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Wilson E, Palmer J, Armstrong A, Messer B, Presswood E, Faull C. End of life decision making when home mechanical ventilation is used to sustain breathing in Motor Neurone Disease: patient and family perspectives. BMC Palliat Care 2024; 23:115. [PMID: 38698397 PMCID: PMC11064348 DOI: 10.1186/s12904-024-01443-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 04/24/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND Motor Neurone Disease (MND) leads to muscle weakening, affecting movement, speech, and breathing. Home mechanical ventilation, particularly non-invasive ventilation (NIV), is used to alleviate symptoms and support breathing in people living with MND. While home mechanical ventilation can alleviate symptoms and improve survival, it does not slow the progression of MND. This study addresses gaps in understanding end-of-life decision-making in those dependent on home mechanical ventilation, considering the perspectives of patients, family members, and bereaved families. METHODS A UK-wide qualitative study using flexible interviews to explore the experiences of people living with MND (n = 16), their family members (n = 10), and bereaved family members (n = 36) about the use of home mechanical ventilation at the end of life. RESULTS Some participants expressed a reluctance to discuss end-of-life decisions, often framed as a desire to "live for the day" due to the considerable uncertainty faced by those with MND. Participants who avoided end-of-life discussions often engaged in 'selective decision-making' related to personal planning, involving practical and emotional preparations. Many faced challenges in hypothesising about future decisions given the unpredictability of the disease, opting to make 'timely decisions' as and when needed. For those who became dependent on ventilation and did not want to discuss end of life, decisions were often 'defaulted' to others, especially once capacity was lost. 'Proactive decisions', including advance care planning and withdrawal of treatment, were found to empower some patients, providing a sense of control over the timing of their death. A significant proportion lacked a clear understanding of the dying process and available options. CONCLUSIONS The study highlights the complexity and evolution of decision-making, often influenced by the dynamic and uncertain nature of MND. The study emphasises the need for a nuanced understanding of decision-making in the context of MND.
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Affiliation(s)
- Eleanor Wilson
- School of Health Sciences, University of Nottingham, Nottingham, UK.
| | - Jonathan Palmer
- University Hospitals, University Hospitals NHS Trust Plymouth, Plymouth, UK
| | - Alison Armstrong
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Ben Messer
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
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Genuis SK, Luth W, Bubela T, Johnston WS. What do people affected by amyotrophic lateral sclerosis want from health communications? Evidence from the ALS Talk Project. Muscle Nerve 2023; 68:286-295. [PMID: 37462337 DOI: 10.1002/mus.27935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 06/22/2023] [Accepted: 06/23/2023] [Indexed: 08/22/2023]
Abstract
INTRODUCTION/AIMS Health communication is central to effective, supportive amyotrophic lateral sclerosis (ALS) clinical care. Guidance for ALS communication is limited, focuses on diagnosis disclosure, and frequently relies on expert consensus and/or reviews. Patient-based evidence is needed to guide ALS health communication. We investigated how the experiences of ALS patients and family caregivers can inform effective communication practices from diagnosis to end-of-life. METHODS Data were drawn from the ALS Talk Project, an asynchronous, online focus group study. Seven focus groups and five interviews (105 participants) were conducted. Data were qualitatively analyzed using directed content analysis and the constant-comparative approach. RESULTS We found four primary themes: communication content, communication circumstances, information sufficiency, and communication manner. Data indicate participants relied on clinicians for medical information but also wanted practical information; health communication should attend to the circumstances within which conversations occur; information must be sufficient for individual needs, without overwhelming; and an empathetic, direct, and honest manner facilitated trust. Participants identified communication challenges and strategies to improve communication across major themes, including stepwise approaches and conversations tailored to individuals and their heterogeneous disease experiences. DISCUSSION Healthcare professionals should discuss patient/caregiver communication preferences early in the therapeutic relationship, co-develop a communication agreement, and update the agreement in response to changing needs and disease progression. This will foster regular discussion of information needs and promote timely discussions of challenging topics, including advance care, while giving patients and families a sense of control. Findings may have implications for other neuromuscular disease and/or seriously ill populations.
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Affiliation(s)
- Shelagh K Genuis
- Division of Neurology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Westerly Luth
- Division of Neurology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Tania Bubela
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Wendy S Johnston
- Division of Neurology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
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White S, O'Cathain A, Halliday V, Croot L, McDermott CJ. Factors influencing decisions people with motor neuron disease make about gastrostomy placement and ventilation: A qualitative evidence synthesis. Health Expect 2023; 26:1418-1435. [PMID: 37254833 PMCID: PMC10349261 DOI: 10.1111/hex.13786] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 05/15/2023] [Accepted: 05/18/2023] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND People with motor neuron disease (pwMND) are routinely offered gastrostomy feeding tube placement and (non-invasive and invasive) ventilation to manage the functional decline associated with the disease. This study aimed to synthesise the findings from the qualitative literature to understand how individual, clinical team and organisational factors influence pwMND decisions about these interventions. METHODS The study design was guided by the enhancing transparency in reporting the synthesis of qualitative research (ENTREC) statement. The search of five bibliography databases and an extensive supplementary search strategy identified 27 papers that included qualitative accounts of pwMND, caregivers and healthcare professionals' (HCPs) experiences of making decisions about gastrostomy and ventilation. The findings from each study were included in a thematic synthesis. FINDINGS Making decisions about interventions is an emotional rather than simply a functional issue for pwMND. The interventions can signal an end to normality, and increasing dependence, where pwMND consider the balance between quality of life and extending survival. Interactions with multiple HCPs and caregivers can influence the process of decision-making and the decisions made. These interactions contribute to the autonomy pwMND are able to exert during decision-making. HCPs can both promote and threaten pwMND perceived agency over decisions through how they approach discussions about these interventions. Though there is uncertainty over the timing of interventions, pwMND who agree to interventions report reaching a tipping point where they accept the need for change. CONCLUSION Discussion of gastrostomy and ventilation options generate an emotional response in pwMND. Decisions are the consequence of interactions with multiple external agents, including HCPs treading a complex ethical path when trying to improve health outcomes while respecting pwMND right to autonomy. Future decision support interventions that address the emotional response and seek to support autonomy have the potential to enable pwMND to make informed and timely decisions about gastrostomy placement and ventilation. PATIENT OR PUBLIC CONTRIBUTION The lead author collaborated with several patient and participant involvement (PPI) groups with regards to the conceptualisation and design of this project. Decisions that have been influenced by discussions with multiple PPI panels include widening the scope of decisions about ventilation in addition to gastrostomy placement and the perceptions of all stakeholders involved (i.e., pwMND, caregivers and HCPs).
