purpose, and proactively address ACP as a continuum with them, while ensuring awareness is raised about ACP, and there is access for who are interested.
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Affiliation(s)
- Deepta Churm
- North Tyneside Hospital, Northumbria Healthcare NHS Foundation Trust, North Shields, Tyne and Wear, United Kingdom
| | | | | | - Paul Paes
- North Tyneside Hospital, Northumbria Healthcare NHS Foundation Trust, North Shields, Tyne and Wear, United Kingdom.,Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Thomas Cronin
- North Tyneside Hospital, Northumbria Healthcare NHS Foundation Trust, North Shields, Tyne and Wear, United Kingdom
| | - Richard Walker
- North Tyneside Hospital, Northumbria Healthcare NHS Foundation Trust, North Shields, Tyne and Wear, United Kingdom.,Newcastle University, Newcastle upon Tyne, United Kingdom
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17
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Macchi ZA, Lum HD. Advance care planning in neurologic illness. HANDBOOK OF CLINICAL NEUROLOGY 2022; 190:129-148. [PMID: 36055711 DOI: 10.1016/b978-0-323-85029-2.00004-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Advance care planning (ACP) is an essential element of neuropalliative care for persons living acquired brain injuries or progressive, neurodegenerative conditions like dementia. This includes early recognition of these conditions as needing timely ACP conversations to maximize patient autonomy and capacity in early disease, leading to discussions and documentation of patients' values and preferences for future care. ACP involves assessing patient readiness, evaluating decision-making capacity, initiating discussions early and iteratively in the disease course, identifying and preparing surrogate decision makers, and documenting patients' goals-of-care. However, this process presents unique challenges for clinicians and patients' families as individuals lose the ability to meaningfully engage in conversations due to multiple factors related to brain dysfunction. This includes evaluations of capacity for medical decision-making which consider the context in which discussions are held across multiple timepoints with repeated conversations. Research has shown that engaging in early ACP leads to greater goal-concordant care in advanced neurologic illness and affects end-of-life medical decision-making. Clinicians should be familiar with the significance of ACP in this context, understand ways for approaching these difficult discussions with patients and their families, and be aware of evidence-based tools which prepare and aid patients for these discussions. Here, we review ACP in the context of serious neurologic illness and discuss how clinicians can approach conversations with patients and families, ensure patients' values and preferences are documented and available, and explore tools which may enhance the ACP process.
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Affiliation(s)
- Zachary A Macchi
- Department of Neurology, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, United States; Division of Geriatric Medicine, Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, United States
| | - Hillary D Lum
- Division of Geriatric Medicine, Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, United States.
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18
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Koljack CE, Miyasaki J, Prizer LP, Katz M, Galifianakis N, Sillau SH, Kluger BM. Predictors of Spiritual Well-Being in Family Caregivers for Individuals with Parkinson's Disease. J Palliat Med 2021; 25:606-613. [PMID: 34818097 DOI: 10.1089/jpm.2020.0797] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Parkinson's disease (PD) is a common neurodegenerative illness that causes disability through both motor and nonmotor symptoms. Family caregivers provide substantial care to persons living with PD, often at great personal cost. While spiritual well-being and spirituality have been suggested to promote resiliency in caregivers of persons living with cancer and dementia, this issue has not been explored in PD. Objective: The aim of this study was to identify predictors of spiritual well-being in PD patients' caregivers. Design: A cross-sectional analysis was performed. Our primary outcome measure, the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being (FACIT-Sp), was measured in caregivers alongside measures of patient quality of life, symptom burden, global function, grief, and spiritual well-being and caregiver mood, burden, and perceptions of patient quality of life. Univariate correlation and multiple regression were used to determine associations between predictor variables and caregiver FACIT-Sp. Setting/Subjects: PD patient/caregiver dyads were recruited through three academic medical centers in the United States and Canada and regional community support groups. Results: We recruited 183 dyads. Patient faith, symptom burden, health-related quality of life, depression, motor function, and grief were significant predictors of caregiver spiritual well-being. Predictive caregiver factors included caregiver depression and anxiety. These factors remained significant in combined models, suggesting that both patient and caregiver factors make independent contributions to caregiver spiritual well-being. Conclusions: The present study suggests that both patient and caregiver factors are associated with spiritual well-being in PD. Further study is needed to understand the causal relationship of these factors and whether interventions to support caregiver spiritual well-being improve outcomes for caregivers or patients. Clinicaltrials.gov registration NCT02533921.
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Affiliation(s)
- Claire E Koljack
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Janis Miyasaki
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Canada
| | | | - Maya Katz
- Department of Neurology, University of California San Francisco Medical Center, San Francisco, California, USA
| | - Nick Galifianakis
- Department of Neurology, University of California San Francisco Medical Center, San Francisco, California, USA
| | - Stefan H Sillau
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Benzi M Kluger
- Department of Neurology and Medicine, University of Rochester Medical Center, Rochester, New York, USA
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19
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Abstract
BACKGROUND Parkinson's disease is a progressive neurodegenerative disorder that negatively impacts the lives of affected people. The therapeutic benefits of treatment only decrease going forward from the time of diagnosis. Motor and non-motor symptoms alike create a heavy burden for patients and those involved in their care. Palliative care is utilized for patients with serious illnesses and when integrated into patients with Parkinson's disease, improves quality of life by addressing symptoms of discomfort, which ultimately reduces symptom burden to patients and alleviates caregiver stress. OBJECTIVE This review aims to assess the efficacy of palliative care in the management of Parkinson's disease by exploring the benefits of palliative care integration throughout multiple relevant themes to demonstrate the optimal care delivery. METHODS Comprehensive searches on the role of palliative care in Parkinson's disease patients within MEDLINE, PUBMED, CINAHL, CENTRAL, PsycINFO, Embase, and BioMed Central, considering publications between March 2010 - February 2020 were performed. A grey literature search was also performed for additional information. RESULTS Analysis of various existing literature has demonstrated promise in timely palliative care integration for patients with Parkinson's disease, which has shown improvement in the quality of life of Parkinson's disease patients. It also strives to alleviate caregivers' stress and improve their quality of life, although insufficient research exists to support this. Palliative care in Parkinson's disease is a growing area of interest, evidently demonstrating the potential to expand among the current approaches. CONCLUSION Understanding the connections between the themes surrounding palliative care is crucial for successful integration in Parkinson's disease management. It is determined that integration of palliative care in patients with Parkinson's disease help to not only improve patients' experiences but also their caregiver's experiences throughout the disease trajectory. Further research should be conducted to address how palliative care will focus on alleviating caregiver burden and establish specific prognostication tools for Parkinson's disease patients.
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Affiliation(s)
- Helen Senderovich
- Department of Family and Community Medicine, Division of Palliative Care, Faculty of Medicine, University of Toronto, Toronto, Canada
- Department of Family and Community Medicine, Baycrest, Toronto, Canada
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20
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Lennaerts-Kats H, Ebenau A, van der Steen JT, Munneke M, Bloem BR, Vissers KCP, Meinders MJ, Groot MM. "No One Can Tell Me How Parkinson's Disease Will Unfold": A Mixed Methods Case Study on Palliative Care for People with Parkinson's Disease and Their Family Caregivers. JOURNAL OF PARKINSONS DISEASE 2021; 12:207-219. [PMID: 34542031 PMCID: PMC8842750 DOI: 10.3233/jpd-212742] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Background: Palliative care for persons with Parkinson’s disease (PD) is developing. However, little is known about the experiences of patients with PD in the palliative phase and of their family caregivers. Objective: To explore needs of patients with PD in the palliative phase and of their family caregivers. Methods: A mixed methods case study design. Health care professionals included patients for whom the answer on the question “Would you be surprised if this patient died in the next 12 months?” was negative. At baseline, and after six and twelve months, we conducted semi-structured interviews with patients and caregivers. Participants completed questionnaires on quality of life, disease burden, caregiver burden, grief, and positive aspects of caregiving. We analyzed quantitative data using descriptive statistics, while we used thematic analysis for qualitative data. Results: Ten patients and eight family caregivers participated, of whom five patients died during the study period. While the quantitative data reflected a moderate disease burden, the qualitative findings indicated a higher disease burden. Longitudinal results showed small differences and changes in time. Patients reported a diverse range of symptoms, such as fatigue, immobility, cognitive changes, and hallucinations, which had a tremendous impact on their lives. Nevertheless, they rated their overall quality of life as moderate to positive. Family caregivers gradually learned to cope with difficult situations such delirium, fluctuations in functioning and hallucinations. They had great expertise in caring for the person with PD but did not automatically share this with health care professionals. Patients sensed a lack of time to discuss their complex needs with clinicians. Furthermore, palliative care was rarely discussed, and none of these patients had been referred to specialist palliative care services. Conclusion: Patients with PD experienced many difficulties in daily living. Patients seems to adapt to living with PD as they rated their quality of life as moderate to positive. Family caregivers became experts in the care for their loved one, but often learned on their own. An early implementation of the palliative care approach can be beneficial in addressing the needs of patients with PD and their family caregivers.
