1
|
Turner N, Faull C, Palmer J, Armstrong A, Bedford J, Turner MR, Wilson E. Understanding Quality of Life for People with Motor Neurone Disease Who Use Tracheostomy Ventilation and Family Members: A Scoping Review. Brain Sci 2024; 14:821. [PMID: 39199512 PMCID: PMC11352738 DOI: 10.3390/brainsci14080821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Revised: 08/06/2024] [Accepted: 08/14/2024] [Indexed: 09/01/2024] Open
Abstract
Tracheostomy ventilation (TV) can increase survival time for people living with motor neurone disease (MND); however, the use of TV varies between countries. Concerns regarding anticipated quality of life (QoL) are among the reasons given by healthcare professionals for not recommending this intervention, yet little is known about QoL in this context. This scoping review was conducted to examine the evidence on QoL for those with MND who use TV and family members involved in their care. Using the methodological guidance of the Joanna Briggs Institute, 23 papers were identified for inclusion, and findings were inductively analysed to identify key themes. We found that people living with MND tend to rate QoL post TV more positively than anticipated by healthcare professionals or family members. QoL was found to be related to positive relationships and activities the person could maintain. Feeling able to make a choice and an adequate level of financial resources were also important factors. Family members tended to experience lower QoL, associated with the uncertainty surrounding an emergency procedure and the complexity of subsequently required care. More evidence on QoL from the perspectives of people with MND who use TV is needed to support decision making and inform guidance.
Collapse
Affiliation(s)
- Nicola Turner
- School of Health Sciences, University of Nottingham, Nottingham NG7 2AH, UK;
| | | | - Jonathan Palmer
- Department of Thoracic Medicine, University Hospitals Plymouth NHS Trust, Plymouth PL6 8DH, UK;
| | - Alison Armstrong
- North-East Assisted Ventilation Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE1 4LP, UK;
| | | | - Martin R. Turner
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford OX3 9DU, UK;
| | - Eleanor Wilson
- School of Health Sciences, University of Nottingham, Nottingham NG7 2AH, UK;
| |
Collapse
|
2
|
Volpato E, Pierucci P, De Candia ML, Casparrini M, Volpi V, Pagnini F, Carpagnano GE, Banfi P. Life Experiences in Neuromuscular Tracheotomized Patients in Times of Covid-19. J Neuromuscul Dis 2023:JND221597. [PMID: 37212066 DOI: 10.3233/jnd-221597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
BACKGROUND The management of tracheotomy at home can be very complex, affecting the patient's quality of life. OBJECTIVES This case series study aimed to explore the experiences of patients affected by neuromuscular diseases (NMD) concerning tracheostomy and Invasive Mechanical Ventilation (IMV) management at home during the COVID-19 health emergency in Italy. METHODS Semi-structured interviews and the following instruments were used: Connor and Davidson Resilience Scale (CD-RISC-25); Acceptance and Action Questionnaire-II (AAQ-II); State-Trait Anxiety Inventory (STAI); Langer Mindfulness Scale (LMS). Descriptive analyses, correlations, and qualitative analyses were carried out. RESULTS 22 patients [50% female, mean age = 50.2 (SD = 21.2)] participated in the study. Participants who showed high levels of dispositional mindfulness in terms of novelty-seeking (r = 0.736, p = 0.013) and novelty production (r = 0.644, p = 0.033) were those with higher resilience. The main emotion that emerged was the fear of contagion (19 patients, 86.36%), due to the previous fragile condition, leading to a significant sense of abandonment. The tracheostomy's perception is seen in extremes as a lifesaver or a condemnation. The relationship with the health professionals moves from satisfaction to a feeling of abandonment with a lack of preparation. CONCLUSIONS The relationship between resilience, flexibility, state anxiety and dispositional mindfulness offers ways to reinforce tracheostomy management at home, even in critical periods when going to the hospital may be difficult.