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Affiliation(s)
- Sean White
- Neurosciences Department, Faculty of Medicine Dentistry and HealthThe University of SheffieldSheffieldUK
| | - Alicia O'Cathain
- School of Health and Related Research (ScHARR)The University of SheffieldSheffieldUK
| | - Vanessa Halliday
- School of Health and Related Research (ScHARR)The University of SheffieldSheffieldUK
| | - Liz Croot
- School of Health and Related Research (ScHARR)The University of SheffieldSheffieldUK
| | - Christopher J. McDermott
- Neurosciences Department, Faculty of Medicine Dentistry and HealthThe University of SheffieldSheffieldUK
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Barć K, Lulé D, Finsel J, Helczyk O, Baader S, Aho‐Özhan H, Ludolph AC, Kuźma‐Kozakiewicz M. Well-being on supportive techniques in amyotrophic lateral sclerosis: from neurologists' perspective. Ann Clin Transl Neurol 2022; 9:1874-1883. [PMID: 36448241 PMCID: PMC9735360 DOI: 10.1002/acn3.51663] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 08/03/2022] [Accepted: 08/24/2022] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE To investigate intercultural neurologists' perception of well-being in patients with amyotrophic lateral sclerosis (ALS) using gastrostomy (PEG), non-invasive, and/or invasive ventilation (NIV/IV) and to analyse the determinants and impact on the management of the above medical interventions (MIs). METHODS The study was based on anonymous questionnaires addressing the clinical approach and personal attitude towards the use of PEG, NIV and IV in ALS patients completed by 465 neurologists: 228 from Germany and 237 from Poland. RESULTS The German and Polish neurologists estimated the quality of life in ALS patients using PEG and NIV as neutral, whilst low in individuals using IV. A regression model revealed an independent influence of palliative care training (PCT) and age on that attitude in the German group. Higher values of estimated patients' depressiveness on PEG, NIV and IV were found amongst the Polish neurologists. Marital status, experience in ALS and being a parent independently influenced the perception of patients' depressiveness in the German, whilst marital status, age and PCT were factors in the Polish group. Amongst German neurologists, a higher perception of patients' depressiveness in individuals using PEG, NIV and IV was linked to the later timing of the MIs discussion. In the Polish group, it was a lower estimation of QoL in patients using PEG. CONCLUSION Neurologists' perception of ALS patients' well-being on MIs reflects their demographic status, professional experience and potentially their cultural background. This perception plays an important role in the timing of MIs discussion, possibly influencing the decision-making process.
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Affiliation(s)
- Krzysztof Barć
- Department of NeurologyUniversity Clinical Centre of Medical University of WarsawWarsawPoland
| | | | - Julia Finsel
- Department of NeurologyUniversity of UlmUlmGermany
| | - Olga Helczyk
- Department of NeurologyUniversity of UlmUlmGermany
| | | | | | - Albert C. Ludolph
- Department of NeurologyUniversity of UlmUlmGermany,German Center of Neurodegenerative Diseases (DZNE)Ulm siteUlmGermany
| | - Magdalena Kuźma‐Kozakiewicz
- Department of NeurologyMedical University of WarsawWarsawPoland,Neurodegenerative Diseases Research GroupMedical University of WarsawWarsawPoland
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Aust E, Linse K, Graupner ST, Joos M, Liebscher D, Grosskreutz J, Prudlo J, Meyer T, Günther R, Pannasch S, Hermann A. Quality of life and mental health in the locked-in-state-differences between patients with amyotrophic lateral sclerosis and their next of kin. J Neurol 2022; 269:5910-5925. [PMID: 35790562 PMCID: PMC9553779 DOI: 10.1007/s00415-022-11238-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 06/14/2022] [Accepted: 06/14/2022] [Indexed: 11/07/2022]
Abstract
For both patients with amyotrophic lateral sclerosis (ALS) and their next of kin (NOK), the maintenance of quality of life (QoL) and mental health is particularly important. First studies suggest significant discrepancies between QoL reports by patients and NOK, but little is known for advanced ALS stages. To address this issue, we screened 52 ALS patients in incomplete locked-in state (iLIS). Final results were obtained for 15 couples of iLIS patients and NOK. We assessed patients' and NOK's subjective QoL, depression and anxiety and NOK's caregiver burden. Gaze controlled questionnaires allowed direct assessment of patients. Patients and NOK self-reported comparable, mostly moderate to high levels of QoL. Of note, NOK indicated stronger anxiety symptoms. Higher anxiety levels in NOK were associated with stronger caregiver burden and reduced QoL. No significant misjudgment of patient's QoL by the NOK was evident, while patients overestimated NOK's global QoL. However, NOK with severe caregiver burden and depression symptoms gave poorer estimations of patients' QoL. This relationship is relevant, considering NOK's impact on life critical treatment decisions. While the daily time NOK and patient spend together was positively correlated with NOK's QoL and mental health, this was not reversely found for the patients. Our results suggest that NOK adapt less successfully to the disease and concomitant experience of loss and point to an urgent need for specialized psychosocial support. The findings emphasize the importance of direct psychological wellbeing assessment of both patients and NOK in clinical practice, enabled by eye-tracking technology for patients in iLIS.
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Affiliation(s)
- Elisa Aust
- Department of Neurology, Technische Universität Dresden, Dresden, Germany
| | - Katharina Linse
- Department of Neurology, Technische Universität Dresden, Dresden, Germany
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE) Dresden, Dresden, Germany
| | - Sven-Thomas Graupner
- Engineering Psychology and Applied Cognitive Research, Technische Universität Dresden, Dresden, Germany
| | - Markus Joos
- Interactive Minds Research, Interactive Minds Dresden GmbH, Dresden, Germany
| | - Daniel Liebscher
- Interactive Minds Research, Interactive Minds Dresden GmbH, Dresden, Germany
| | | | - Johannes Prudlo
- Department of Neurology, University of Rostock, Rostock, Germany
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE) Rostock/Greifswald, Rostock, Germany
| | - Thomas Meyer
- Center for ALS and other Motor Neuron Disorders, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - René Günther
- Department of Neurology, Technische Universität Dresden, Dresden, Germany
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE) Dresden, Dresden, Germany
| | - Sebastian Pannasch
- Engineering Psychology and Applied Cognitive Research, Technische Universität Dresden, Dresden, Germany
| | - Andreas Hermann
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE) Rostock/Greifswald, Rostock, Germany.
- Center for Transdisciplinary Neurosciences Rostock (CTNR), University Medical Center Rostock, University of Rostock, Rostock, Germany.
- Translational Neurodegeneration Section "Albrecht Kossel," Department of Neurology, University Medical Center Rostock, University of Rostock, Gehlsheimer Straße 20, 18147, Rostock, Germany.