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Affiliation(s)
- Herma Lennaerts-Kats
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands.,Department of Anesthesiology, Radboud University Medical Center, Pain and Palliative Care, Nijmegen, The Netherlands
| | - Anne Ebenau
- Department of Anesthesiology, Radboud University Medical Center, Pain and Palliative Care, Nijmegen, The Netherlands
| | - Jenny T van der Steen
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Marten Munneke
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Bastiaan R Bloem
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Kris C P Vissers
- Department of Anesthesiology, Radboud University Medical Center, Pain and Palliative Care, Nijmegen, The Netherlands
| | - Marjan J Meinders
- Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare, Nijmegen, the Netherlands
| | - Marieke M Groot
- Department of Anesthesiology, Radboud University Medical Center, Pain and Palliative Care, Nijmegen, The Netherlands
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21
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Meinders MJ, Gentile G, Schrag AE, Konitsiotis S, Eggers C, Taba P, Lorenzl S, Odin P, Rosqvist K, Chaudhuri KR, Antonini A, Bloem BR, Groot MM. Advance Care Planning and Care Coordination for People With Parkinson's Disease and Their Family Caregivers-Study Protocol for a Multicentre, Randomized Controlled Trial. Front Neurol 2021; 12:673893. [PMID: 34434156 PMCID: PMC8382049 DOI: 10.3389/fneur.2021.673893] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 06/30/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Parkinson's disease (PD) is a progressive neurodegenerative disease with motor- and non-motor symptoms. When the disease progresses, symptom burden increases. Consequently, additional care demands develop, the complexity of treatment increases, and the patient's quality of life is progressively threatened. To address these challenges, there is growing awareness of the potential benefits of palliative care for people with PD. This includes communication about end-of-life issues, such as Advance Care Planning (ACP), which helps to elicit patient's needs and preferences on issues related to future treatment and care. In this study, we will assess the impact and feasibility of a nurse-led palliative care intervention for people with PD across diverse European care settings. Methods: The intervention will be evaluated in a multicentre, open-label randomized controlled trial, with a parallel group design in seven European countries (Austria, Estonia, Germany, Greece, Italy, Sweden and United Kingdom). The “PD_Pal intervention” comprises (1) several consultations with a trained nurse who will perform ACP conversations and support care coordination and (2) use of a patient-directed “Parkinson Support Plan-workbook”. The primary endpoint is defined as the percentage of participants with documented ACP-decisions assessed at 6 months after baseline (t1). Secondary endpoints include patients' and family caregivers' quality of life, perceived care coordination, patients' symptom burden, and cost-effectiveness. In parallel, we will perform a process evaluation, to understand the feasibility of the intervention. Assessments are scheduled at baseline (t0), 6 months (t1), and 12 months (t2). Statistical analysis will be performed by means of Mantel–Haenszel methods and multilevel logistic regression models, correcting for multiple testing. Discussion: This study will contribute to the current knowledge gap on the application of palliative care interventions for people with Parkinson's disease aimed at ameliorating quality of life and managing end-of-life perspectives. Studying the impact and feasibility of the intervention in seven European countries, each with their own cultural and organisational characteristics, will allow us to create a broad perspective on palliative care interventions for people with Parkinson's disease across settings. Clinical Trial Registration:www.trialregister.nl, NL8180.
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Affiliation(s)
- Marjan J Meinders
- Scientific Center for Quality of Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands.,Department of Neurology, Center of Expertise for Parkinson and Movement Disorders, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, Netherlands
| | | | - Anette E Schrag
- Department of Clinical and Movement Neurosciences, UCL Institute of Neurology, University College London, London, United Kingdom
| | - Spiros Konitsiotis
- Department of Neurology, Medical School, University of Ioannina, Ioannina, Greece
| | - Carsten Eggers
- Department of Neurology, Philipps University Marburg, Marburg, Germany.,Knappschaftskrankenhaus Bottrop GmbH, Department of Neurology, Bottrop, Germany
| | - Pille Taba
- Department of Neurology and Neurosurgery, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia.,Neurology Clinic, Tartu University Hospital, Tartu, Estonia
| | - Stefan Lorenzl
- Institute of Nursing Science and Practice, Paracelsus Medical University, Salzburg, Austria.,Department of Neurology and Department of Palliative Care, Ludwig-Maximilians-University, Munich, Germany.,Department of Neurology, Klinikum Agatharied, Hausham, Germany
| | - Per Odin
- Division of Neurology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Kristina Rosqvist
- Division of Neurology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - K Ray Chaudhuri
- Department of Basic and Clinical Neuroscience, Parkinson's Foundation Centre of Excellence, King's College London, London, United Kingdom
| | - Angelo Antonini
- Department of Neuroscience, University of Padua, Padua, Italy
| | - Bastiaan R Bloem
- Department of Neurology, Center of Expertise for Parkinson and Movement Disorders, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, Netherlands
| | - Marieke M Groot
- Department of Anesthesiology, Pain and Palliative Care, Radboud University Medical Center, Nijmegen, Netherlands
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22
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Understanding how people with Parkinson's disease and their relatives approach advance care planning. Eur Geriatr Med 2021; 13:109-117. [PMID: 34398428 DOI: 10.1007/s41999-021-00548-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 07/22/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Advance care planning gives individuals with capacity the option of planning for their future, and anticipating future decision-making about their treatment or care should they then lose capacity. People with Parkinson's disease (PD) may develop significant physical and cognitive problems as the disease progresses, which creates a great need for, but significant challenges to, advance care planning. As a result, we set out to explore the views of people with PD and relatives on planning for the future and advance care planning. METHODS Qualitative study with semi-structured interviews of thirty-three people with PD and their relatives in the North-East of England. RESULTS Interviewees with PD were generally not keen to engage with advance care planning in the present, in comparison to the future. Three main themes arose from the data in identifying why this may be the case: (1) 'Awareness'-which included the limited awareness on purpose of advance care planning and Parkinson's disease; (2) 'Uncertainty'-the uncertainty of living with PD and of life; and (3) 'Salience'-the complex decision-making processes that interviewees engaged in, which were highly variable. CONCLUSION The use of advance care planning in PD is influenced by its perception amongst people with PD and their relatives. Health professionals have an important role in raising the salience of health care planning.
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23
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Hindmarsh J, Hindmarsh S, Lee M. Idiopathic Parkinson's Disease at the End of Life: A Retrospective Evaluation of Symptom Prevalence, Pharmacological Symptom Management and Transdermal Rotigotine Dosing. Clin Drug Investig 2021; 41:675-683. [PMID: 34213758 DOI: 10.1007/s40261-021-01054-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Distressing symptoms are prevalent in patients with idiopathic Parkinson's disease, yet little is known about symptom burden and subsequent pharmacological management at the end of life. Additionally, when oral administration of antiparkinsonian medications is no longer possible in dying patients, it is becoming common place to initiate transdermal rotigotine, despite a paucity of evidence to guide dosing. OBJECTIVES To assess: (1) symptom prevalence from the use of anticipatory medicines in patients with idiopathic Parkinson's disease, (2) the prescribing of antiparkinsonian medication at the end of life; and (3) the accuracy of conversion from oral antiparkinsonian medicines to transdermal rotigotine and any associations between rotigotine dosing and end-of-life symptoms. METHODS A retrospective case review was performed. One hundred consecutive patients with idiopathic Parkinson's disease who died during an inpatient admission at a UK teaching hospital were assessed. RESULTS The most prevalent terminal symptoms were excess respiratory secretions (58%), pain (52%), agitation (51%) and fever (23%). The majority of patients were converted to transdermal rotigotine (90%). Patients converted to a higher than equivalent dose of rotigotine were more likely to be agitated (p < 0.05), whilst those converted to a lower than equivalent dose were less likely to develop excess respiratory secretions (p < 0.05). The prevalence of pain did not differ according to rotigotine dosing. CONCLUSIONS This study highlights for the first time use of anticipatory medications at the end of life in patients with idiopathic Parkinson's disease and the prevalence of terminal symptoms. It also demonstrates the widespread use of rotigotine patches, and that lower than equivalent doses may be better tolerated.
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Affiliation(s)
- Jonathan Hindmarsh
- Specialist Centre for Palliative Care, St. Benedict's Hospice, Sunderland, UK.
- Department of Pharmacy, Sunderland Royal Hospital, South Tyneside and Sunderland Foundation Trust, Kayll Road, Sunderland, SR4 7TP, UK.
| | - Sharlene Hindmarsh
- Department of Pharmacy, Sunderland Royal Hospital, South Tyneside and Sunderland Foundation Trust, Kayll Road, Sunderland, SR4 7TP, UK
| | - Mark Lee
- Specialist Centre for Palliative Care, St. Benedict's Hospice, Sunderland, UK
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24
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Akbar U, McQueen RB, Bemski J, Carter J, Goy ER, Kutner J, Johnson MJ, Miyasaki JM, Kluger B. Prognostic predictors relevant to end-of-life palliative care in Parkinson's disease and related disorders: a systematic review. J Neurol Neurosurg Psychiatry 2021; 92:jnnp-2020-323939. [PMID: 33789923 PMCID: PMC8142437 DOI: 10.1136/jnnp-2020-323939] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 01/10/2021] [Accepted: 01/12/2021] [Indexed: 11/22/2022]
Abstract
Parkinson's disease and related disorders (PDRD) are the second most common neurodegenerative disease and a leading cause of death. However, patients with PDRD receive less end-of-life palliative care (hospice) than other illnesses, including other neurologic illnesses. Identification of predictors of PDRD mortality may aid in increasing appropriate and timely referrals. To systematically review the literature for causes of death and predictors of mortality in PDRD to provide guidance regarding hospice/end-of-life palliative care referrals. We searched MEDLINE, PubMed, EMBASE and CINAHL databases (1970-2020) of original quantitative research using patient-level, provider-level or caregiver-level data from medical records, administrative data or survey responses associated with mortality, prognosis or cause of death in PDRD. Findings were reviewed by an International Working Group on PD and Palliative Care supported by the Parkinson's Foundation. Of 1183 research articles, 42 studies met our inclusion criteria. We found four main domains of factors associated with mortality in PDRD: (1) demographic and clinical markers (age, sex, body mass index and comorbid illnesses), (2) motor dysfunction and global disability, (3) falls and infections and (4) non-motor symptoms. We provide suggestions for consideration of timing of hospice/end-of-life palliative care referrals. Several clinical features of advancing disease may be useful in triggering end-of-life palliative/hospice referral. Prognostic studies focused on identifying when people with PDRD are nearing their final months of life are limited. There is further need for research in this area as well as policies that support need-based palliative care for the duration of PDRD.