Collapse
Affiliation(s)
- Eleonora Volpato
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
- IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Paola Pierucci
- Cardiothoracic Department, Respiratory and Critical care Unit Bari Policlinic University Hospital, B. Section of Respiratory Diseases, Department of Basic Medical Science Neuroscience and Sense Organs, University of Bari 'Aldo Moro', Bari, Italy
| | - Maria Luisa De Candia
- Cardiothoracic Department, Respiratory and Critical care Unit Bari Policlinic University Hospital, B. Section of Respiratory Diseases, Department of Basic Medical Science Neuroscience and Sense Organs, University of Bari 'Aldo Moro', Bari, Italy
| | - Massimo Casparrini
- Cardiothoracic Department, Respiratory and Critical care Unit Bari Policlinic University Hospital, B. Section of Respiratory Diseases, Department of Basic Medical Science Neuroscience and Sense Organs, University of Bari 'Aldo Moro', Bari, Italy
| | | | - Francesco Pagnini
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
- Department of Psychology, Harvard University, Cambridge, MA, USA
| | - Giovanna Elisiana Carpagnano
- Cardiothoracic Department, Respiratory and Critical care Unit Bari Policlinic University Hospital, B. Section of Respiratory Diseases, Department of Basic Medical Science Neuroscience and Sense Organs, University of Bari 'Aldo Moro', Bari, Italy
| | - Paolo Banfi
- IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
| |
Collapse
|
3
|
Kwak S. Pain in amyotrophic lateral sclerosis: a narrative review. JOURNAL OF YEUNGNAM MEDICAL SCIENCE 2022; 39:181-189. [PMID: 35673830 PMCID: PMC9273136 DOI: 10.12701/jyms.2022.00332] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 05/21/2022] [Accepted: 05/26/2022] [Indexed: 11/04/2022]
Abstract
Amyotrophic lateral sclerosis (ALS) is a rapidly progressive neurodegenerative condition characterized by loss of motor neurons, resulting in motor weakness of the limbs and/or bulbar muscles. Pain is a prevalent but neglected symptom of ALS, and it has a significant negative impact on the quality of life of patients and their caregivers. This review outlines the epidemiology, clinical characteristics, underlying mechanisms, and management strategies of pain in ALS to improve clinical practice and patient outcomes related to pain. Pain is a prevalent symptom among patients with ALS, with a variable reported prevalence. It may occur at any stage of the disease and can involve any part of the body without a specific pattern. Primary pain includes neuropathic pain and pain from spasticity or cramps, while secondary pain is mainly nociceptive, occurring with the progression of muscle weakness and atrophy, prolonged immobility causing degenerative changes in joints and connective tissue, and long-term home mechanical ventilation. Prior to treatment, the exact patterns and causes of pain must first be identified, and the treatment should be tailored to each patient. Treatment options can be classified into pharmacological treatments, including nonsteroidal anti-inflammatory drugs, antiepileptic drugs, drugs for cramps or spasticity, and opioid; and nonpharmacological treatments, including positioning, splints, joint injections, and physical therapy. The development of standardized and specific assessment tools for pain-specific to ALS is required, as are further studies on treatments to reduce pain, diminish suffering, and improve the quality of life of patients with ALS.
Collapse
Affiliation(s)
- Soyoung Kwak
- Department of Physical Medicine and Rehabilitation, Yeungnam University College of Medicine, Daegu, Korea
| |
Collapse
|
4
|
Tucker-Bartley A, Lemme J, Gomez-Morad A, Shah N, Veliu M, Birklein F, Storz C, Rutkove S, Kronn D, Boyce AM, Kraft E, Upadhyay J. Pain Phenotypes in Rare Musculoskeletal and Neuromuscular Diseases. Neurosci Biobehav Rev 2021; 124:267-290. [PMID: 33581222 PMCID: PMC9521731 DOI: 10.1016/j.neubiorev.2021.02.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 01/18/2021] [Accepted: 02/03/2021] [Indexed: 12/11/2022]
Abstract
For patients diagnosed with a rare musculoskeletal or neuromuscular disease, pain may transition from acute to chronic; the latter yielding additional challenges for both patients and care providers. We assessed the present understanding of pain across a set of ten rare, noninfectious, noncancerous disorders; Osteogenesis Imperfecta, Ehlers-Danlos Syndrome, Achondroplasia, Fibrodysplasia Ossificans Progressiva, Fibrous Dysplasia/McCune-Albright Syndrome, Complex Regional Pain Syndrome, Duchenne Muscular Dystrophy, Infantile- and Late-Onset Pompe disease, Charcot-Marie-Tooth Disease, and Amyotrophic Lateral Sclerosis. Through the integration of natural history, cross-sectional, retrospective, clinical trials, & case studies we described pathologic and genetic factors, pain sources, phenotypes, and lastly, existing therapeutic approaches. We highlight that while rare diseases possess distinct core pathologic features, there are a number of shared pain phenotypes and mechanisms that may be prospectively examined and therapeutically targeted in a parallel manner. Finally, we describe clinical and research approaches that may facilitate more accurate diagnosis, monitoring, and treatment of pain as well as elucidation of the evolving nature of pain phenotypes in rare musculoskeletal or neuromuscular illnesses.