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Paynter C, Mathers S, Gregory H, Vogel AP, Cruice M. The impact of communication on healthcare involvement for people living with motor neurone disease and their carers: A longitudinal qualitative study. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2022; 57:1318-1333. [PMID: 35860953 PMCID: PMC9796182 DOI: 10.1111/1460-6984.12757] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 06/06/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Communication and cognitive impairments are known barriers to shared decision-making. Most people diagnosed with motor neurone disease (MND) will develop a motor speech impairment over the disease course. Some will develop cognitive, linguistic or behavioural disturbance. Despite this, the impact of communication and cognitive impairment on personal healthcare decision-making in MND is not well known. AIMS This exploratory, longitudinal study aimed to capture the perspectives of people living with MND (plwMND) and family members on managing their healthcare with, or in anticipation of, a communication impairment. METHODS & PROCEDURES Semi-structured interviews and functional assessments were conducted with plwMND and family members over one to three time points between December 2017 and January 2020. Participants were recruited from a specialist MND clinic using a maximum variation sampling approach. Interview transcripts were analysed using trajectory data analysis: a matrix-based approach for thematic analysis of longitudinal data. The study was underpinned by interpretive descriptive methodology. OUTCOMES & RESULTS A total of 19 plwMND with a range of MND phenotypes and 15 family members were recruited. Disease progression and participant withdrawal resulted in attrition, however 12 plwMND and seven family members participated at all three time points. Consistent cognitive screening was not feasible, which limited the opportunity to explore the impact of cognitive change. An overarching theme 'Communicating takes effort' was identified and illustrates the efforts required to compensate for, or circumnavigate, impairments to maintain involvement in healthcare. Assistance from family and accommodation from healthcare professionals (HCPs) was needed for ongoing engagement. Where plwMND were dependent on alternative communication devices, this assistance was essential and primarily carried out by family members. Despite these efforts, the quality, quantity and accuracy of communication were sometimes compromised. Participants equated good communication with receiving good healthcare, and some expressed anxiety in the anticipation of being unable to express their needs to healthcare workers. CONCLUSION & IMPLICATIONS Communication impairment has a direct impact on healthcare involvement. This study demonstrates the effort required by plwMND and their carers to maintain or maximize ongoing involvement. This effort may not always be visible to HCPs. This information may prompt clinicians to consider the best ways to conduct clinical consultations to accommodate patients' abilities. Compromised communication experiences can be moderated by accommodations and support from HCPs and appropriate adjustments in the health system. Asking patients about their communication preferences and needs, allowing extra time and conducting multidisciplinary sessions are examples of such support. WHAT THIS PAPER ADDS What is already known on this subject? Communication and cognitive impairments are known contributors to negative health outcomes and barriers to shared decision-making generally. The existing literature in decision-making in MND does not address the specific impact of these impairments on personal healthcare involvement for plwMND and their carers. What this paper adds to existing knowledge? This paper reports the findings of a research project that interviewed 19 plwMND and 15 carers on one to three occasions over a 26-month period to obtain their perspectives of the impact of communication on healthcare involvement. Whilst a priori the intention was to look at both communicative and cognitive decline, only the former was achieved. The effort and often 'invisible' activity undertaken to manage or maintain involvement in healthcare is identified. Communication impairment requires support and accommodation, otherwise healthcare involvement can be compromised. Results show participants may associate effective communication with good healthcare. What are the potential or actual clinical implications of the work? Clinicians may wish to use these insights from plwMND and their carers to guide adjustments to their professional practice to maximize healthcare involvement for their patients. Tailored education for different healthcare groups is needed to improve understanding of MND-related communication impairments and supportive strategies so that involvement in healthcare is not compromised.
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Affiliation(s)
- Camille Paynter
- Department of Audiology and Speech PathologyUniversity of MelbourneMelbourneVICAustralia
| | - Susan Mathers
- Calvary Health Care BethlehemMelbourneVICAustralia
- School of Clinical SciencesMonash UniversityMelbourneVICAustralia
| | - Heidi Gregory
- Calvary Health Care BethlehemMelbourneVICAustralia
- Eastern Health Clinical SchoolMonash UniversityMelbourneVICAustralia
| | - Adam P. Vogel
- Department of Audiology and Speech PathologyUniversity of MelbourneMelbourneVICAustralia
- RedenlabMelbourneVICAustralia
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Gillespie J, Przybylak-Brouillard A, Watt CL. The Palliative Care Information Needs of Patients with Amyotrophic Lateral Sclerosis and their Informal Caregivers: A Scoping Review. J Pain Symptom Manage 2021; 62:848-862. [PMID: 33757892 DOI: 10.1016/j.jpainsymman.2021.03.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/10/2021] [Accepted: 03/11/2021] [Indexed: 12/12/2022]
Abstract
CONTEXT Amyotrophic Lateral Sclerosis (ALS) is a fatal neurodegenerative disease, associated with impaired quality of life for patients and caregivers. As treatment is largely supportive, early involvement of palliative care (PC) is recommended as standard of care. Despite this, literature surrounding PC information needs is limited. OBJECTIVES To explore the PC information needs of patients with ALS and their caregivers and identify gaps in the literature. METHODS A scoping review using MEDLINE, EMBASE, CINAHL and PsycINFO databases (2000-2019) was conducted. Articles examining PC information needs as stated by ALS patients and/or current/bereaved caregivers were included. Studies examining other diagnoses and those focused on healthcare workers were excluded. Thematic synthesis was used to summarize and identify prevalent domains and themes in the literature. RESULTS 581 articles underwent primary screening, with thirty-two ultimately included (26 original articles, six reviews). Fourteen examined information needs of both patients and caregivers, 13 caregivers only, 5 patients only. The most common PC information needs were as follows: for patients, disease course/prognosis (n = 10), general disease information (n = 9), decision-making (n = 7) and symptoms (n = 6); for caregivers, services and resources (n = 15), disease course/prognosis (n = 14), general disease information (n = 13) and skills (n = 10). There was substantial variability in information needs, both between patients and caregivers and among members of the same group. CONCLUSION ALS patients and caregivers have unique and varying PC information needs. Future research should better characterize these needs to improve patient and caregiver quality of life. The delivery of information must be tailored to individual patient or caregiver preferences.
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Affiliation(s)
- Jacqueline Gillespie
- Division of Palliative Care, Trillium Health Partners, Mississauga, Ontario, Canada
| | | | - Christine L Watt
- Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Bruyere Research Institute, Ottawa, Ontario, Canada.
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Cleary S, Misiaszek JE, Wheeler S, Kalra S, Genuis SK, Johnston WS. Lung volume recruitment improves volitional airway clearance in amyotrophic lateral sclerosis. Muscle Nerve 2021; 64:676-682. [PMID: 34505708 PMCID: PMC9293446 DOI: 10.1002/mus.27417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 09/01/2021] [Accepted: 09/03/2021] [Indexed: 11/11/2022]
Abstract
Introduction/Aims In this study we evaluated the effects of lung volume recruitment treatment (LVR), a low‐tech, low‐cost, manual “breath‐stacking” technique used to help people cough with enough force to clear their airways, thereby reducing the risk of aspiration and choking, on five volitional airway clearance and protection behaviors used by people living with amyotrophic lateral sclerosis (PwALS). Methods Using a repeated‐measures cross‐over design, 29 PwALS performed five volitional airway clearance and protection behaviors in LVR treatment and in no‐treatment, control conditions. Peak cough flow (PCF) was used to measure maximum expiratory rate during forced expiration, throat clearing, hawking, post‐swallow coughing, and the supraglottic swallowing maneuver. Comparisons were made as a function of condition (treatment or control) and three time‐points (pretreatment, and 15 and 30 minutes posttreatment). Results LVR treatment had a significant positive effect on maximum expiratory rates during all tested airway clearance and protection behaviors. Increased PCF values lasted for up to 30 minutes post‐LVR for all tested behaviors in the treatment condition. Discussion We found that LVR treatment could increase control over airway clearance in PwALS, as well as provide improved airway protection for up to 30 minutes, the duration of a typical meal. This study has implications for patient care. These include offering patients control over some of the most feared symptoms of ALS, particularly choking during activities of daily living, and enhanced ALS respiratory care in low‐resource settings. Findings may have implications for other neurodegenerative disorders in which dysphagia occurs with retained sensory function.