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Affiliation(s)
- Umer Akbar
- Neurology, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
| | | | - Julienne Bemski
- Department of Neurology, University of Colorado, Denver, Colorado, USA
| | - Julie Carter
- Department of Neurology, University of Colorado, Denver, Colorado, USA
| | - Elizabeth R Goy
- Department of Neurology, Portland VA Medical Center, Portland, Oregon, USA
| | - Jean Kutner
- Department of Neurology, University of Colorado, Denver, Colorado, USA
| | - Miriam J Johnson
- Department of Palliative Medicine, Hull York Medical School, Hull, Kingston upon Hull, UK
| | - Janis M Miyasaki
- Department of Neurology, University of Alberta, Edmonton, Alberta, Canada
| | - Benzi Kluger
- Department of Neurology, University of Rochester, Rochester, New York, USA
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25
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Kluger BM, Dolhun R, Sumrall M, Hall K, Okun MS. Palliative Care and Parkinson's Disease: Time to Move Beyond Cancer. Mov Disord 2021; 36:1325-1329. [PMID: 33786871 DOI: 10.1002/mds.28556] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 02/02/2021] [Accepted: 02/16/2021] [Indexed: 12/23/2022] Open
Affiliation(s)
- Benzi M Kluger
- Departments of Neurology and Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Rachel Dolhun
- The Michael J. Fox Foundation, New York, New York, USA
| | - Malenna Sumrall
- Parkinson Foundation Patient and Family Advisory Council, New York, New York, USA
| | - Kirk Hall
- Parkinson Foundation Patient and Family Advisory Council, New York, New York, USA
| | - Michael S Okun
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, Florida, USA.,Parkinson's Foundation, Miami, Florida, USA
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26
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Kluger BM, Miyasaki J, Katz M, Galifianakis N, Hall K, Pantilat S, Khan R, Friedman C, Cernik W, Goto Y, Long J, Fairclough D, Sillau S, Kutner JS. Comparison of Integrated Outpatient Palliative Care With Standard Care in Patients With Parkinson Disease and Related Disorders: A Randomized Clinical Trial. JAMA Neurol 2021; 77:551-560. [PMID: 32040141 PMCID: PMC7042842 DOI: 10.1001/jamaneurol.2019.4992] [Citation(s) in RCA: 103] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Importance Parkinson disease and related disorders (PDRD) have consequences for quality of life (QoL) and are the 14th leading cause of death in the United States. Despite growing interest in palliative care (PC) for persons with PDRD, few studies are available supporting its effectiveness. Objective To determine if outpatient PC is associated with improvements in patient-centered outcomes compared with standard care among patients with PDRD and their caregivers. Design, Setting, and Participants This randomized clinical trial enrolled participants at 3 academic tertiary care centers between November 1, 2015, and September 30, 2017, and followed them up for 1 year. A total of 584 persons with PDRD were referred to the study. Of those, 351 persons were excluded by phone and 23 were excluded during in-person screenings. Patients were eligible to participate if they had PDRD and moderate to high PC needs. Patients were excluded if they had urgent PC needs, another diagnosis meriting PC, were already receiving PC, or were unable or unwilling to follow the study protocol. Enrolled participants were assigned to receive standard care plus outpatient integrated PC or standard care alone. Data were analyzed between November 1, 2018, and December 9, 2019. Interventions Outpatient integrated PC administered by a neurologist, social worker, chaplain, and nurse using PC checklists, with guidance and selective involvement from a palliative medicine specialist. Standard care was provided by a neurologist and a primary care practitioner. Main Outcomes and Measures The primary outcomes were the differences in patient quality of life (QoL; measured by the Quality of Life in Alzheimer Disease scale) and caregiver burden (measured by the Zarit Burden Interview) between the PC intervention and standard care groups at 6 months. Results A total of 210 patients with PDRD (135 men [64.3%]; mean [SD] age, 70.1 [8.2] years) and 175 caregivers (128 women [73.1%]; mean [SD] age, 66.1 [11.1] years) were enrolled in the study; 193 participants (91.9%) were white and non-Hispanic. Compared with participants receiving standard care alone at 6 months, participants receiving the PC intervention had better QoL (mean [SD], 0.66 [5.5] improvement vs 0.84 [4.2] worsening; treatment effect estimate, 1.87; 95% CI, 0.47-3.27; P = .009). No significant difference was observed in caregiver burden (mean [SD], 2.3 [5.0] improvement vs 1.2 [5.6] improvement in the standard care group; treatment effect estimate, -1.62; 95% CI, -3.32 to 0.09; P = .06). Other significant differences favoring the PC intervention included nonmotor symptom burden, motor symptom severity, completion of advance directives, caregiver anxiety, and caregiver burden at 12 months. No outcomes favored standard care alone. Secondary analyses suggested that benefits were greater for persons with higher PC needs. Conclusions and Relevance Outpatient PC is associated with benefits among patients with PDRD compared with standard care alone. This study supports efforts to integrate PC into PDRD care. The lack of diversity and implementation of PC at experienced centers suggests a need for implementation research in other populations and care settings. Trial Registration ClinicalTrials.gov Identifier: NCT02533921.
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Affiliation(s)
- Benzi M Kluger
- Department of Neurology, Anschutz Medical Campus, University of Colorado, Denver, Aurora.,Now with Department of Neurology, University of Rochester Medical Center, Rochester, New York
| | - Janis Miyasaki
- Department of Neurology, University of Alberta, Edmonton, Alberta, Canada
| | - Maya Katz
- Department of Neurology, University of California, San Francisco, San Francisco
| | | | - Kirk Hall
- Department of Neurology, Anschutz Medical Campus, University of Colorado, Denver, Aurora
| | - Steven Pantilat
- Division of Palliative Medicine, Department of Medicine, University of California, San Francisco, San Francisco
| | - Ryan Khan
- Department of Neurology, Anschutz Medical Campus, University of Colorado, Denver, Aurora
| | - Cari Friedman
- Department of Neurology, Anschutz Medical Campus, University of Colorado, Denver, Aurora
| | - Wendy Cernik
- Department of Neurology, Anschutz Medical Campus, University of Colorado, Denver, Aurora
| | - Yuika Goto
- Division of Palliative Medicine, Department of Medicine, University of California, San Francisco, San Francisco
| | - Judith Long
- Department of Neurology, University of California, San Francisco, San Francisco
| | - Diane Fairclough
- Department of Biostatistics and Informatics, School of Public Health, University of Colorado, Aurora
| | - Stefan Sillau
- Department of Neurology, Anschutz Medical Campus, University of Colorado, Denver, Aurora
| | - Jean S Kutner
- Division of General Internal Medicine, Department of Medicine, School of Medicine, University of Colorado, Aurora
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Abstract
PURPOSE OF REVIEW This review summarizes the current state of evidence for palliative care (PC) in movement disorders, describes the application of PC to clinical practice, and suggests future research directions. RECENT FINDINGS PC needs are common in persons living with movement disorders and their families from the time of diagnosis through end-of-life and contribute to quality of life. Early advance care planning is preferred by patients, impacts outcomes and is promoted by PC frameworks. Systematic assessment of non-motor symptoms, psychosocial needs and spiritual/existential distress may address gaps in current models of care. Several complementary and emerging models of PC may be utilized to meet the needs of this population. A PC approach may identify and improve important patient and caregiver-centered outcomes. As a relatively new application of PC, there is a need for research to adapt, develop and implement approaches to meet the unique needs of this population.
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Affiliation(s)
- Zachary A Macchi
- Department of Neurology, University of Colorado, Aurora, CO Building 400, Mail Stop F429, 12469 E 17th Place, Aurora, CO, 80045, USA.
| | - Christopher G Tarolli
- Department of Neurology, University of Rochester, Rochester, NY, USA
- Center for Health + Technology, University of Rochester, Rochester, NY, USA
| | - Benzi M Kluger
- Department of Neurology, University of Rochester, Rochester, NY, USA
- Center for Health + Technology, University of Rochester, Rochester, NY, USA
- Department of Medicine, Palliative Care Division, University of Rochester, Rochester, NY, USA
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Sofronas M, Wright DK. Neuropalliative care: An integrative review of the nursing literature. Int J Nurs Stud 2021; 117:103879. [PMID: 33582395 DOI: 10.1016/j.ijnurstu.2021.103879] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 11/26/2020] [Accepted: 11/30/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND In the last few decades, research and clinical care have attempted to identify and meet the palliative care needs, concerns and challenges of patients of all ages with neurologic disease, under the newly defined subspecialty of neuropalliative care. However, the role of nurses in care organization and provision, as well as nursing priorities with regards to the needs and concerns of patients and families, have not been well articulated. The purpose of this review is to outline priorities in neuropalliative care nursing and examine what questions have been investigated to date. METHODS The integrative review approach was used to produce an analysis of existing nursing literature on neuropalliative care. As the broadest of research review methods, integrative review includes experimental and non-experimental research, as well as theoretical work, allowing us to engage with concepts and evidence from multiple perspectives. RESULTS AND DISCUSSION Six themes of concern for nursing care and research were identified: (1) managing a heavy symptom burden, (2) unmet care needs, (3) the need for care pathways and protocols, (4) caregiver burden, (5) poor recognition of the dying, and (6) the impact of communication and cognition changes. An analysis and critique of the literature yielded the following recommendations for clinical and research priorities: (1) a paradigm shift in how neurologic disorders is perceived and managed, (2) redefining the scope of neuropalliative care and services, (3) understanding and addressing the needs of family members and caregivers and including them in assessments, care planning and provision; (4) having the difficult conversations and asking the right questions. CONCLUSIONS Nurses and nursing studies pay attention to things that matter to patients and their families. As the health professionals who spend the most time with patients and families at the bedside and in the community, nurses are well placed to build strong relationships, recognize needs and concerns, and recommend strategies and interventions to enhance comfort and alleviate suffering. In neuropalliative care nursing, this relational engagement becomes critical since patients experience changes to their cognition and communication as a result of disease progression. To enhance patient agency during a vulnerable time, methodologies to include patients who think and communicate differently in clinical care and research are urgently needed. Tweetable abstract: Neuropalliative nursing researchers call for better prognostication, recognition of the dying process, including patients in care decisions.
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Affiliation(s)
- Marianne Sofronas
- Doctoral Candidate and Faculty Lecturer, Ingram School of Nursing, McGill University, Nurse Clinician, Montreal Neurological Hospital, 1800-680 Sherbrooke Ouest, Montreal, Quebec H3A 2M7 Canada.
| | - David Kenneth Wright
- Associate Professor, School of Nursing, University of Ottawa, Roger Guindon Hall, Room 3247A, 451 Smyth Rd, Ottawa, ON K1H 8L1 Canada.