Collapse
Affiliation(s)
- Anthony Tucker-Bartley
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Jordan Lemme
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Andrea Gomez-Morad
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Nehal Shah
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, 02115, USA
| | - Miranda Veliu
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Frank Birklein
- Department of Neurology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Rhineland-Palatinate, 55131, Germany
| | - Claudia Storz
- Department of Orthopedics, Physical Medicine and Rehabilitation, University Hospital LMU Munich, Munich, Bavaria, 80539, Germany
| | - Seward Rutkove
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, 02215, USA
| | - David Kronn
- Department of Pathology and Pediatrics, New York Medical College, Valhalla, NY, 10595, USA; Medical Genetics, Inherited Metabolic & Lysosomal Storage Disorders Center, Boston Children's Health Physicians, Westchester, NY, 10532, USA
| | - Alison M Boyce
- Skeletal Disorders and Mineral Homeostasis Section, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Eduard Kraft
- Department of Orthopedics, Physical Medicine and Rehabilitation, University Hospital LMU Munich, Munich, Bavaria, 80539, Germany; Interdisciplinary Pain Unit, University Hospital LMU Munich, Munich, 80539, Germany
| | - Jaymin Upadhyay
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, 02115, USA; Department of Psychiatry, McLean Hospital, Harvard Medical School, Belmont, MA, 02478, USA.
| |
Collapse
|
5
|
Cave R, Bloch S. Voice banking for people living with motor neurone disease: Views and expectations. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2021; 56:116-129. [PMID: 33350040 DOI: 10.1111/1460-6984.12588] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 11/01/2020] [Accepted: 11/02/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND More than 80% of people living with MND (plwMND) develop difficulties with their speech, affecting communication, self-identity and quality of life. Most plwMND eventually use an augmentative and alternative communication device (AAC) to communicate. Some AAC devices provide a synthesized voice for speech, however these voices are often viewed as impersonal and a factor in AAC acceptance. Voice banking creates an approximation of the person's own voice that can be used in AAC and is argued to go some way to preserve a person's identity when natural voice is lost, but there has been little supporting research. AIMS To understand what plwMND consider when deciding whether or not to bank their voice, what their expectations are, and the expectations of significant communication partners. METHODS Semi-structured interviews were undertaken with plwMND who had either decided to bank their voice or had decided not to. Thematic analysis was used to provide a qualitative analysis of the data. PROCEDURES Participants were an opportunistic sample of plwMND within England recruited via an open advert distributed by the MND Association (MNDA). OUTCOMES AND RESULTS Twelve plwMND were interviewed with nine significant others. Nine participants had decided to bank their voice and three decided not to. The data suggest 'preserving identity' is the overarching motivation in decision making for voice banking. Participants who decided to voice bank considered it would help to maintain their identity and preserve their social and work networks. Participants deciding not to bank their voice highlighted it could not replace their natural voice or preserve their identity. However, few in either group showed an awareness of how a voice bank is used in AAC, and how communication using AAC is significantly different to natural speech. CONCLUSIONS AND IMPLICATIONS This research is the first study of its kind to examine the considerations for decision making around voice banking for plwMND. Preserving identity is central to decision making when considering whether or not to voice bank. However, the reality of using AAC and voice banking for communication is poorly understood. Professionals have a role to provide plwMND with more information about voice banking in the wider context of using AAC for communication. It may be that the process of voice banking itself is seen as a positive act for plwMND, independent of how it is used later. Further research with associated professionals and stakeholders is indicated. What this paper adds What is already known on this subject Voice banking creates an approximation of the person.s own voice that can be used in AAC, and is argued to go some way to preserve a person's identity when natural voice is lost. There is significant and growing interest in voice banking from the MND community, but there has been little supporting research. What this study adds This research is the first study of its kind to examine decision making surrounding voice banking. It shows how preserving identity is critically important in how people deal with a diagnosis of MND. For those choosing to voice bank, it is seen as an effective way of preserving their identity, a way of 'fighting back' and giving a positive psychological benefit. Those deciding against voice banking do not believe it could maintain their identity and cannot bring back the natural voice they once had. Clinical implications of this study The reality of using AAC and voice banking for communication may be poorly understood. It would be helpful for professionals to provide information about voice banking as part of a wider discussion about the range of options for communication as the condition progresses. It is important that this includes the opportunity to listen to a voice bank to support understanding of how it is used in a communication device, and how different it sounds to natural speech.
Collapse
Affiliation(s)
- Richard Cave
- Language and Cognition, University College London, London, UK
| | - Steven Bloch
- Language and Cognition, University College London, London, UK
| |
Collapse
|
6
|
Klein E. Ethics and the emergence of brain-computer interface medicine. HANDBOOK OF CLINICAL NEUROLOGY 2020; 168:329-339. [PMID: 32164863 DOI: 10.1016/b978-0-444-63934-9.00024-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Brain-computer interface (BCI) technology will usher in profound changes to the practice of medicine. BCI devices, broadly defined as those capable of reading brain activity and translating this into operation of a device, will offer patients and clinicians new ways to address impairments of communication, movement, sensation, and mental health. These new capabilities will bring new responsibilities and raise a diverse set of ethical challenges. One way to understand and begin to address these challenges is to view them in terms of the goals of medicine. In this chapter, different ways in which BCI technology may subserve the goals of medicine is explored. This is followed by articulation of additional goals particularly relevant to BCI technology: neural diversity, neural privacy, agency, and authenticity. The goals of medicine provide a useful ethical framework for the introduction of BCI devices into medicine.