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Affiliation(s)
- Stuart Cleary
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - John E Misiaszek
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Sonya Wheeler
- Misericordia Hospital, Covenant Health Group, Edmonton, Alberta, Canada
| | - Sanjay Kalra
- Division of Neurology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Shelagh K Genuis
- Division of Neurology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Wendy S Johnston
- Division of Neurology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
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Erdmann A, Spoden C, Hirschberg I, Neitzke G. The wish to die and hastening death in amyotrophic lateral sclerosis: A scoping review. BMJ Support Palliat Care 2021; 11:271-287. [PMID: 33397660 PMCID: PMC8380909 DOI: 10.1136/bmjspcare-2020-002640] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 11/05/2020] [Accepted: 11/18/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Amyotrophic lateral sclerosis (ALS) develops into a life-threatening condition 2 to 4 years after the onset of symptoms. Although many people with the disease decide in favour of life-sustaining measures, thoughts about hastening death are not uncommon. OBJECTIVES Our aim was to examine the scope of literature on the wish to die in ALS and provide an insight into determinants and motives for different end-of-life options. METHODS We searched eight databases for English and German publications on death wishes in ALS for the period from 2008 to 2018 and updated the search up to May 2020. After the screening process, 213 full texts were included for the final analysis. We analysed the texts in MAXQDA, using deductively and inductively generated codes. RESULTS We identified end-of-life considerations, ranging from wishes to die without hastening death, to options with the possibility or intention of hastening death. Besides physical impairment, especially psychosocial factors, socio-demographic status and socio-cultural context have a great impact on decisions for life-shortening options. There is huge variation in the motives and determinants for end-of-life considerations between individuals, different societies, healthcare and legal systems. CONCLUSIONS For a variety of reasons, the information and counselling provided on different options for sustaining life or hastening death is often incomplete and insufficient. Since the motives and determinants for the wish to hasten death are extremely diverse, healthcare professionals should investigate the reasons, meaning and strength of the desire to die to detect unmet needs and examine which interventions are appropriate in each individual case.
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Affiliation(s)
- Anke Erdmann
- Institute for History, Ethics and Philosophy of Medicine, Hannover Medical School, Hannover, Germany
- Institute for Experimental Medicine, Medical Ethics Working Group, Kiel University, Kiel, Germany
| | - Celia Spoden
- Institute for History, Ethics and Philosophy of Medicine, Hannover Medical School, Hannover, Germany
| | - Irene Hirschberg
- Institute for History, Ethics and Philosophy of Medicine, Hannover Medical School, Hannover, Germany
| | - Gerald Neitzke
- Institute for History, Ethics and Philosophy of Medicine, Hannover Medical School, Hannover, Germany
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Genuis SK, Luth W, Campbell S, Bubela T, Johnston WS. Communication About End of Life for Patients Living With Amyotrophic Lateral Sclerosis: A Scoping Review of the Empirical Evidence. Front Neurol 2021; 12:683197. [PMID: 34421792 PMCID: PMC8371472 DOI: 10.3389/fneur.2021.683197] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 07/09/2021] [Indexed: 12/03/2022] Open
Abstract
Background: Communication about end of life, including advance care planning, life-sustaining therapies, palliative care, and end-of-life options, is critical for the clinical management of amyotrophic lateral sclerosis patients. The empirical evidence base for this communication has not been systematically examined. Objective: To support evidence-based communication guidance by (1) analyzing the scope and nature of research on health communication about end of life for amyotrophic lateral sclerosis; and (2) summarizing resultant recommendations. Methods: A scoping review of empirical literature was conducted following recommended practices. Fifteen health-related and three legal databases were searched; 296 articles were screened for inclusion/exclusion criteria; and quantitative data extraction and analysis was conducted on 211 articles with qualitative analysis on a subset of 110 articles that focused primarily on health communication. Analyses summarized article characteristics, themes, and recommendations. Results: Analysis indicated a multidisciplinary but limited evidence base. Most reviewed articles addressed end-of-life communication as a peripheral focus of investigation. Generic communication skills are important; however, substantive and sufficient disease-related information, including symptom management and assistive devices, is critical to discussions about end of life. Few articles discussed communication about specific end-of-life options. Communication recommendations in analyzed articles draw attention to communication processes, style and content but lack the systematized guidance needed for clinical practice. Conclusions: This review of primary research articles highlights the limited evidence-base and consequent need for systematic, empirical investigation to inform effective communication about end of life for those with amyotrophic lateral sclerosis. This will provide a foundation for actionable, evidence-based communication guidelines about end of life. Implications for research, policy, and practice are discussed.
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Affiliation(s)
- Shelagh K. Genuis
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Westerly Luth
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Sandra Campbell
- John W. Scott Health Sciences Library, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Tania Bubela
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Wendy S. Johnston
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
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Fernández-Rodríguez Á, Medina-Juliá MT, Velasco-Álvarez F, Ron-Angevin R. Different effects of using pictures as stimuli in a P300 brain-computer interface under rapid serial visual presentation or row-column paradigm. Med Biol Eng Comput 2021; 59:869-881. [PMID: 33742353 DOI: 10.1007/s11517-021-02340-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 02/23/2021] [Indexed: 02/08/2023]
Abstract
Previous proposals for controlling a P300-based BCI speller have shown an improvement using alternative images instead of letters as target stimuli under a row-column paradigm (RCP). However, the RCP is not suitable for those patients with a lack of gaze control. To solve that, the rapid serial visual presentation (RSVP) paradigm has been proposed in previous studies. The aim of the present work is to assess if a set of alternative pictures that improved performance in RCP could also improve performance in RSVP. Sixteen participants controlled four conditions in calibration and online tasks: letters in RCP, pictures in RCP, letters in RSVP and pictures in RSVP. The effect given by pictures was greater under RCP than under RSVP, both for performance and event-related potential analyses. Indeed, pictures did not show any improvement under RSVP in comparison to letters. In addition, the condition with pictures under RCP was declared the favourite by most users (68.75%), while the condition with pictures under RSVP was not chosen as favourite by any participant. Therefore, this work shows that the improvement related to the use of pictures as alternative flashing stimuli under RCP may not be transferred to RSVP. Graphical abstract.
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Affiliation(s)
- Álvaro Fernández-Rodríguez
- Departamento de Tecnología Electrónica, Universidad de Málaga, 35 Louis Pasteur Boulevard, 29071, Malaga, Spain.
| | - María Teresa Medina-Juliá
- Departamento de Tecnología Electrónica, Universidad de Málaga, 35 Louis Pasteur Boulevard, 29071, Malaga, Spain
| | - Francisco Velasco-Álvarez
- Departamento de Tecnología Electrónica, Universidad de Málaga, 35 Louis Pasteur Boulevard, 29071, Malaga, Spain
| | - Ricardo Ron-Angevin
- Departamento de Tecnología Electrónica, Universidad de Málaga, 35 Louis Pasteur Boulevard, 29071, Malaga, Spain
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12
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Paynter C, Mathers S, Gregory H, Vogel AP, Cruice M. How people living with motor neurone disease and their carers experience healthcare decision making: a qualitative exploration. Disabil Rehabil 2020; 44:3095-3103. [PMID: 33295820 DOI: 10.1080/09638288.2020.1855261] [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: 12/28/2022]
Abstract
PURPOSE Healthcare decision making in motor neurone disease (MND) focuses on symptom management and quality of life. Decision making may be affected by personal approach to receiving information, decision making style, and disease symptoms. This study explored decision making from the perspectives of people living with motor neurone disease (plwMND). The issues impacting engagement and involvement in healthcare decisions were investigated. METHODS Semi-structured interviews were conducted with 19 plwMND and 15 carers. Interview data was inductively analysed to identify and describe patterns and themes. RESULTS Data analysis identified six overarching themes: Dimensions of decision making; Window of opportunity for choice; Intrinsic influences on decision making; Extrinsic influences impacting decision making; Planning in uncertainty; and, Communication is core. Many participants did not identify a process of "decision-making" except if considering early gastrostomy placement. Information provision requires a balance between ensuring patients are informed but not overwhelmed. Communication impairment impacts involvement. Healthcare professionals' communication style influences engagement in decision making. CONCLUSION PlwMND perceive a lack of clinical decisions to make because disease symptoms and clinical phenotypes dictate necessary interventions. PlwMND describe communication impairment as a barrier to involvement in decision making and extra support is required to ensure they maintain engagement.IMPLICATIONS FOR REHABILITATIONPeople living with MND (plwMND) perceive they have few clinical decisions to make and viewed this process as "accepting a recommendation", rather than "making a decision" although early gastrostomy placement is the exception with considerable deliberation evident.Specialist multidisciplinary clinic advice is especially helpful for plwMND without dysphagia (swallowing problems) when considering early gastrostomy placement.Communication impairment may be a barrier to involvement in healthcare decisions and extra support to remain engaged is required.Some plwMND choose not to involve others in their decisions, and patients/families with medical or scientific backgrounds are more likely to collaborate with each other outside the context of clinic appointments.