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Symptom Burden and Unmet Support Needs of Patients With Parkinson's Disease: A Cross-Sectional Study in Asia-Pacific Regions. J Am Med Dir Assoc 2020; 22:1255-1264. [PMID: 33268298 DOI: 10.1016/j.jamda.2020.09.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 08/17/2020] [Accepted: 09/08/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Support care is rarely assessed and offered to people with long-term neurologic conditions, particularly Parkinson's disease. This study aimed to assess the symptom burden and unmet support care needs in people with mild to severe Parkinson's disease. DESIGN Cross-sectional study. SETTING AND PARTICIPANTS Patients with Parkinson's disease were recruited from neurologic outpatient clinics from 3 East and Southeast Asian regions, including Hong Kong, Taiwan, and Thailand. METHODS A standardized set of questionnaires assessing unmet care needs [Palliative care Outcome Scale (POS)], disease-specific symptom burden (POS-Symptoms-Parkinson's Disease), generic health-related quality of life (HRQOL) (EQ-5D-3L), and sociodemographic and clinical background. RESULTS Completed questionnaires (n = 186) were collected from 64 Hong Kong Chinese, 64 Taiwanese, and 58 Thai patients. Their mean age was 67.23 ± 8.07, 54% were female, and 80% had mild-to-moderate disease. Their mean POS score was 10.48 ± 6.38, indicating moderate unmet support needs. Two-thirds of the participants rated constipation, fatigue, leg problem, and daytime somnolence as the most prevalent and burdensome symptoms. Patients from Hong Kong and Taiwan prioritized psychosocial and spiritual support, whereas Thai patients prioritized physical needs and emotional concerns. Multivariate adjustment for demographics and clinical characteristics showed that high psychological, spiritual, and practical burdens are associated with young age, male gender, and advanced disease stages. CONCLUSIONS AND IMPLICATIONS Patients experience significant symptom burden and moderate unmet support needs at the early to middle stage of Parkinson's disease. Routine assessment of changes in symptom burden should start early. The timely referral of support care services should provide appropriate psychospiritual and practical support in addition to motor training. Planning for support care services should consider cultural and health service contexts.
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Nimmons D, Hatter L, Davies N, Sampson EL, Walters K, Schrag A. Experiences of advance care planning in Parkinson's disease and atypical parkinsonian disorders: a mixed methods systematic review. Eur J Neurol 2020; 27:1971-1987. [PMID: 32603525 DOI: 10.1111/ene.14424] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 06/25/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND PURPOSE Advance care planning allows people to plan for their future care needs and can include medical, psychological and social aspects. However, little is known on the use, experience of and attitudes towards advance care planning in patients with parkinsonian disorders, their family carers and healthcare professionals. METHODS A systematic search of online databases was conducted in April 2019 using a narrative synthesis approach with thematic analysis and tabulation to synthesize the findings. RESULTS In all, 507 articles were identified and 27 were included. There were five overarching themes: (i) what is involved in advance care planning discussions, (ii) when and how advance care planning discussions are initiated, (iii) barriers to advance care planning, (iv) the role of healthcare professionals and (v) the role of the family carer. This evidence was used to highlight eight effective components to support optimal advance care planning in parkinsonian disorders: advance care planning discussions should be individualized in content, timing and approach; patients should be invited to discuss advance care planning early and regularly; palliative care services should be introduced early; a skilled professional should deliver advance care planning; support to family carers should be offered in the advance care planning process; healthcare professionals should be educated on parkinsonian disorders and palliative care; advance care planning should be clearly documented and shared with relevant services; and healthcare professionals should be enabled to conduct effective advance care planning. CONCLUSIONS These components can inform best practice in advance care planning in patients with parkinsonian disorders.
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Affiliation(s)
- D Nimmons
- Research Department of Primary Care and Population Health, Centre for Ageing and Population Studies, UCL, London, UK
| | - L Hatter
- Research Department of Primary Care and Population Health, Centre for Ageing and Population Studies, UCL, London, UK
| | - N Davies
- Research Department of Primary Care and Population Health, Centre for Ageing and Population Studies, UCL, London, UK.,Division of Psychiatry, Marie Curie Palliative Care Research Department, Centre for Dementia Palliative Care Research, UCL, London, UK
| | - E L Sampson
- Division of Psychiatry, Marie Curie Palliative Care Research Department, Centre for Dementia Palliative Care Research, UCL, London, UK
| | - K Walters
- Research Department of Primary Care and Population Health, Centre for Ageing and Population Studies, UCL, London, UK
| | - A Schrag
- Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, UCL, London, UK
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31
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Lennaerts-Kats H, Ebenau A, Steppe M, van der Steen JT, Meinders MJ, Vissers K, Munneke M, Groot M, Bloem BR. "How Long Can I Carry On?" The Need for Palliative Care in Parkinson's Disease: A Qualitative Study from the Perspective of Bereaved Family Caregivers. JOURNAL OF PARKINSONS DISEASE 2020; 10:1631-1642. [PMID: 32651330 PMCID: PMC8764597 DOI: 10.3233/jpd-191884] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background: Family caregivers provide the majority of care for people with Parkinson’s disease (PD) in the palliative care phase. For many this is a demanding experience, affecting their quality of life. Objective: We set out to map the experiences of bereaved family caregivers during the period of informal care in the palliative care phase as well as after the death of their loved one with PD. Methods: Ten bereaved family caregivers participated in this qualitative study. Semi-structured interviews were conducted and interpretative phenomenological analysis was used executed. Results: We identified four main themes. 1) Feeling like a professional caregiver: while caring for a person with PD, the family caregivers took over many roles and tasks of the person with PD. 2) Healthcare professionals do not always know what PD really means: most interviewees had negative experiences with knowledge and understanding of PD of, especially, (practice) nurses. 3) Being on your own: many respondents had felt highly responsible for their loved one’s care and lacked time and space for themselves. Grief and feelings of guilt were present during the caregiving period and after death. 4) Being behind the times: to provide palliative care in line with patients’ preferences and to feel prepared for the palliative care phase of PD, proactive palliative care planning was considered important. However, the interviewees told that this was most often not provided. Conclusion: These findings indicate that caring for a person with PD in the palliative care phase is a demanding experience for family caregivers. They experience psychological problems for many years before and after the death of the person with PD. Increasing healthcare professionals’ awareness of family and bereaved caregivers’ needs may mitigate these long-term detrimental effects.
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Affiliation(s)
- Herma Lennaerts-Kats
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Centre of Expertise for Parkinson & Movement Disorders, Nijmegen, the Netherlands.,Radboud University Medical Center (Radboudumc), Department of Anesthesiology, Pain and Palliative Care, Nijmegen, The Netherlands
| | - Anne Ebenau
- Radboud University Medical Center (Radboudumc), Department of Anesthesiology, Pain and Palliative Care, Nijmegen, The Netherlands
| | - Maxime Steppe
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Centre of Expertise for Parkinson & Movement Disorders, Nijmegen, the Netherlands
| | - Jenny T van der Steen
- Radboud University Medical Center (Radboudumc), Nijmegen, Department of Primary and Community Care, Nijmegen, The Netherlands; and Leiden University Medical Center, Department of Public Health and Primary Care, Leiden, The Netherlands
| | - Marjan J Meinders
- Radboud University Medical Center (Radboudumc), Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare, Nijmegen, the Netherlands
| | - Kris Vissers
- Radboud University Medical Center (Radboudumc), Department of Anesthesiology, Pain and Palliative Care, Nijmegen, The Netherlands
| | - Marten Munneke
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Centre of Expertise for Parkinson & Movement Disorders, Nijmegen, the Netherlands
| | - Marieke Groot
- Radboud University Medical Center (Radboudumc), Department of Anesthesiology, Pain and Palliative Care, Nijmegen, The Netherlands
| | - Bastiaan R Bloem
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Centre of Expertise for Parkinson & Movement Disorders, Nijmegen, the Netherlands
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32
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Bloem BR, Darweesh SKL, Meinders MJ. Palliative Programs for Persons With Parkinsonism—The Next Frontier. JAMA Neurol 2020; 77:548-550. [DOI: 10.1001/jamaneurol.2019.4697] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Bastiaan R. Bloem
- Center of Expertise for Parkinson & Movement Disorders, Donders Institute for Brain, Cognition and Behavior, Department of Neurology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Sirwan K. L. Darweesh
- Center of Expertise for Parkinson & Movement Disorders, Donders Institute for Brain, Cognition and Behavior, Department of Neurology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Marjan J. Meinders
- Scientific Center for Quality of Healthcare (IQ Healthcare), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
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RADPAC-PD: A tool to support healthcare professionals in timely identifying palliative care needs of people with Parkinson's disease. PLoS One 2020; 15:e0230611. [PMID: 32315302 PMCID: PMC7173770 DOI: 10.1371/journal.pone.0230611] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 03/03/2020] [Indexed: 01/21/2023] Open
Abstract
Background Parkinson’s disease (PD) is a progressive degenerative disease without curative treatment perspectives. Even when palliative care for people with PD seems to be beneficial, the need for palliative care is often not timely recognized. Aim Our aim was to develop a tool that can help healthcare professionals in timely identifying palliative care needs in people with PD. Design We used a mixed-methods design, including individual and focus group interviews and a three-round modified Delphi study with healthcare professionals from a multidisciplinary field. Results Data from the interviews suggested two distinct moments in the progressive PD trajectory: 1) an ultimate moment to initiate Advance Care Planning (ACP); and 2) the actual start of the palliative phase. During the Delphi process, six indicators for ACP were identified, such as presence of frequent falls and first unplanned hospital admission. The start of the palliative phase involved four indicators: 1) personal goals have started to focus on maximization of comfort; 2) care needs have changed; 3) PD drug treatment has become less effective or an increasingly complex regime of drug treatments is needed; and 4) specific PD-symptoms or complications have appeared, such as significant weight loss, recurrent infections, or progressive dysphagia. Indicators for both moments are included in the RADboud indicators for PAlliative Care Needs in Parkinson’s Disease (RADPAC-PD) tool. Conclusion The RADPAC-PD may support healthcare professionals in timely initiating palliative care for persons with PD. Identification of one or more indicators can mark the need for ACP or the palliative phase. We expect that applying the RADPAC-PD, for example on an annual basis throughout the PD trajectory, can facilitate identification of the palliative phase in PD patients in daily practice. However, further prospective research is needed on the implementation of the RADPAC-PD.
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34
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Abstract
Palliative care (PC) is an approach to the care of persons affected by serious illness that focuses on reducing suffering by addressing medical, psychosocial, and spiritual needs. Persons living with Parkinson disease have PC needs that begin at the time of diagnosis and continue throughout the course of the illness including nonmotor symptom burden, caregiver distress, grief, and increased mortality. Primary PC refers to essential PC skills that may be practiced by nonpalliative medicine specialists to improve outcomes for their patients.