Collapse
Affiliation(s)
- Eran Klein
- Department of Neurology, Oregon Health and Science University, Portland, OR, United States; Department of Philosophy, University of Washington, Seattle, WA, United States.
| |
Collapse
|
7
|
Pain in amyotrophic lateral sclerosis. КЛИНИЧЕСКАЯ ПРАКТИКА 2019. [DOI: 10.17816/clinpract10266-73] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
In this review, we discuss different aspects of pain syndrome in patients with amyotrophic lateral sclerosis: etiology, incidence, pathophysiology and main clinical features. Also we review the modern approaches to the treatment of pain in amyotrophic lateral sclerosis. Pain is actually not rare in this condition: it appears in 80% of patients, affecting their quality of life and functional activity, leading to the development of depressive and anxiety disorders. Pain in amyotrophic lateral sclerosis is often overlooked by clinicians, since their attention may focus on the motor symptoms of the disease. Thus, a more careful approach is needed to diagnose and treat pain in amyotrophic lateral sclerosis.
Collapse
|
8
|
Delpont B, Beauvais K, Jacquin-Piques A, Alavoine V, Rault P, Blanc-Labarre C, Osseby GV, Hervieu-Bègue M, Giroud M, Béjot Y. Clinical features of pain in amyotrophic lateral sclerosis: A clinical challenge. Rev Neurol (Paris) 2018; 175:11-15. [PMID: 30131172 DOI: 10.1016/j.neurol.2017.11.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 11/09/2017] [Accepted: 11/20/2017] [Indexed: 12/12/2022]
Abstract
Pain in amyotrophic lateral sclerosis (ALS) is paradoxical in this disease of the upper and lower motor neurons. As such, it remains an underestimated and neglected clinical problem because it is poorly identified by physicians, its mechanisms are numerous and its treatments are generally not effective. Pain may be primary in the form of cramps, spasticity and neuropathy, or secondary as nociceptive pain, and may arise before the first motor symptoms. It may also lead to depression and, in all cases, affect patients' daily activities and quality of life. Given the high frequency of pain in ALS, the use of analgesic or sedative drugs is necessary and should reduce the course of the disease. Nevertheless, it is important to understand the pathophysiological mechanisms of pain in ALS, and to train physicians how to detect ALS pain early on and provide dedicated treatments. In France, the implementation of ALS centers is a positive response to the public-health problem resulting from this disorder.
Collapse
Affiliation(s)
- B Delpont
- Service de Neurologie, CHU de Dijon-Bourgogne, 14, rue Paul-Gaffarel, 21079 Dijon cedex, France; Centre de Lutte contre la Douleur, CHU de Dijon-Bourgogne, 14, rue Paul-Gaffarel, 21079 Dijon cedex, France
| | - K Beauvais
- Centre SLA, CHU de Dijon-Bourgogne, 14, rue Paul-Gaffarel, 21079 Dijon cedex, France
| | - A Jacquin-Piques
- Centre SLA, CHU de Dijon-Bourgogne, 14, rue Paul-Gaffarel, 21079 Dijon cedex, France
| | - V Alavoine
- Unité de Soins Palliatifs, CHU de Dijon-Bourgogne, 14, rue Paul-Gaffarel, 21079 Dijon cedex, France
| | - P Rault
- Centre de Lutte contre la Douleur, CHU de Dijon-Bourgogne, 14, rue Paul-Gaffarel, 21079 Dijon cedex, France
| | - C Blanc-Labarre
- Service de Neurologie, CHU de Dijon-Bourgogne, 14, rue Paul-Gaffarel, 21079 Dijon cedex, France
| | - G-V Osseby
- Service de Neurologie, CHU de Dijon-Bourgogne, 14, rue Paul-Gaffarel, 21079 Dijon cedex, France; Centre de Lutte contre la Douleur, CHU de Dijon-Bourgogne, 14, rue Paul-Gaffarel, 21079 Dijon cedex, France
| | - M Hervieu-Bègue
- Service de Neurologie, CHU de Dijon-Bourgogne, 14, rue Paul-Gaffarel, 21079 Dijon cedex, France
| | - M Giroud
- Service de Neurologie, CHU de Dijon-Bourgogne, 14, rue Paul-Gaffarel, 21079 Dijon cedex, France; Centre de Lutte contre la Douleur, CHU de Dijon-Bourgogne, 14, rue Paul-Gaffarel, 21079 Dijon cedex, France; Centre SLA, CHU de Dijon-Bourgogne, 14, rue Paul-Gaffarel, 21079 Dijon cedex, France.