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Affiliation(s)
- C Paynter
- Centre for Neuroscience of Speech, University of Melbourne, Parkville, Australia.,Department of Audiology and Speech Pathology, The University of Melbourne, Melbourne, Australia
| | - S Mathers
- Calvary Health Care Bethlehem, Melbourne, Australia.,School of Clinical Sciences, Monash University, Melbourne, Australia
| | - H Gregory
- Calvary Health Care Bethlehem, Melbourne, Australia
| | - A P Vogel
- Centre for Neuroscience of Speech, University of Melbourne, Parkville, Australia.,Department of Audiology and Speech Pathology, The University of Melbourne, Melbourne, Australia.,Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, Germany.,Redenlab, Australia
| | - M Cruice
- Division of Language and Communication Science, City, University of London, London, UK
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13
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Kageyama Y, He X, Shimokawa T, Sawada J, Yanagisawa T, Shayne M, Sakura O, Kishima H, Mochizuki H, Yoshimine T, Hirata M. Nationwide survey of 780 Japanese patients with amyotrophic lateral sclerosis: their status and expectations from brain-machine interfaces. J Neurol 2020; 267:2932-2940. [PMID: 32488296 DOI: 10.1007/s00415-020-09903-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 05/05/2020] [Accepted: 05/07/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease that causes eventual death through respiratory failure unless mechanical ventilation is provided. Brain-machine interfaces (BMIs) may provide brain control supports for communication and motor function. We investigated the interests and expectations of patients with ALS concerning BMIs based on a large-scale anonymous questionnaire survey supported by the Japan Amyotrophic Lateral Sclerosis Association. METHODS We surveyed 1918 patients with ALS regarding their present status, tracheostomy use, interest in BMIs, and their level of expectation for communication (conversation, emergency alarm, internet, and writing letters) and movement support (postural change, controlling the bed, controlling household appliances, robotic arms, and wheel chairs). FINDINGS Seven hundred and eighty participants responded. Fifty-eight percent of the participants underwent tracheostomy. Approximately, 80% of the patients experienced stress or trouble during communication. For all nine supports, > 60% participants expressed expectations regarding BMIs. More than 98% of participants who underwent tracheostomy expected support with conversation and emergency alarms. Participants who did not undergo tracheostomy exhibited significantly greater expectations than participants with tracheostomy did regarding all five movement supports. Seventy-seven percent of participants were interested in BMIs. Participants aged < 60 years had greater interest in both BMIs. INTERPRETATION This is the first large-scale survey to reveal the present status of patients with ALS and probe their interests and expectations regarding BMIs. Communication and emergency alarms should be supported by BMIs initially. BMIs should provide wide-ranging and high-performance support that can easily be used by severely disabled elderly patients with ALS.
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Affiliation(s)
- Yu Kageyama
- Department of Neurological Diagnosis and Restoration, Osaka University Graduate School of Medicine, CoMIT, 2-2 Yamadaoka, Suita, Osaka, 913A565-0871, Japan.,Department of Neurosurgery, Osaka University Medical School, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Xin He
- Department of Neurological Diagnosis and Restoration, Osaka University Graduate School of Medicine, CoMIT, 2-2 Yamadaoka, Suita, Osaka, 913A565-0871, Japan.,Department of Neurosurgery, Osaka University Medical School, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Toshio Shimokawa
- Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Japan
| | - Jinichi Sawada
- Osaka Intractable Diseases Medical Information Center, 3-1-56 Mandaihigashi, Sumiyoshi, Osaka, 558-8558, Japan
| | - Takufumi Yanagisawa
- Department of Neurosurgery, Osaka University Medical School, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.,Institute for Advanced Co-Creation Studies, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Morris Shayne
- Department of Neurosurgery, Osaka University Medical School, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Osamu Sakura
- Interfaculty Initiative in Information Studies, University of Tokyo, 7-3-1 Hongou, Bunkyou,, Tokyo, 113-0033, Japan
| | - Haruhiko Kishima
- Department of Neurosurgery, Osaka University Medical School, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Hideki Mochizuki
- Department of Neurology, Osaka University Medical School, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Toshiki Yoshimine
- Endowed Research Department of Clinical Neuroengineering, Global Center for Medical Engineering and Informatics, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Masayuki Hirata
- Department of Neurological Diagnosis and Restoration, Osaka University Graduate School of Medicine, CoMIT, 2-2 Yamadaoka, Suita, Osaka, 913A565-0871, Japan. .,Endowed Research Department of Clinical Neuroengineering, Global Center for Medical Engineering and Informatics, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan. .,Department of Neurosurgery, Osaka University Medical School, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
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14
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Flemming K, Turner V, Bolsher S, Hulme B, McHugh E, Watt I. The experiences of, and need for, palliative care for people with motor neurone disease and their informal caregivers: A qualitative systematic review. Palliat Med 2020; 34:708-730. [PMID: 32286157 PMCID: PMC7444021 DOI: 10.1177/0269216320908775] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Despite being a terminal neurodegenerative disease, the role of palliative care is less recognised for motor neurone disease than for other life-limiting conditions. Understanding the experiences of, and need for, palliative care for patients and carers is key to configuring optimal policy and healthcare services. AIM To explore the experiences of, and need for, palliative care of people with motor neurone disease and their informal carers across the disease trajectory. DESIGN A systematic review of qualitative research conducted using Thematic Synthesis - PROSPERO registration CRD42017075311. DATA SOURCES Four electronic databases were searched (MEDLINE, CINAHL, PsycINFO, Social Science Citation Index) using terms for motor neurone disease, amyotrophic lateral sclerosis, palliative care, and qualitative research, from inception to November 2018. Included papers were data extracted and assessed for quality. RESULTS A total of 41 papers were included, representing the experiences of 358 people with motor neurone disease and 369 caregivers. Analytical themes were developed detailing patients' and carers' experiences of living with motor neurone disease and of palliative care through its trajectory including response to diagnosis, maintaining control, decision-making during deterioration, engaging with professionals, planning for end-of-life care, bereavement. CONCLUSION The review identified a considerable literature exploring the care needs of people with motor neurone disease and their carers; however, descriptions of palliative care were associated with the last days of life. Across the disease trajectory, clear points were identified where palliative care input could enhance patient and carer experience of the disease, particularly at times of significant physical change.