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Affiliation(s)
- Hillary D Lum
- Division of Geriatric Medicine, Department of Medicine, University of Colorado Denver, University of Colorado Anschutz Medical Campus, Mail Stop C-293, 12631 East 17th Avenue, Aurora, CO 80045, USA; Eastern Colorado VA Geriatric Research Education and Clinical Center, Aurora, CO, USA
| | - Benzi M Kluger
- Department of Neurology, University of Colorado Denver, University of Colorado Anschutz Medical Campus, Mail Stop B-185, 12631 East 17th Avenue, Aurora, CO 80045, USA.
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35
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Levin O, Bril E, Zymnyakova O, Anikina M, Hasina A, Fedorova N. Palliative care in Parkinson’s disease and neurodegenerative diseases. Zh Nevrol Psikhiatr Im S S Korsakova 2020; 120:5-15. [DOI: 10.17116/jnevro20201201025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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36
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Schwartz R, Trivedi R, Gray C, Lorenz KA, Zulman D. Neurologist Strategies for Optimizing the Parkinson's Disease Clinical Encounter. J Geriatr Psychiatry Neurol 2019; 32:246-256. [PMID: 31046525 DOI: 10.1177/0891988719845509] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE For patients with Parkinson's disease (PD), effective communication during neurology encounters is critical to ensuring the treatment plan maximizes quality of life. However, few research studies have engaged neurologists as key experts in identifying opportunities to optimize the clinical encounter. In this study, 16 neurologists from 4 clinic sites participated in hour-long semistructured interviews targeting opportunities to better address patients' quality of life needs. MAIN FINDINGS Neurologists identified opportunities to meet needs across 4 domains: (1) PD patient education materials and self-management tools to facilitate clinical communication; (2) techniques for improving clinical communication, including strategies for eliciting nonmotor symptoms and contextualizing symptoms to better meet patient quality of life needs; (3) addressing system-level barriers, including time constraints and the lack of an identified specialist referral network; and (4) training in how to lead difficult conversations. PRINCIPAL CONCLUSIONS Neurologists identified specific barriers, and proposed solutions, to improving care delivery for patients with PD. Integrating practice tools to address quality of life needs, training neurologists in communication around end-of-life care, and strengthening referral networks for rehabilitation and psychosocial support hold promise for improving quality of life for patients with PD.
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Affiliation(s)
- Rachel Schwartz
- 1 Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA, USA.,2 Stanford University Center for Health Policy and the Center for Primary Care and Outcomes Research, Palo Alto, CA, USA
| | - Ranak Trivedi
- 1 Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA, USA.,3 Division of Public Mental Health and Population Sciences, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Caroline Gray
- 1 Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA, USA
| | - Karl A Lorenz
- 1 Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA, USA.,4 VA Palliative Care Quality Improvement Resource Center (QuIRC), Palo Alto, CA, USA.,5 Division of Primary Care and Population Health, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Donna Zulman
- 1 Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA, USA.,5 Division of Primary Care and Population Health, Stanford University School of Medicine, Palo Alto, CA, USA
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Holden SK, Koljack CE, Prizer LP, Sillau SH, Miyasaki JM, Kluger BM. Measuring quality of life in palliative care for Parkinson's disease: A clinimetric comparison. Parkinsonism Relat Disord 2019; 65:172-177. [PMID: 31253494 PMCID: PMC6774894 DOI: 10.1016/j.parkreldis.2019.06.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 06/14/2019] [Accepted: 06/22/2019] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Quality of life (QOL) assessments allow for more complete evaluation of patients' lived experiences in relation to chronic conditions, such as Parkinson's disease (PD). In palliative care, such instruments are vital to ensure QOL issues are catalogued and addressed for patients. However, little is known regarding the psychometric properties of quality of life scales for use in palliative care for PD, specifically. METHODS 210 participants with parkinsonian disorders, who participated in a larger palliative intervention clinical trial, completed four quality of life scales (PDQ-39, PROMIS-29, QOL-AD, and McGill QOL) at baseline and post-intervention. Psychometric properties, including internal consistency and concurrent validity, were examined. Factor analyses were performed to evaluate relationships between scale items. Minimal clinically important differences (MCID) and responsiveness were calculated for each scale. RESULTS All scales demonstrated good internal consistency and concurrent validity. Factor analyses revealed few deviations from the defined subdomains of the scales. Mean absolute MCID values were estimated at 12.7, 10.9, 3.9, and 18.9 for PDQ-39, PROMIS-29, QOL-AD, and McGill QOL, respectively. The PDQ-39 and PROMIS-29 demonstrated higher responsiveness to palliative intervention, while the QOL-AD was more responsive in the control group. CONCLUSIONS The PDQ-39, PROMIS-29, QOL-AD, and McGill QOL are all valid for use in PD palliative care, though subdomains of the scales in this population may differ slightly from those initially defined. We recommend the use of PDQ-39 and PROMIS-29 as outcome measures in clinical trials for palliative care in PD, though the QOL-AD may be superior for tracking disease progression.
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Affiliation(s)
- Samantha K Holden
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA.
| | - Claire E Koljack
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
| | | | - Stefan H Sillau
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Janis M Miyasaki
- Department of Medicine, Division of Neurology, University of Alberta, Edmonton, Canada
| | - Benzi M Kluger
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
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Lennaerts H, Steppe M, Munneke M, Meinders MJ, van der Steen JT, Van den Brand M, van Amelsvoort D, Vissers K, Bloem BR, Groot M. Palliative care for persons with Parkinson's disease: a qualitative study on the experiences of health care professionals. BMC Palliat Care 2019; 18:53. [PMID: 31288821 PMCID: PMC6617627 DOI: 10.1186/s12904-019-0441-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 07/01/2019] [Indexed: 11/11/2022] Open
Abstract
Background Parkinson’s disease (PD) is a chronic and neurodegenerative disease associated with a wide variety of symptoms. The risk of complications increases with progression of the disease. These complications have a tremendous impact on the quality of life of people with PD. The aim of this study was to examine health care professionals’ experiences of potential barriers and facilitators in providing palliative care for people with PD in the Netherlands. Methods This was a qualitative descriptive study. The data were collected from 10 individual in-depth interviews and three focus groups (n = 29) with health care professionals. Health care professionals were selected based on a positive answer to the question: “In the past 2 years, did you treat or support a person with PD who subsequently died?” The data were analyzed by thematic text analysis. Results Health care professionals supported the development of a palliative care system for PD but needed to better understand the essence of palliative care. In daily practice, they struggled to identify persons’ needs due to interfering PD-specific symptoms such as cognitive decline and communication deficits. Timely addressing the personal preferences for providing palliative care was identified as an important facilitator. Health care professionals acknowledged being aware of their lack of knowledge and of their little competence in managing complex PD. Findings indicate a perceived lack of care continuity, fragmentation of services, time pressure and information discontinuity. Conclusions Health care professionals experienced several facilitators and barriers to the provision of palliative care to people with PD. There is a need to improve the knowledge on complex PD and the continuity of information, as well as optimize coordination and deliver care based on a persons’ preferences. Additional training can help to become more knowledgeable and confident. Electronic supplementary material The online version of this article (10.1186/s12904-019-0441-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Herma Lennaerts
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Reinier Postlaan 4, 6500, Nijmegen, AB, The Netherlands.
| | - Maxime Steppe
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Reinier Postlaan 4, 6500, Nijmegen, AB, The Netherlands
| | - Marten Munneke
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Reinier Postlaan 4, 6500, Nijmegen, AB, The Netherlands
| | - Marjan J Meinders
- Scientific Center for Quality of Healthcare, Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, The Netherlands
| | - Jenny T van der Steen
- Department of Primary and Community Care, Radboud university medical center, Nijmegen, The Netherlands.,Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Marieke Van den Brand
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud university medical center, Nijmegen, The Netherlands
| | | | - Kris Vissers
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud university medical center, Nijmegen, The Netherlands
| | - Bastiaan R Bloem
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Reinier Postlaan 4, 6500, Nijmegen, AB, The Netherlands
| | - Marieke Groot
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud university medical center, Nijmegen, The Netherlands
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Seeber AA, Pols AJ, Hijdra A, Grupstra HF, Willems DL, de Visser M. Advance care planning in progressive neurological diseases: lessons from ALS. BMC Palliat Care 2019; 18:50. [PMID: 31196046 PMCID: PMC6567602 DOI: 10.1186/s12904-019-0433-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 05/27/2019] [Indexed: 02/08/2023] Open
Abstract
Background There is increasing awareness of the need for an integrated palliative care approach in chronic progressive neurological diseases. Advance care planning (ACP) is an integral part of this approach. As a systematically organized and ongoing communication process about patients’ values, goals and preferences regarding medical care during serious and chronic illness, ACP aims to involve patients in decision-making before they become cognitively and communicatively incapable. However, it remains underutilized in daily neurological practice except for speciality clinics such as ALS centers. Our aim was to study ACP in the tertiary ALS center Amsterdam and to investigate patients’ reflections on it. Subsequently we used this knowledge to formulate recommendations for integration of ACP in the care of patients with other chronic progressive neurological diseases. Methods Non-participating observations of all appointments of patients with amyotrophic lateral sclerosis (ALS) or progressive muscular atrophy (PMA) with the treating physician, in various stages of disease, during 6 consecutive months, followed by single in-depth interviews, and an inductive analysis. Results Twenty-eight Dutch patients participated, varying in age, gender, disease onset and severity of physical decline. ACP started directly when the diagnosis was given, by means of a general outlook on the future with progressive disability and immediate introduction to a customized multidisciplinary team. During follow-up ACP was realized by regular appointments in which monitoring of the patient’s status and clear communication strategies formed the basis of tailor-made discussions on treatment options. Patients accepted this policy as careful professional guidance. Conclusions ACP is a professional communication process throughout the whole course of progressive disease. It is feasible to integrate ACP into follow-up of patients with ALS and PMA from diagnosis onwards. Supported by recent literature, we argue that such a well-structured approach would also enhance the quality of care and life of patients with other chronic progressive neurological diseases. Electronic supplementary material The online version of this article (10.1186/s12904-019-0433-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Antje A Seeber
- Department of Neurology, Amsterdam University Medical Center, Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands. .,Section of Medical Ethics, Department of General Practice, Amsterdam University Medical Center, Academic Medical Centre, University of Amsterdam, P.O. Box 22660, Amsterdam, The Netherlands.