| | - Y Béjot
- Service de Neurologie, CHU de Dijon-Bourgogne, 14, rue Paul-Gaffarel, 21079 Dijon cedex, France
| |
Collapse
|
9
|
Nakayama R, Nishiyama A, Matsuda C, Nakayama Y, Hakuta C, Shimada M. Oral health status of hospitalized amyotrophic lateral sclerosis patients: a single-centre observational study. Acta Odontol Scand 2018; 76:294-298. [PMID: 29278008 DOI: 10.1080/00016357.2017.1420228] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To assess the intraoral conditions and oral function of patients with amyotrophic lateral sclerosis (ALS). MATERIAL AND METHODS This single-centre, cross-sectional observational study included 50 ALS patients, who were treated with tracheostomy positive-pressure ventilation (TPPV) while hospitalized. The disease duration, TPPV duration, current number of teeth, number of occlusal units, number of decayed/missing/filled teeth, community periodontal index, bleeding on probing, dental calculus, maximum mouth opening, salivation rate, tongue anomalies (atrophy or hypertrophy) and tongue coating were determined for each patient. Differences in intraoral conditions according to disease duration or TPPV duration were statistically analysed. RESULTS The maximum mouth opening was low in the included patients, with a mean distance of 13.7 ± 7.4 mm. Furthermore, the maximum mouth opening showed a significant negative correlation with both disease duration and TPPV duration. No statistically significant differences were found between any other intraoral parameters and disease duration or TPPV duration. CONCLUSIONS Severe dental disease is uncommon among hospitalized ALS patients who receive oral care by nurses; however, mouth opening is very restricted in these patients. Early intervention for restricted mouth opening, directed by a dentist or dental hygienist, is essential in this population.
Collapse
Affiliation(s)
- Rena Nakayama
- Orofacial Pain Management, Oral Health Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Akira Nishiyama
- Orofacial Pain Management, Oral Health Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Chiharu Matsuda
- ALS Nursing Care Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Yuki Nakayama
- ALS Nursing Care Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Chiyoko Hakuta
- Oral Health Sciences for Community Welfare, Oral Health Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masahiko Shimada
- Orofacial Pain Management, Oral Health Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| |
Collapse
|
10
|
Ang K, Umapathi T, Tong J, Ng J, Tseng LJ, Woo IMH. Healthcare Needs of Patients with Amyotrophic Lateral Sclerosis (ALS) in Singapore: A patient-centred qualitative study from multiple perspectives. J Palliat Care 2017; 31:150-7. [DOI: 10.1177/082585971503100304] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background One challenge for those who manage amyotrophic lateral sclerosis (ALS) is to understand patients’ needs. Aim The aim of this study was to examine the needs of Singapore ALS patients from their perspective as well as that of their caregivers and healthcare professionals in order to develop a template for better services. Methods A cross-sectional qualitative study was conducted, with one-to-one interviews and focus group discussions. Results All 30 participants, key stakeholders in the field of caring for ALS patients, identified these needs categories: psychological – diagnosis must be staged and comfortably paced, and efforts must be made to encourage patients’ resilience; social – positive relationships, open communication, and spiritual support must be developed; physical – attention should be paid to alleviating discomfort and disability; and environmental -appropriate services should be made available. Conclusion The identified needs categories do overlap, but there are significant differences. Our findings provide a template for developing individualized patient services, which should be done within the framework of a comprehensive palliative care program.