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Affiliation(s)
- Kate Flemming
- Department of Health Sciences, Faculty of Science, University of York, York, UK
| | - Victoria Turner
- Department of Health Sciences, Faculty of Science, University of York, York, UK
| | | | | | - Elizabeth McHugh
- Department of Health Sciences, Faculty of Science, University of York, York, UK
| | - Ian Watt
- Department of Health Sciences, Faculty of Science, University of York, York, UK
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15
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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.
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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.
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16
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Gottberg K, Ytterberg C, Sandstedt P, Johansson S, Kierkegaard M. Experiences of next of kin to patients with amyotrophic lateral sclerosis using invasive ventilation via tracheostomy. Disabil Rehabil 2019; 43:2403-2410. [PMID: 31847618 DOI: 10.1080/09638288.2019.1700561] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To investigate the experience of being the next of kin to patients with amyotrophic lateral sclerosis who use invasive ventilation via tracheostomy. METHODS Semi-structured interviews with eight next of kin were conducted and analysed using qualitative content analysis. RESULTS Three main themes comprising a total of nine subthemes emerged from the analysis: A turbulent care process aiming to extend life, Struggling to cope with the strains of everyday life, and Conflicting roles as next of kin and carer. CONCLUSION The results highlight the importance of involving next of kin throughout the whole care process and considering their specific needs. Furthermore, the development of specific support interventions to facilitate the everyday life for next of kin and to ease their burden are much needed.IMPLICATIONS FOR REHABILITATIONIt is important to involve next of kin and consider their needs throughout the whole care process regarding invasive ventilation via tracheostomy.Specific support interventions need to be developed to facilitate the everyday life for next of kin and to ease their burden.
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Affiliation(s)
- Kristina Gottberg
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Charlotte Ytterberg
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.,Function Area Occupational Therapy and Physiotherapy, Karolinska University Hospital, Huddinge, Sweden
| | - Petter Sandstedt
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.,Function Area Ageing Health and Functioning, Karolinska University Hospital, Huddinge, Sweden
| | - Sverker Johansson
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.,Function Area Occupational Therapy and Physiotherapy, Karolinska University Hospital, Huddinge, Sweden
| | - Marie Kierkegaard
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.,Function Area Occupational Therapy and Physiotherapy, Karolinska University Hospital, Huddinge, Sweden.,Academic Specialist Center, Stockholm Health Services, Stockholm, Sweden
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17
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Paynter C, Cruice M, Mathers S, Gregory H, Vogel AP. Communication and cognitive impairments and health care decision making in MND: A narrative review. J Eval Clin Pract 2019; 25:1182-1192. [PMID: 31282612 DOI: 10.1111/jep.13219] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 04/22/2019] [Accepted: 06/04/2019] [Indexed: 12/12/2022]
Abstract
RATIONALE Motor neurone disease (MND) is a neurodegenerative disease presenting with progressive weakness of voluntary muscles. For any condition, person-centred health care relies on the sharing of information and a mutual understanding of the person's needs and preferences. Decision making in MND becomes more complex as there is no cure and a high prevalence of co-morbid communication and/or cognitive difficulties. OBJECTIVE To identify the reported impact of communication and/or cognitive impairment on patient and carer involvement in health care decision making in MND. METHODS A review and synthesis of studies addressing issues of communication impairment and/or cognitive impairment in relation to decision making focussed on MND was conducted. Articles were excluded if they were reviews, case studies, conference papers, or commentaries. To be included studies needed to address issues of communication impairment or cognitive impairment specifically in relation to decision making. Relevant data were extracted verbatim and subjected to content analysis to support the narrative summary. RESULTS Seventy-six articles were identified, and 35 articles screened. Six articles met inclusion criteria each describing examples of decision making in MND. There was limited data related to communication and/or cognitive impairment, and the impact these impairments may have on decision making despite recognition that many people with MND may lose verbal communication or develop subtle cognitive impairments. The literature is primarily from the perspective of others. CONCLUSION This review highlights that the current body of literature exploring decision making within the MND population presents us with extremely limited insights into the impact of communication and/or cognitive impairments on health care decision making. Extant literature focuses on interventions (namely, ventilation and gastrostomy), the broad process of decision making, or cognitive assessment of decision-making ability. Whilst most studies acknowledge that deficits in communication or cognition impact the decision-making process, this issue is not the focus of any study.
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Affiliation(s)
- Camille Paynter
- Centre for Neuroscience of Speech, University of Melbourne, Carlton, Victoria, Australia
| | - Madeline Cruice
- Division of Language and Communication Sciences, City, University of London, London, UK
| | - Susan Mathers
- Statewide Progressive Neurological Disease Service, Calvary Health Care Bethlehem, Melbourne, Victoria, Australia.,School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| | - Heidi Gregory
- Statewide Progressive Neurological Disease Service, Calvary Health Care Bethlehem, Melbourne, Victoria, Australia.,Department of Palliative Care, University of Notre Dame, Melbourne, Victoria, Australia
| | - Adam P Vogel
- Centre for Neuroscience of Speech, University of Melbourne, Carlton, Victoria, Australia.,Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, Tubingen, Germany.,Science Department, Redenlab, Melbourne, Victoria, Australia
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18
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Phillips G, Lifford K, Edwards A, Poolman M, Joseph-Williams N. Do published patient decision aids for end-of-life care address patients' decision-making needs? A systematic review and critical appraisal. Palliat Med 2019; 33:985-1002. [PMID: 31199197 DOI: 10.1177/0269216319854186] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Many decisions are made by patients in their last months of life, creating complex decision-making needs for these individuals. Identifying whether currently existing patient decision aids address the full range of these patient decision-making needs will better inform end-of-life decision support in clinical practice. AIMS AND DESIGN This systematic review aimed to (a) identify the range of patients' decision-making needs and (b) assess the extent to which patient decision aids address these needs. DATA SOURCES MEDLINE, PsycINFO and CINAHL electronic literature databases were searched (January 1990-January 2017), supplemented by hand-searching strategies. Eligible literature reported patient decision-making needs throughout end-of-life decision-making or were evaluations of patient decision aids. Identified decision aid content was mapped onto and assessed against all patient decision-making needs that were deemed 'addressable'. RESULTS Twenty-two studies described patient needs, and seven end-of-life patient decision aids were identified. Patient needs were categorised, resulting in 48 'addressable' needs. Mapping needs to patient decision aid content showed that 17 patient needs were insufficiently addressed by current patient decision aids. The most substantial gaps included inconsistent acknowledgement, elicitation and documentation of how patient needs varied individually for the level of information provided, the extent patients wanted to participate in decision-making, and the extent they wanted their families and associated healthcare professionals to participate. CONCLUSION Patient decision-making needs are broad and varied. Currently developed patient decision aids are insufficiently addressing patient decision-making needs. Improving future end-of-life patient decision aid content through five key suggestions could improve patient-focused decision-making support at the end of life.