| | - A Jeannette Pols
- Section of Medical Ethics, Department of General Practice, Amsterdam University Medical Center, Academic Medical Centre, University of Amsterdam, P.O. Box 22660, Amsterdam, The Netherlands
| | - Albert Hijdra
- Department of Neurology, Amsterdam University Medical Center, Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - Hepke F Grupstra
- Department of Rehabilitation, Amsterdam University Medical Center, Academic Medical Center, University of Amsterdam, P.O. Box 22660, Amsterdam, The Netherlands
| | - Dick L Willems
- Section of Medical Ethics, Department of General Practice, Amsterdam University Medical Center, Academic Medical Centre, University of Amsterdam, P.O. Box 22660, Amsterdam, The Netherlands
| | - Marianne de Visser
- Department of Neurology, Amsterdam University Medical Center, Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
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Kluger BM, Katz M, Galifianakis N, Pantilat SZ, Kutner JS, Sillau S, Gritz M, Jones J, Fairclough D, Sumrall M, Hall K, Miyasaki J. Does outpatient palliative care improve patient-centered outcomes in Parkinson's disease: Rationale, design, and implementation of a pragmatic comparative effectiveness trial. Contemp Clin Trials 2019; 79:28-36. [PMID: 30779960 DOI: 10.1016/j.cct.2019.02.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 01/24/2019] [Accepted: 02/13/2019] [Indexed: 02/05/2023]
Abstract
Patients with Parkinson's disease and related disorders (PDRD) and their families have considerable unmet needs including non-motor symptom management, caregiver support, spiritual wellbeing, advance care planning, and end-of-life care. There is increasing interest in applying palliative care (PC) models to better meet these needs. While PC has been shown to improve care and quality of life (QOL) for people with cancer and heart failure, few studies have evaluated the role of PC for people with PDRD. Well-designed clinical trials are needed to optimize the PC approach for PDRD and to influence policy and implementation efforts. We initiated a randomized multicenter comparative effectiveness trial of team-based outpatient PC versus usual care for people with PDRD and their caregivers. The primary aims of this study are to determine the effects of PC on patient QOL and caregiver burden. Qualitative interviews will be utilized to gain additional insights into the impact of PC on participants, the outcomes that matter most to this population, and to find opportunities to refine future interventions and trials. As a novel application of PC, challenges involved in the design of this study include choosing appropriate inclusion criteria, standardizing the intervention, defining usual care, and choosing outcome measures suitable to our research questions. Challenges involved in implementation include participant recruitment, retention, and management of participant burden. We anticipate the results of this trial will have relevance for both clinical care and future clinical research trial design in evaluating models of PC for people with PDRD and other serious illnesses.
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Affiliation(s)
- Benzi M Kluger
- Department of Neurology, University of Colorado School of Medicine, 12631 E 17th Ave, MS-B185, Aurora, CO 80045, USA.
| | - Maya Katz
- Movement Disorders and Neuromodulation Center, University of California, San Francisco 1635 Divisadero Street, Suite 520, San Francisco, CA 94118, USA.
| | - Nicholas Galifianakis
- Movement Disorders and Neuromodulation Center, University of California, San Francisco 1635 Divisadero Street, Suite 520, San Francisco, CA 94118, USA.
| | - Steven Z Pantilat
- Division of Palliative Medicine, Department of Medicine, University of California, San Francisco 533 Parnassus Ave., Suite U-109, Box 0131, San Francisco, CA 94143, USA.
| | - Jean S Kutner
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, 12631 E 17th Ave, MS-B180, Aurora, CO, USA.
| | - Stefan Sillau
- Department of Neurology, University of Colorado School of Medicine, 12631 E 17th Ave, MS-B185, Aurora, CO 80045, USA.
| | - Mark Gritz
- Division of Healthcare Policy and Research, Department of Medicine, University of Colorado, 13199 East Montview Boulevard, MS-F480, Aurora, CO 80045, USA.
| | - Jacqueline Jones
- College of Nursing, University of Colorado, 13120 East 19th Avenue, MS-C288, Aurora, CO 80045, USA.
| | - Diane Fairclough
- School of Public Health, Department of Biostatistics and Informatics, University of Colorado, 13199 East Montview Boulevard, MS-F443, Aurora, CO 80045, USA.
| | - Malenna Sumrall
- Department of Neurology, University of Colorado School of Medicine, 12631 E 17th Ave, MS-B185, Aurora, CO 80045, USA
| | - Kirk Hall
- Department of Neurology, University of Colorado School of Medicine, 12631 E 17th Ave, MS-B185, Aurora, CO 80045, USA
| | - Janis Miyasaki
- Division of Neurology, University of Alberta, 11350-83 Avenue, 7-112 Clinical Sciences Building, Edmonton, AB T6G 2G3, Canada.
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van der Steen JT, Lennaerts H, Hommel D, Augustijn B, Groot M, Hasselaar J, Bloem BR, Koopmans RTCM. Dementia and Parkinson's Disease: Similar and Divergent Challenges in Providing Palliative Care. Front Neurol 2019; 10:54. [PMID: 30915012 PMCID: PMC6421983 DOI: 10.3389/fneur.2019.00054] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Accepted: 01/16/2019] [Indexed: 12/29/2022] Open
Abstract
Dementia and Parkinson's disease are incurable neurological conditions. Patients often experience specific, complex, and varying needs along their disease trajectory. Current management typically employs a multidisciplinary team approach. Recognition is growing that this team approach should also address palliative care issues to optimize quality of life for patient and family caregivers, but it remains unclear how palliative care is best delivered. To inspire future service development and research, we compare the trajectories and conceptualization of palliative care between dementia and Parkinson's disease. Both Parkinson's disease and dementia are characterized by a protracted course, with progressive but fairly insidious development of disability. However, patients with Parkinson's disease may experience relatively stable periods initially but with time, a wide range of debilitating symptoms develops, many of which do not respond well to treatment. Eventually, dementia develops in most Parkinson patients, while motor disability develops in many dementia patients. In both diseases, symptoms such as pain, apathy, sleeping problems, falls, and a high caregiver burden are prevalent. Advance care planning has benefits in terms of being prepared before the disease progresses into a stage with communication problems or severe cognitive impairment. However, for both conditions, the protracted disease trajectories complicate conceptualization of palliative care through different stages of the disease, with pertinent questions such as when to offer what interventions pro-actively. Given the similarities and differences, we should develop palliative approaches that are partially generic and partially disease-specific. These should be integrated seamlessly with disease-specific care. Substantial research is already being performed on dementia palliative care. This may also inform the further development of palliative care for Parkinson's disease, including an evaluation of palliative interventions and services.
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Affiliation(s)
- Jenny T. van der Steen
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
- Department of Primary and Community Care, Radboud university medical center, Nijmegen, Netherlands
| | - Herma Lennaerts
- Departments of Neurology and Anesthesiology, Pain and Palliative Care, Radboud university medical center, Nijmegen, Netherlands
| | - Danny Hommel
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Nijmegen, Netherlands
- Groenhuysen Organisation, Roosendaal, Netherlands
| | | | - Marieke Groot
- Department of Anesthesiology, Pain and Palliative Care/Expertise Center for Palliative Care, Radboud university medical center, Nijmegen, Netherlands
| | - Jeroen Hasselaar
- Department of Anesthesiology, Pain and Palliative Care/Expertise Center for Palliative Care, Radboud university medical center, Nijmegen, Netherlands
| | - Bastiaan R. Bloem
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Nijmegen, Netherlands
| | - Raymond T. C. M. Koopmans
- Department of Primary and Community Care, Radboud university medical center, Nijmegen, Netherlands
- Radboudumc Alzheimer Center, Nijmegen, Netherlands
- De Waalboog “Joachim en Anna, ” Center for Specialized Geriatric Care, Nijmegen, Netherlands
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Kluger BM, Shattuck J, Berk J, Sebring K, Jones W, Brunetti F, Fairmont I, Bowles DW, Sillau S, Bekelman DB. Defining Palliative Care Needs in Parkinson's Disease. Mov Disord Clin Pract 2019; 6:125-131. [PMID: 30838311 PMCID: PMC6384178 DOI: 10.1002/mdc3.12702] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 09/25/2018] [Accepted: 10/21/2018] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES Palliative care addresses the suffering of patients and families affected by progressive illness through the management of medical symptoms, psychosocial issues, and spiritual concerns. Although there is an emerging interest in applying palliative care to Parkinson's disease (PD), potential palliative care needs have not been systematically investigated in PD patients. Our primary objective was to determine the prevalence of clinically significant symptomatic, psychosocial, and spiritual issues in PD and understand their impact on health-related quality of life (HRQOL). Secondary objectives included comparing the level of palliative care needs of PD patients to advanced cancer patients and assessing preferences for advance care planning. METHODS Ninety PD patients and 47 patients with advanced cancer were surveyed regarding potential palliative care needs, including symptom burden, mood, anticipatory grief, and spiritual well-being. PD patients completed additional scales regarding HRQOL, motor symptoms, cognitive impairment, and preferences regarding advance care planning. RESULTS Potential palliative care needs, including high symptom burden and grief, were common in PD patients and contributed to HRQOL even when controlling for depression and motor severity. In all domains investigated, PD patients had similar or higher levels of palliative care needs as patients with advanced cancer. PD patients expressed a desire to complete advance directives early in the disease course and with a physician. CONCLUSIONS Palliative care needs contribute to HRQOL in PD and are of similar severity as cancer patients. This study supports and helps focus efforts to integrate palliative care principles in PD care across the spectrum of the disease.