Collapse
Affiliation(s)
- Kexin Ang
- Department of Neurology, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore 308433
| | | | - Jieli Tong
- Department of Neurology, National Neuroscience Institute, Singapore
| | - Justin Ng
- Department of Neurology, National Neuroscience Institute, Singapore
| | - Liang Jun Tseng
- Department of Neurology, National Neuroscience Institute, Singapore
| | - Ivan Mun Hong Woo
- Department of Care and Counselling, Tan Tock Seng Hospital, Singapore
| |
Collapse
|
11
|
Oh J, Kim JA. Supportive care needs of patients with amyotrophic lateral sclerosis/motor neuron disease and their caregivers: A scoping review. J Clin Nurs 2017; 26:4129-4152. [PMID: 28681543 DOI: 10.1111/jocn.13945] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2017] [Indexed: 12/11/2022]
Abstract
AIMS AND OBJECTIVES To identify the supportive care needs of amyotrophic lateral sclerosis/motor neuron disease patients and their caregivers, categorise and summarise them into a Supportive Care Needs Framework and identify gaps in literature. BACKGROUND Little is known about the supportive care needs of amyotrophic lateral sclerosis/motor neuron disease patients and their caregivers, and this subject has not previously been systemically reviewed. DESIGN Scoping review. METHODS We conducted a scoping review from the MEDLINE, EMBASE, CINAHL and Cochrane databases for the period January 2000-July 2016, using the following inclusion criteria: (i) written in English only, (ii) published in peer-reviewed journals, (iii) at least part of the research considered the supportive care needs perspective of amyotrophic lateral sclerosis/motor neuron disease patients or their caregivers and (iv) the population sample included patients of amyotrophic lateral sclerosis/motor neuron disease or their caregivers. RESULTS Thirty-seven articles were included. Our review shows that amyotrophic lateral sclerosis/motor neuron disease patients and their caregivers' supportive care needs were mentioned across all seven domains of the Supportive Care Needs Framework. Most common were practical needs (n = 24), followed by Informational needs (n = 19), Social needs (n = 18), Psychological needs (n = 16), Physical needs (n = 15), Emotional needs (n = 13) and Spiritual needs (n = 8). CONCLUSION From the perspectives of amyotrophic lateral sclerosis/motor neuron disease patients and their caregivers, there is a significant need for more practical, social, informational, psychological, physical, emotional and spiritual support. RELEVANCE TO CLINICAL PRACTICE The Supportive Care Needs Framework has potential utility in the development of patient-centred support services or healthcare policies and serves as an important base for further studies; especially, specific examples of each supportive care needs domain can guide in clinical settings when healthcare professionals provide multidisciplinary care to amyotrophic lateral sclerosis/motor neuron disease patients and individualised care.
Collapse
Affiliation(s)
- Juyeon Oh
- Division of Nursing, Hanyang University, Seoul, Korea.,Cell therapy Center for Intractable Disorders, Hanyang University Hospital, Seoul, Korea
| | - Jung A Kim
- Division of Nursing, Hanyang University, Seoul, Korea
| |
Collapse
|
12
|
Pain in amyotrophic lateral sclerosis. Lancet Neurol 2017; 16:144-157. [DOI: 10.1016/s1474-4422(16)30358-1] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Revised: 10/31/2016] [Accepted: 11/21/2016] [Indexed: 12/12/2022]
|
13
|
Tracheostomy and invasive ventilation in Japanese ALS patients: decision-making and survival analysis: 1990-2010. J Neurol Sci 2014; 344:158-64. [PMID: 25017882 DOI: 10.1016/j.jns.2014.06.047] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Revised: 06/13/2014] [Accepted: 06/23/2014] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To evaluate the factors related to the choice of a tracheostomy and invasive ventilation in amyotrophic lateral sclerosis patients and to determine survival time after a tracheostomy at a single institute in Japan between 1990 and 2010. METHODS Data for survival time until death or tracheostomy were obtained from 160 patients. Fifty-two patients (33%) underwent tracheostomy/mechanical ventilation. RESULTS Tracheostomy and invasive ventilation prolonged median survival time (74 months), as did non-invasive ventilation (48 months) when compared to a non-ventilation-supported control group (32 months; p<0.001 each). The ratio of tracheostomy/mechanical ventilation in patients >65 years old significantly increased after 1999 (27%) compared to earlier years (10%, p=0.002). Cox proportional modeling confirmed an age of ≤65 years as advantageous for long-term survival after a tracheostomy. In univariate logistic regression analysis, factors related to the decision to perform a tracheostomy included an age of ≤65 years, greater use of non-invasive ventilation, the presence of a spouse, interval and speed from disease onset to diagnosis/tracheostomy and preservation of motor function. In multivariate logistic regression analysis, age, shorter duration from disease onset until tracheostomy and the presence of a spouse were independently associated with the decision to perform a tracheostomy. Kaplan-Meier plots revealed longer survival times in patients who resided at home after a tracheostomy compared to patients who stayed at a hospital (p=0.007). CONCLUSIONS Tracheostomy and invasive ventilation are frequently used in Japan. Various factors impact patients' decisions to have these procedures. This study identified factors related to the decision-making process and post-tracheostomy survival.