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Affiliation(s)
- Georgina Phillips
- 1 Division of Population Medicine, School of Medicine, University Hospital of Wales, Cardiff University, Cardiff, UK
| | - Kate Lifford
- 1 Division of Population Medicine, School of Medicine, University Hospital of Wales, Cardiff University, Cardiff, UK
| | - Adrian Edwards
- 1 Division of Population Medicine, School of Medicine, University Hospital of Wales, Cardiff University, Cardiff, UK
| | - Marlise Poolman
- 2 Bangor Institute for Health & Medical Research, Bangor University, Bangor, UK
- 3 Department of Palliative Medicine, Betsi Cadwaladr University Health Board, Bangor, UK
| | - Natalie Joseph-Williams
- 1 Division of Population Medicine, School of Medicine, University Hospital of Wales, Cardiff University, Cardiff, UK
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19
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O'Brien D, Stavroulakis T, Baxter S, Norman P, Bianchi S, Elliott M, Johnson M, Clowes M, Garcia-Sánchez A, Hobson E, McDermott C. The optimisation of noninvasive ventilation in amyotrophic lateral sclerosis: a systematic review. Eur Respir J 2019; 54:13993003.00261-2019. [DOI: 10.1183/13993003.00261-2019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 06/25/2019] [Indexed: 12/11/2022]
Abstract
BackgroundNoninvasive ventilation (NIV) prolongs survival and quality of life in amyotrophic lateral sclerosis (ALS); however, its benefits depend upon the optimisation of both ventilation and adherence. We aimed to identify factors associated with effective initiation and ongoing use of NIV in ALS to develop evidence-based guidance and identify areas for further research.MethodsWe searched 11 electronic databases (January 1998 to May 2018) for all types of quantitative and qualitative studies. Supplementary grey literature searches were conducted. Records were screened against eligibility criteria, data were extracted from included studies and risk of bias was assessed. We present findings using a narrative synthesis.ResultsWe screened 2430 unique records and included 52 quantitative and six qualitative papers. Factors reported to be associated with NIV optimisation included coordinated multidisciplinary care, place of initiation, selection of interfaces, ventilator modes and settings appropriate for the individual patient, and adequate secretion management. The literature indicated that patients with significant bulbar dysfunction can still derive considerable benefit from NIV if their needs are met. Research emphasises that obstructive airway events, mask leak and uncontrolled secretions should be addressed by adjustments to the interface and machine settings, and the concomitant use of cough augmentation.ConclusionThis review highlights that NIV optimisation requires an individualised approach to respiratory management tailored to the differing needs of each patient. Ultimately, this should lead to improved survival and quality of life. This review expands on recommendations in current international guidelines for NIV use in ALS and identifies areas for future research.
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20
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Baxter SK, Johnson M, Clowes M, O’Brien D, Norman P, Stavroulakis T, Bianchi S, Elliott M, McDermott C, Hobson E. Optimizing the noninvasive ventilation pathway for patients with amyotrophic lateral sclerosis/motor neuron disease: a systematic review. Amyotroph Lateral Scler Frontotemporal Degener 2019; 20:461-472. [DOI: 10.1080/21678421.2019.1627372] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
| | | | | | | | | | | | - Stephen Bianchi
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK, and
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21
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Abstract
Amyotrophic lateral sclerosis (ALS) is a fatal motor neuron disease that occurs in 4 among 100 000 people in the United States. Individuals with ALS gradually lose their ability to control voluntary muscles, diminishing their ability to communicate. A comprehensive multidatabase search retrieved 31 qualitative research articles that addressed persons with end-of-life experiences with ALS. Inclusion/exclusion criteria were applied and a critical appraisal was applied for the final 8 included articles. First-person data extraction from the final articles represented emergence of 3 themes significant to persons with ALS: decisions for life-sustaining support, coping and fear of what is to come, and communication with providers. Tracheostomy and ventilation as a means of prolonging life were important considerations for individuals with ALS. Persons with ALS struggled emotionally with their sudden loss of control and facing their demise. Some facets in which they did exert control, such as living wills, were hindered by patient and health care provider communication. Effective communication in end-of-life circumstances is paramount to preserving patient autonomy and dignity. This can be achieved by the patients conveying their preferences with respect to end-of-life care in advance, as well the nurses and other health care providers supporting the patients emotionally as they cope with terminal illness. Understanding patients' views regarding end-of-life circumstances is pertinent to nurses and other health care providers as they plan for palliative care.
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22
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MacLaren J, Smith P, Rodgers S, Bateman AP, Ramsay P. A qualitative study of experiences of health and social care in home mechanical ventilation. Nurs Open 2019; 6:283-292. [PMID: 30918680 PMCID: PMC6419121 DOI: 10.1002/nop2.213] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 07/09/2018] [Accepted: 09/03/2018] [Indexed: 11/25/2022] Open
Abstract
AIM To contribute insight into health and social care integration through an exploration of the care experiences of adults with degenerative neuromuscular conditions who use a mechanical ventilator at home. DESIGN Descriptive qualitative research. METHODS Seventeen semi-structured interviews were conducted with patients and family carers living in Scotland during 2015-2016 and thematically analysed. RESULTS To achieve a satisfying life, home ventilated participants required help from a variety of health and social care services, as well as care from family. Examples of successful care were identified, but there were also serious failures and conflict with services. Identifying how care fails or succeeds for this patient population and their families requires an understanding of the interdependency of health and social care. This was achieved by examining health and social care provision from the experiential perspective of care-users to provide insights into how disconnected provision has an impact on users' lives in numerous, idiosyncratic ways.
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Affiliation(s)
- Jessica MacLaren
- University of EdinburghOld Medical SchoolTeviot PlaceEdinburghUK
- Present address:
School of Health and Social CareEdinburgh Napier UniversityEdinburghUK
| | - Pam Smith
- University of EdinburghOld Medical SchoolTeviot PlaceEdinburghUK
| | - Sheila Rodgers
- University of EdinburghOld Medical SchoolTeviot PlaceEdinburghUK
| | | | - Pam Ramsay
- University of EdinburghOld Medical SchoolTeviot PlaceEdinburghUK
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23
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Thurn T, Borasio GD, Chiò A, Galvin M, McDermott CJ, Mora G, Sermeus W, Winkler AS, Anneser J. Physicians' attitudes toward end-of-life decisions in amyotrophic lateral sclerosis. Amyotroph Lateral Scler Frontotemporal Degener 2019; 20:74-81. [PMID: 30789031 DOI: 10.1080/21678421.2018.1536154] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE This study aims (1) to assess physicians' attitudes toward different palliative end-of-life (EOL) practices in amyotrophic lateral sclerosis (ALS) care, including forgoing artificial nutrition and hydration (FANH), continuous sedation until death (CSD), and withdrawing invasive ventilation (WIV), and toward physician-assisted dying (PAD) including physician-assisted suicide and euthanasia and (2) to explore variables influencing these attitudes. METHODS We used two clinical vignettes depicting ALS patients in different stages of their disease progression to assess the influence of suffering (physical/psycho-existential) on attitudes toward WIV and the influence of suffering and prognosis (short-term/long-term) on attitudes toward FANH, CSD, and PAD. RESULTS 50 physicians from European ALS centers and neurological departments completed our survey. Short-term prognosis had a positive impact on attitudes toward offering FANH (p = 0.014) and CSD (p = 0.048) as well as on attitudes toward performing CSD (p = 0.036) and euthanasia (p = 0.023). Predominantly psycho-existential suffering was associated with a more favorable attitude toward WIV but influenced attitudes toward performing CSD negatively. Regression analysis showed that religiosity was associated with more reluctant attitudes toward palliative EOL practices and PAD, whereas training in palliative care was associated with more favorable attitudes toward palliative EOL practices only. CONCLUSION ALS physicians seem to acknowledge psycho-existential suffering as a highly acceptable motive for WIV but not CSD. Physicians appear to be comfortable with responding to the patient's requests, but more reluctant to assume a proactive role in the decision-making process. Palliative care training may support ALS physicians in these challenging situations.