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Affiliation(s)
- Benzi M. Kluger
- Department of NeurologyUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - Jo Shattuck
- Center for Brain, Biology, and BehaviorUniversity of NebraskaLincolnNebraskaUSA
| | - Julie Berk
- Department of NeurologyUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - Kelly Sebring
- Department of NeurologyUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - Wallace Jones
- Department of NeurologyUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - Fabian Brunetti
- Department of NeurologyUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - Isabel Fairmont
- Department of NeurologyUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - Daniel W. Bowles
- Division of Medical OncologyUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - Stefan Sillau
- Department of NeurologyUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - David B. Bekelman
- Division of General Internal MedicineUniversity of Colorado School of MedicineAuroraColoradoUSA
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43
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Walter HAW, Seeber AA, Willems DL, de Visser M. The Role of Palliative Care in Chronic Progressive Neurological Diseases-A Survey Amongst Neurologists in the Netherlands. Front Neurol 2019; 9:1157. [PMID: 30692960 PMCID: PMC6340288 DOI: 10.3389/fneur.2018.01157] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Accepted: 12/14/2018] [Indexed: 12/12/2022] Open
Abstract
Background: Chronic progressive neurological diseases like high grade glioma (HGG), Parkinson's disease (PD), and multiple sclerosis (MS) are incurable, and associated with increasing disability including cognitive impairment, and reduced life expectancy. Patients with these diseases have complex care needs. Therefore, timely advance care planning (ACP) is required. Our aim was to investigate timing and content of discussions on treatment restrictions, i.e., to initiate, withhold, or withdraw treatment in patients with HGG, PD, and MS, from the neurologists' perspective. Methods: We performed a national online survey amongst consultants in neurology and residents in The Netherlands. The questionnaire focused on their daily practice concerning timing and content of discussions on treatment restrictions with patients suffering from HGG, PD or MS. We also inquired about education and training in discussing these issues. Results: A total of 125 respondents [89 neurologists (71%), 62% male, with a median age of 44 years, and 36 residents (29%), 31% male with a median age of 29 years] responded. Initial discussions on treatment restrictions were said to take place during the first year after diagnosis in 28% of patients with HGG, and commonly no earlier than in the terminal phase in patients with PD and MS. In all conditions, significant cognitive decline was the most important trigger to advance discussions, followed by physical decline, and initiation of the terminal phase. Most discussed issues included ventilation, resuscitation, and admission to the intensive care unit. More than half of the consultants in neurology and residents felt that they needed (more) education and training in having discussions on treatment restrictions. Conclusion: In patients with HGG discussions on treatment restrictions are initiated earlier than in patients with PD or MS. However, in all three diseases these discussions usually take place when significant physical and cognitive decline has become apparent and commonly mark the initiation of end-of-life care. More than half of the responding consultants in neurology and residents feel the need for improvement of their skills in performing these discussions.
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Affiliation(s)
- Hannah A W Walter
- Department of Neurology, Amsterdam University Medical Center, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Antje A Seeber
- Department of Neurology, Amsterdam University Medical Center, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Dick L Willems
- Section of Medical Ethics, Department of General Practice, Amsterdam University Medical Center, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Marianne de Visser
- Department of Neurology, Amsterdam University Medical Center, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
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44
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Sebring K, Shattuck J, Berk J, Boersma I, Sillau S, Kluger BM. Assessing the validity of proxy caregiver reporting for potential palliative care outcome measures in Parkinson's disease. Palliat Med 2018; 32:1522-1528. [PMID: 30015552 DOI: 10.1177/0269216318785830] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND There is increasing interest in applying palliative care approaches for patients with Parkinson's disease. Methodological studies are needed to validate palliative care outcome measures for Parkinson's disease to build this evidence base. As many patients with Parkinson's disease have cognitive and/or communication issues, proxy outcome measures may improve the inclusivity and relevance of research. AIM To assess the validity of proxy caregiver reports for several potential palliative care outcome measures. DESIGN A cross-sectional study of Parkinson's disease patients and caregivers completed a battery of outcome measures relevant to palliative care including the Memorial Symptom Assessment Scale, Hospital Anxiety and Depression Scale, Prolonged Grief Questionnaire 12, Parkinson Disease Questionnaire 39, Functional Assessment of Chronic Illness Therapy-Spiritual Wellbeing, and Schwab and England. Intraclass correlation coefficients were used to assess agreement. SETTING/PARTICIPANTS A total of 50 Parkinson's disease patient and caregiver dyads recruited at an academic medical center, Veterans Affairs Medical Center, and community support groups. RESULTS There was moderate to good agreement for Schwab and England, Parkinson Disease Questionnaire 39 total, and majority of Parkinson Disease Questionnaire 39 subscales; moderate to good agreement for the Hospital Anxiety and Depression Scale, Functional Assessment of Chronic Illness Therapy-Spiritual Wellbeing, Prolonged Grief Questionnaire 12, and Memorial Symptom Assessment Scale; and poor to moderate agreement for the Parkinson Disease Questionnaire 39 stigma, social support, and bodily pain subscales. Caregivers tended to attribute higher symptom severity than patients. We did not detect differences in intraclass correlation coefficient based on cognitive status but patients with advanced illness had significantly lower intraclass correlation coefficients for several outcomes. CONCLUSIONS Caution is indicated when considering caregiver proxy reporting for most outcomes assessed, particularly in Parkinson's disease patients with advanced disease.
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Affiliation(s)
- Kelly Sebring
- 1 Department of Neurology, University of Colorado Denver, Aurora, CO, USA.,2 Department of Psychiatry, University of Colorado Denver, Aurora, CO, USA
| | - Jo Shattuck
- 1 Department of Neurology, University of Colorado Denver, Aurora, CO, USA.,2 Department of Psychiatry, University of Colorado Denver, Aurora, CO, USA
| | - Julie Berk
- 1 Department of Neurology, University of Colorado Denver, Aurora, CO, USA.,2 Department of Psychiatry, University of Colorado Denver, Aurora, CO, USA
| | - Isabel Boersma
- 1 Department of Neurology, University of Colorado Denver, Aurora, CO, USA.,2 Department of Psychiatry, University of Colorado Denver, Aurora, CO, USA
| | - Stefan Sillau
- 1 Department of Neurology, University of Colorado Denver, Aurora, CO, USA.,2 Department of Psychiatry, University of Colorado Denver, Aurora, CO, USA
| | - Benzi M Kluger
- 1 Department of Neurology, University of Colorado Denver, Aurora, CO, USA.,2 Department of Psychiatry, University of Colorado Denver, Aurora, CO, USA
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Katz M, Goto Y, Kluger BM, Galifianakis NB, Miyasaki JM, Kutner JS, Jones CA, Pantilat SZ. Top Ten Tips Palliative Care Clinicians Should Know About Parkinson's Disease and Related Disorders. J Palliat Med 2018; 21:1507-1517. [PMID: 30204543 DOI: 10.1089/jpm.2018.0390] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Parkinson's disease (PD) affects 1%-2% of individuals older than 60 years and is the 14th leading cause of death in the United States. People with PD, across all stages of the disease, suffer from a significant symptom burden that includes many nonmotor symptoms (such as depression, fatigue, pain, and dementia), and most will ultimately die from complications of this degenerative and incurable illness. Even at diagnosis, a palliative care (PC) approach can help the patient adjust to his or her diagnosis and maintain an optimal quality of life. We brought together a team of PD and PC experts to assemble practical tips for the care of people with PD. The "Top 10" format emphasizes the most relevant issues to enable PC clinicians to provide optimal care for those suffering with this complex neurodegenerative disease.
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Affiliation(s)
- Maya Katz
- 1 Department of Neurology, University of California , San Francisco, San Francisco, California
| | - Yuika Goto
- 2 Division of Palliative Medicine, Department of Medicine, University of California , San Francisco, San Francisco, California
| | - Benzi M Kluger
- 3 Departments of Neurology and Medicine, University of Colorado School of Medicine , Aurora, Colorado
| | - Nicholas B Galifianakis
- 1 Department of Neurology, University of California , San Francisco, San Francisco, California
| | - Janis M Miyasaki
- 4 Department of Neurology, University of Alberta , Edmonton, Alberta, Canada
| | - Jean S Kutner
- 5 Department of Medicine, University of Colorado School of Medicine , Aurora, Colorado
| | - Christopher A Jones
- 6 Department of Medicine and Palliative and Advanced Illness Research Center, University of Pennsylvania , Philadelphia
| | - Steve Z Pantilat
- 2 Division of Palliative Medicine, Department of Medicine, University of California , San Francisco, San Francisco, California
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46
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Creutzfeldt CJ, Kluger B, Kelly AG, Lemmon M, Hwang DY, Galifianakis NB, Carver A, Katz M, Curtis JR, Holloway RG. Neuropalliative care: Priorities to move the field forward. Neurology 2018; 91:217-226. [PMID: 29950434 DOI: 10.1212/wnl.0000000000005916] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 04/06/2018] [Indexed: 11/15/2022] Open
Abstract
Neuropalliative care is an emerging subspecialty in neurology and palliative care. On April 26, 2017, we convened a Neuropalliative Care Summit with national and international experts in the field to develop a clinical, educational, and research agenda to move the field forward. Clinical priorities included the need to develop and implement effective models to integrate palliative care into neurology and to develop and implement informative quality measures to evaluate and compare palliative approaches. Educational priorities included the need to improve the messaging of palliative care and to create standards for palliative care education for neurologists and neurology education for palliative specialists. Research priorities included the need to improve the evidence base across the entire research spectrum from early-stage interventional research to implementation science. Highest priority areas include focusing on outcomes important to patients and families, developing serious conversation triggers, and developing novel approaches to patient and family engagement, including improvements to decision quality. As we continue to make remarkable advances in the prevention, diagnosis, and treatment of neurologic illness, neurologists will face an increasing need to guide and support patients and families through complex choices involving immense uncertainty and intensely important outcomes of mind and body. This article outlines opportunities to improve the quality of care for all patients with neurologic illness and their families through a broad range of clinical, educational, and investigative efforts that include complex symptom management, communication skills, and models of care.