Collapse
|
14
|
Foley G, Timonen V, Hardiman O. Understanding psycho-social processes underpinning engagement with services in motor neurone disease: a qualitative study. Palliat Med 2014; 28:318-25. [PMID: 24637571 DOI: 10.1177/0269216313512013] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND People with motor neurone disease access healthcare services from disease onset to end-of-life care, but there has been paucity of research on how people with motor neurone disease understand and use healthcare services. AIM To identify key psycho-social processes that underpin how people with motor neurone disease engage with healthcare services. DESIGN Grounded theory approach comprising in-depth qualitative interviews was used in this study. Data were collected and analysed using open, axial and selective coding procedures. SETTING/PARTICIPANTS A total of 34 people with motor neurone disease were recruited from the Irish motor neurone disease population-based register. RESULTS We identified that control, reassurance, resignation and trust are key variables that shape how people with motor neurone disease engage with healthcare services. Participants exerted control in care to cope with loss. Most participants were resigned to death and sought reassurances from healthcare professionals about end-of-life care. Participants questioned the benefit of life-sustaining interventions in motor neurone disease and few of them associated life-sustaining interventions with palliative care. Participants trusted healthcare professionals who reassured them about their care and who were attuned to how they were coming to terms with loss. CONCLUSION This study identified new and important aspects of control, trust and reassurance which shed light on how people with motor neurone disease engage with healthcare professionals and approach end-of-life care. People with motor neurone disease exert control in care and meaningful relationships with healthcare professionals are important to them. Some people with motor neurone disease prefer to die without life-sustaining interventions.
Collapse
Affiliation(s)
- Geraldine Foley
- 1School of Social Work and Social Policy, Trinity College Dublin, Dublin, Ireland
| | | | | |
Collapse
|
15
|
Foley G, Timonen V, Hardiman O. Acceptance and decision making in amyotrophic lateral sclerosis from a life-course perspective. QUALITATIVE HEALTH RESEARCH 2014; 24:67-77. [PMID: 24336481 DOI: 10.1177/1049732313516545] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Researchers have explored perceptions of health care services among people with amyotrophic lateral sclerosis (ALS), but little is known about how and why people with ALS engage with services. We undertook a grounded theory study to identify key psychosocial processes that underpin how and why people with ALS engage with health care services. We conducted in-depth interviews with 34 participants sampled from the Irish ALS population-based register. We found that age and life stage shaped participants' decision making about care. Participants in later life were more accepting of ALS and of death than young and middle-aged participants. Family was the primary context to how participants engaged with services, and their decisions about care were shaped by parenthood at different life stages. Health care professionals need to be attuned to the impact of life-course trajectories and family relations on the decisions people with ALS make about their care.
Collapse
|
16
|
Dyrstad DN, Hansen BS, Gundersen EM. Factors that influence user satisfaction: tracheotomised home mechanical ventilation users’ experiences. J Clin Nurs 2012; 22:331-8. [DOI: 10.1111/j.1365-2702.2012.04304.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2012] [Indexed: 11/30/2022]
Affiliation(s)
| | | | - Evy M Gundersen
- Department of Health Studies; Faculty of Social Sciences; University of Stavanger; Stavanger; Norway
| |
Collapse
|
17
|
Lechtzin N. Causes of death amongst French patients with amyotrophic lateral sclerosis: is guideline recommended care getting lost in translation? Eur J Neurol 2012; 16:5-6. [PMID: 19087142 DOI: 10.1111/j.1468-1331.2008.02327.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
18
|
Foley G, Timonen V, Hardiman O. Patients’ perceptions of services and preferences for care in amyotrophic lateral sclerosis: A review. ACTA ACUST UNITED AC 2011; 13:11-24. [DOI: 10.3109/17482968.2011.607500] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
|
19
|
A Literature Review of Studies Using Qualitative Research to Explore Chronic Neuromuscular Disease. J Neurosci Nurs 2011; 43:172-82. [DOI: 10.1097/jnn.0b013e3182135ac9] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
20
|
Lima NMFV, Nucci A. Clinical attention and assistance profile of patients with amyotrophic lateral sclerosis. ARQUIVOS DE NEURO-PSIQUIATRIA 2011; 69:170-5. [DOI: 10.1590/s0004-282x2011000200005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2010] [Accepted: 11/16/2010] [Indexed: 11/21/2022]
Abstract
OBJECTIVE: To evaluate the functional status of amyotrophic lateral sclerosis (ALS) patients diagnosed at this institution; to analyze hospital and palliative care; to identify patients' knowledge about home care and supportive resources. METHOD: Twenty-nine patients were evaluated on the ALSFRS-R scale and two semi-structured questionnaires, at the start of the study and every four months thereafter for 1 year. RESULTS: ALSFRS-R score was 30.1±11.5 initially and 24.4±10.5 at 1 year. There was an increase in use of physiotherapeutic care and adaptive aids. The primary caregivers were spouses (55.2%), parents/children/cousins (20.7%), friends (10.3%) and private nurses (3.5%); 10.3% of patients had no caregivers. Basic ALS patient care was provided by the public health system. CONCLUSION: ALS patients' multidisciplinary care was provided by UNICAMP hospital and its outpatient clinics and, in some patients, complemented by a private health plan or personal expenditure. Few ALS patients were aware of the possibility of home nursing. It is necessary to implement national and regional public home nursing in addition to multidisciplinary specialized care of ALS patients.
Collapse
|
21
|
Abstract
AbstractBackground: Throughout the course of their illness, people with amyotrophic lateral sclerosis (ALS) must make many treatment decisions; however, none has such a significant impact on quality of life and survival as decisions about assisted ventilation.Objective: The purpose of this study was to better understand the experience of decision-making about assisted ventilation for ALS patients.Methods: Using qualitative phenomenology methodology, 10 semi-structured interviews were conducted with persons with ALS and their caregivers to elicit factors that are pertinent to their decision-making process about assisted ventilation.Results: Six main themes emerged from the interviews. (1) the meaning of the intervention — participants made a sharp distinction between non-invasive ventilation, which they viewed as a means to relieve symptoms of respiratory failure, and invasive ventilation, which they viewed as taking over their breathing and thereby saving their life when they otherwise would die, (2) the importance of context — including functional status, available supports, and financial implications, (3) the importance of values — with respect to communication, relationships, autonomy, life, and quality of life, (4) the effect of fears — particularly respiratory distress, chocking, running out of air, and the process of death itself, (5) the need for information — how use of assisted ventilation would impact daily life, how death from respiratory failure would occur, how caregivers and persons with ALS differ in their information needs and common misconceptions, and (6) adaptation to or acceptance of the intervention — a lengthy process that involved gradual familiarization with the equipment and its benefits.Significance of the research: People with ALS and caregivers value autonomy in decision-making about assisted ventilation. Their decision-making process is neither wholly rational nor self-interested, and includes factors that health professionals should anticipate and address. Discussions about assisted ventilation and timing should be tailored to each individual and undertaken periodically.
Collapse
|
22
|
Hirano Y, Yamazaki Y. Ethical issues in invasive mechanical ventilation for amyotrophic lateral sclerosis. Nurs Ethics 2010; 17:51-63. [PMID: 20089625 DOI: 10.1177/0969733009350945] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Currently in Japan, discontinuing an invasive mechanical ventilator (IMV) is illegal; therefore IMV-related decision making is a crucial issue. This study examined IMV decision-making factors and psychological conflict in 50 patients with amyotrophic lateral sclerosis. The Herth Hope Index was used for the assessment of pre- and post-IMV conflict. Interviews identified some decision-making factors: patient's decision, patient's and family's mutual decision, family's decision, and emergency-induced without patient's or family's consent. Participants who experienced no IMV-related regret received sufficient prior IMV education from physicians and nurses, and time for reflection and family consultation. Their hope was similar to their pre-onset levels. Patients who received no prior IMV education accepted treatment as a natural progression. Their hope levels were lower than pre-onset. Those who received only a brief prior IMV explanation rejected the ventilator, experiencing regret if they were given an emergency IMV. Their hope levels were among the lowest. However, some of these patients managed to overcome their regret through being helped by nurses. Sufficient physician explanation and nursing advocacy for autonomous patient decision making are critical for improving hope in this patient group.
Collapse
|
23
|
Abstract
AbstractObjective: The objective of this review is to describe the current status of research on hope in palliative care.Methods: Integrative review was conducted to determine current knowledge on the topic. CINAHL and PubMed MEDLINE databases were used to find the articles relevant to this review. The data consisted of 34 articles on hope and palliative care published in peer-reviewed journals. A qualitative approach utilizing content analysis was used in this review.Results: There are at least two overarching themes of patients' hope in the palliative context: “living with hope” and “hoping for something” which however are not separate contents. Several instruments for measuring hope in a palliative context have been produced. However, future research is needed to gather further validity evidence for these instruments. Factors related to patients, other people (e. g. significant others), illness, care and context contribute to or threaten patient hope. Hope of the significant other was defined as an inner force. However, the main concern for caregivers was “hanging on to hope” in spite of eroding effects on hope caused by different factors, for example in the health care system. Also significant others' hope in a palliative care context has been measured, but the results of the studies appear inconsistent. Nurses' reflection in action, affirmation of the patient's worth, working with the patient, considering the patient in a holistic sense were the main hope-engendering interventions generated from this review.Significance of the research: Hope is important in both living and dying. The majority of the hope research in a palliative context focuses on patient hope and factors influencing patient hope. Research on hope in significant others and nurses in palliative care is scant. More research is needed about the factors threatening patient hope, hope in significant others, and interventions to engender hope in palliative and their outcomes.
Collapse
|
24
|
HIRANO Y, YAMAZAKI Y. Illness experiences of invasive mechanical ventilator-dependent amyotrophic lateral sclerosis patients in Japan : A study of trajectories and correlates of psychological well-being. ACTA ACUST UNITED AC 2009. [DOI: 10.3861/jshhe.75.79] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|