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Affiliation(s)
- Claire J Creutzfeldt
- From the Department of Neurology (C.J.C.), University of Washington, Harborview Medical Center, Seattle; Department of Neurology (B.K.), University of Colorado Anschutz Medical Center, Denver; Department of Neurology (A.G.K., R.G.H.), University of Rochester Medical Center, NY; Department of Pediatrics (M.L.), Division of Child Neurology, Duke University Hospital, Durham, NC; Division of Neurocritical Care and Emergency Neurology (D.Y.H.) and Center for Neuroepidemiology and Clinical Neurological Research (D.Y.H.), Yale School of Medicine, New Haven, CT; Department of Neurology (N.B.G., M.K.), University of California in San Francisco; Department of Neurology (A.C.), Memorial Sloan Kettering Cancer Center, New York, NY; and Cambia Palliative Care Center of Excellence (J.R.C.), University of Washington, Seattle.
| | - Benzi Kluger
- From the Department of Neurology (C.J.C.), University of Washington, Harborview Medical Center, Seattle; Department of Neurology (B.K.), University of Colorado Anschutz Medical Center, Denver; Department of Neurology (A.G.K., R.G.H.), University of Rochester Medical Center, NY; Department of Pediatrics (M.L.), Division of Child Neurology, Duke University Hospital, Durham, NC; Division of Neurocritical Care and Emergency Neurology (D.Y.H.) and Center for Neuroepidemiology and Clinical Neurological Research (D.Y.H.), Yale School of Medicine, New Haven, CT; Department of Neurology (N.B.G., M.K.), University of California in San Francisco; Department of Neurology (A.C.), Memorial Sloan Kettering Cancer Center, New York, NY; and Cambia Palliative Care Center of Excellence (J.R.C.), University of Washington, Seattle
| | - Adam G Kelly
- From the Department of Neurology (C.J.C.), University of Washington, Harborview Medical Center, Seattle; Department of Neurology (B.K.), University of Colorado Anschutz Medical Center, Denver; Department of Neurology (A.G.K., R.G.H.), University of Rochester Medical Center, NY; Department of Pediatrics (M.L.), Division of Child Neurology, Duke University Hospital, Durham, NC; Division of Neurocritical Care and Emergency Neurology (D.Y.H.) and Center for Neuroepidemiology and Clinical Neurological Research (D.Y.H.), Yale School of Medicine, New Haven, CT; Department of Neurology (N.B.G., M.K.), University of California in San Francisco; Department of Neurology (A.C.), Memorial Sloan Kettering Cancer Center, New York, NY; and Cambia Palliative Care Center of Excellence (J.R.C.), University of Washington, Seattle
| | - Monica Lemmon
- From the Department of Neurology (C.J.C.), University of Washington, Harborview Medical Center, Seattle; Department of Neurology (B.K.), University of Colorado Anschutz Medical Center, Denver; Department of Neurology (A.G.K., R.G.H.), University of Rochester Medical Center, NY; Department of Pediatrics (M.L.), Division of Child Neurology, Duke University Hospital, Durham, NC; Division of Neurocritical Care and Emergency Neurology (D.Y.H.) and Center for Neuroepidemiology and Clinical Neurological Research (D.Y.H.), Yale School of Medicine, New Haven, CT; Department of Neurology (N.B.G., M.K.), University of California in San Francisco; Department of Neurology (A.C.), Memorial Sloan Kettering Cancer Center, New York, NY; and Cambia Palliative Care Center of Excellence (J.R.C.), University of Washington, Seattle
| | - David Y Hwang
- From the Department of Neurology (C.J.C.), University of Washington, Harborview Medical Center, Seattle; Department of Neurology (B.K.), University of Colorado Anschutz Medical Center, Denver; Department of Neurology (A.G.K., R.G.H.), University of Rochester Medical Center, NY; Department of Pediatrics (M.L.), Division of Child Neurology, Duke University Hospital, Durham, NC; Division of Neurocritical Care and Emergency Neurology (D.Y.H.) and Center for Neuroepidemiology and Clinical Neurological Research (D.Y.H.), Yale School of Medicine, New Haven, CT; Department of Neurology (N.B.G., M.K.), University of California in San Francisco; Department of Neurology (A.C.), Memorial Sloan Kettering Cancer Center, New York, NY; and Cambia Palliative Care Center of Excellence (J.R.C.), University of Washington, Seattle
| | - Nicholas B Galifianakis
- From the Department of Neurology (C.J.C.), University of Washington, Harborview Medical Center, Seattle; Department of Neurology (B.K.), University of Colorado Anschutz Medical Center, Denver; Department of Neurology (A.G.K., R.G.H.), University of Rochester Medical Center, NY; Department of Pediatrics (M.L.), Division of Child Neurology, Duke University Hospital, Durham, NC; Division of Neurocritical Care and Emergency Neurology (D.Y.H.) and Center for Neuroepidemiology and Clinical Neurological Research (D.Y.H.), Yale School of Medicine, New Haven, CT; Department of Neurology (N.B.G., M.K.), University of California in San Francisco; Department of Neurology (A.C.), Memorial Sloan Kettering Cancer Center, New York, NY; and Cambia Palliative Care Center of Excellence (J.R.C.), University of Washington, Seattle
| | - Alan Carver
- From the Department of Neurology (C.J.C.), University of Washington, Harborview Medical Center, Seattle; Department of Neurology (B.K.), University of Colorado Anschutz Medical Center, Denver; Department of Neurology (A.G.K., R.G.H.), University of Rochester Medical Center, NY; Department of Pediatrics (M.L.), Division of Child Neurology, Duke University Hospital, Durham, NC; Division of Neurocritical Care and Emergency Neurology (D.Y.H.) and Center for Neuroepidemiology and Clinical Neurological Research (D.Y.H.), Yale School of Medicine, New Haven, CT; Department of Neurology (N.B.G., M.K.), University of California in San Francisco; Department of Neurology (A.C.), Memorial Sloan Kettering Cancer Center, New York, NY; and Cambia Palliative Care Center of Excellence (J.R.C.), University of Washington, Seattle
| | - Maya Katz
- From the Department of Neurology (C.J.C.), University of Washington, Harborview Medical Center, Seattle; Department of Neurology (B.K.), University of Colorado Anschutz Medical Center, Denver; Department of Neurology (A.G.K., R.G.H.), University of Rochester Medical Center, NY; Department of Pediatrics (M.L.), Division of Child Neurology, Duke University Hospital, Durham, NC; Division of Neurocritical Care and Emergency Neurology (D.Y.H.) and Center for Neuroepidemiology and Clinical Neurological Research (D.Y.H.), Yale School of Medicine, New Haven, CT; Department of Neurology (N.B.G., M.K.), University of California in San Francisco; Department of Neurology (A.C.), Memorial Sloan Kettering Cancer Center, New York, NY; and Cambia Palliative Care Center of Excellence (J.R.C.), University of Washington, Seattle
| | - J Randall Curtis
- From the Department of Neurology (C.J.C.), University of Washington, Harborview Medical Center, Seattle; Department of Neurology (B.K.), University of Colorado Anschutz Medical Center, Denver; Department of Neurology (A.G.K., R.G.H.), University of Rochester Medical Center, NY; Department of Pediatrics (M.L.), Division of Child Neurology, Duke University Hospital, Durham, NC; Division of Neurocritical Care and Emergency Neurology (D.Y.H.) and Center for Neuroepidemiology and Clinical Neurological Research (D.Y.H.), Yale School of Medicine, New Haven, CT; Department of Neurology (N.B.G., M.K.), University of California in San Francisco; Department of Neurology (A.C.), Memorial Sloan Kettering Cancer Center, New York, NY; and Cambia Palliative Care Center of Excellence (J.R.C.), University of Washington, Seattle
| | - Robert G Holloway
- From the Department of Neurology (C.J.C.), University of Washington, Harborview Medical Center, Seattle; Department of Neurology (B.K.), University of Colorado Anschutz Medical Center, Denver; Department of Neurology (A.G.K., R.G.H.), University of Rochester Medical Center, NY; Department of Pediatrics (M.L.), Division of Child Neurology, Duke University Hospital, Durham, NC; Division of Neurocritical Care and Emergency Neurology (D.Y.H.) and Center for Neuroepidemiology and Clinical Neurological Research (D.Y.H.), Yale School of Medicine, New Haven, CT; Department of Neurology (N.B.G., M.K.), University of California in San Francisco; Department of Neurology (A.C.), Memorial Sloan Kettering Cancer Center, New York, NY; and Cambia Palliative Care Center of Excellence (J.R.C.), University of Washington, Seattle
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Scorza FA, Fiorini AC, Scorza CA, Finsterer J. Cardiac abnormalities in Parkinson's disease and Parkinsonism. J Clin Neurosci 2018; 53:1-5. [PMID: 29706419 DOI: 10.1016/j.jocn.2018.04.031] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 04/09/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVES Though there is increasing evidence for primary cardiac disease in Parkinson's disease (PD) and Parkinsonism (PS), this evidence is hardly included in the general management of these patients. METHODS Literature review. RESULTS PD is one of the most common age-related neurodegenerative disorders. Epidemiological studies have shown that PD is accompanied by high rates of premature death compared with the general population. In general, death in PD/PS is usually caused by determinant factors such as pneumonia, cerebrovascular, and cardiovascular disease. There is a significant body of literature demonstrating involvement of the heart in PD/PS. Cardiac involvement in PD/PS includes cardiac autonomic dysfunction, cardiomyopathy, coronary heart disease, arrhythmias, conduction defects, and sudden cardiac death (SCD), and sudden unexpected death in Parkinson's disease (SUDPAR). CONCLUSIONS Cardiac abnormalities found in PD/PS are manifold but the most prominent is cardiac autonomic dysfunction. The frequency of coronary heart disease in PD is a matter of debate. Only rarely reported in PD/PS are cardiomyopathies, arrhythmias, and sudden cardiac death, and SUDPAR. It is particularly recommended that PD/PS patients are more intensively investigated cardiologically as soon as the diagnosis is established. Early recognition of cardiac involvement is important for preventing SCD and SUDPAR.
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Affiliation(s)
- Fulvio A Scorza
- Disciplina de Neurociência, Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brazil.
| | - Ana C Fiorini
- Programa de Estudos Pós-Graduado em Fonoaudiologia, Pontifícia Universidade Católica de São Paulo (PUC-SP), Brazil; Departamento de Fonoaudiologia, Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brazil.
| | - Carla A Scorza
- Disciplina de Neurociência, Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brazil
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Valent F, Devigili G, Rinaldo S, Del Zotto S, Tullio A, Eleopra R. The epidemiology of Parkinson’s disease in the Italian region Friuli Venezia Giulia: a population-based study with administrative data. Neurol Sci 2018; 39:699-704. [DOI: 10.1007/s10072-018-3273-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 02/01/2018] [Indexed: 10/18/2022]
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Historical perspective: The pros and cons of conventional outcome measures in Parkinson's disease. Parkinsonism Relat Disord 2018; 46 Suppl 1:S47-S52. [DOI: 10.1016/j.parkreldis.2017.07.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Accepted: 07/29/2017] [Indexed: 11/18/2022]
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