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Affiliation(s)
- Tamara Thurn
- a Palliative Care Team, Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar , Technical University Munich , Munich , Germany
| | - Gian Domenico Borasio
- b Palliative and Supportive Care Service, Centre Hospitalier Universitaire Vaudois (CHUV) , University of Lausanne , Lausanne , Switzerland
| | - Adriano Chiò
- c Department of Neuroscience "Rita Levi Montalcini" , University of Turin , Turin , Italy
| | - Miriam Galvin
- d Academic Unit of Neurology, Trinity Biomedical Sciences Institute , Trinity College Dublin , Dublin , Ireland
| | - Christopher J McDermott
- e Sheffield Institute for Translational Neuroscience , University of Sheffield , Sheffield , United Kingdom
| | | | - Walter Sermeus
- g Leuven Institute for Healthcare Policy , KU Leuven , Leuven , Belgium
| | - Andrea S Winkler
- h Department of Neurology, Klinikum rechts der Isar , Technical University Munich , Munich , Germany.,i Centre for Global Health, Institute of Health and Society , University of Oslo , Oslo , Norway
| | - Johanna Anneser
- a Palliative Care Team, Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar , Technical University Munich , Munich , Germany
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Regan L, Preston NJ, Eccles FJR, Simpson J. The views of adults with neurodegenerative diseases on end-of-life care: a metasynthesis. Aging Ment Health 2019; 23:149-157. [PMID: 29105497 DOI: 10.1080/13607863.2017.1396578] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Improving end-of-life care for people with neurodegenerative diseases is seen as a clinical priority. In order to do this, it is important to take into account the views expressed by people with these conditions on their experiences of this care. The purpose of this review was to provide a thematic synthesis of the views of adults with neurodegenerative diseases on end-of-life care. METHODS After a systematic search, 13 articles were included and thematic synthesis was used to collate and interpret findings. RESULTS Four analytical themes were identified; (1) Importance of autonomy and control; (2) Informed decision-making and the role of healthcare professionals; (3) Contextual factors in decision-making; (4) The pitfalls of care. CONCLUSION Participants' views were framed by the context of their lives and experience of their illness and these shaped their engagement with end-of-life care. Given the varying disease trajectories, care needs to be individualised and needs-based, implementing palliative care in a timely way to prevent crises and loss of autonomy.
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Affiliation(s)
- Laurence Regan
- a Division of Health Research , Lancaster University , Lancaster , UK
| | - Nancy J Preston
- a Division of Health Research , Lancaster University , Lancaster , UK
| | - Fiona J R Eccles
- a Division of Health Research , Lancaster University , Lancaster , UK
| | - Jane Simpson
- a Division of Health Research , Lancaster University , Lancaster , UK
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25
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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.
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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
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26
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Foley G, Hynes G. Decision-making among patients and their family in ALS care: a review. Amyotroph Lateral Scler Frontotemporal Degener 2017; 19:173-193. [DOI: 10.1080/21678421.2017.1353099] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Geraldine Foley
- Discipline of Occupational Therapy, School of Medicine, Trinity College Dublin, Ireland, and
| | - Geralyn Hynes
- School of Nursing and Midwifery, Trinity College Dublin, Ireland
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27
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Ngandu H, Gale N, Hopkinson JB. Experiences of noninvasive ventilation in adults with hypercapnic respiratory failure: a review of evidence. Eur Respir Rev 2017; 25:451-471. [PMID: 27903667 DOI: 10.1183/16000617.0002-2016] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 03/21/2016] [Indexed: 11/05/2022] Open
Abstract
Noninvasive ventilation (NIV) has been shown to be beneficial for patients with respiratory failure; however, many patients fail to tolerate it and require other interventions. The objective of this thematic synthesis was to describe the nature of NIV experiences in adults with hypercapnic respiratory failure. A systematic, computerised literature search of English-language databases was undertaken with no restriction on date of publication. A total of 99 papers was identified and screened for eligibility from databases including CINAHL, Medline and PsycINFO, and some were hand searched. 45 papers were critically appraised and 32 met our inclusion criteria. Thematic analysis identified six key themes: benefits of NIV; fear (of various categories, namely, fear of technology/mask, fear of death and dying, and fear of pain and suffering); adaptation to NIV machine; decision making; need for information; and relationship with healthcare professionals. For people using NIV treatment, the experience of being on the NIV machine is unexpected and can be stressful. Findings from this review offer healthcare professionals insights and understanding into the patient experience of NIV. Healthcare professionals may use these findings to implement new strategies in NIV provision and the exploration of the applicability of age-specific supportive care NIV guidelines.
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Affiliation(s)
| | - Nichola Gale
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
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28
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Schaepe C, Ewers M. 'I need complete trust in nurses' - home mechanical ventilated patients' perceptions of safety. Scand J Caring Sci 2017; 31:948-956. [PMID: 28156012 DOI: 10.1111/scs.12418] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 11/22/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Although home care has advanced over the last few decades, little research on patient safety has been carried out in this setting. Furthermore, it is unclear how patients perceive their situation and safety. The insiders' views might be especially relevant for technology-dependent individuals, such as users of home mechanical ventilation (HMV). AIM The aim of this study was to examine how HMV patients perceive their situation and what makes them feel safe or unsafe. DESIGN Explorative qualitative study. METHODS Data were collected in two regions in Germany between April and December 2014 by means of semi-structured interviews with 21 HMV patients. Thematic analysis was used to analyse data. FINDINGS Three themes emerged: the meaning of an interpersonal relationship between the nurse and HMV patient is expressed in the theme Being familiar - Having trust. The importance of the attentiveness of nurses for the patients' feeling of safety is described in the theme Being able to communicate - Being noticed. The theme Experiencing continuity - Feeling presence points to the organisational dimension of HMV care provision. CONCLUSIONS The interpersonal nurse-patient relationship plays a key role in promoting HMV patients' feeling of safety. Thus, HMV patients have a relational approach to safety. In order to enhance the patients' feeling of safety, nurses should strive to develop a trusting relationship with patients and demonstrate their presence and attentiveness. Regarding the provision of care, competent and continuous care should be made a priority.
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Affiliation(s)
- Christiane Schaepe
- Institute of Health and Nursing Science, Charité - Universitaetsmedizin Berlin, Berlin, Germany
| | - Michael Ewers
- Institute of Health and Nursing Science, Charité - Universitaetsmedizin Berlin, Berlin, Germany
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29
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Aho-Özhan HEA, Böhm S, Keller J, Dorst J, Uttner I, Ludolph AC, Lulé D. Experience matters: neurologists' perspectives on ALS patients' well-being. J Neurol 2017; 264:639-646. [PMID: 28120043 DOI: 10.1007/s00415-016-8382-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 12/22/2016] [Accepted: 12/23/2016] [Indexed: 12/14/2022]
Abstract
Despite the fatal outcome and progressive loss of physical functioning in amyotrophic lateral sclerosis (ALS), many patients maintain contentment in life. It has been shown that non-professionals tend to underestimate the well-being of patients with ALS, but professionals' perspective is yet to be studied. In total, 105 neurologists with varying degrees of experience with ALS were included in an anonymous survey. They were asked to estimate the quality of life and depressiveness of ALS patients with artificial ventilation and nutrition. Physicians' estimations were compared with previously reported subjective ratings of ALS patients with life-prolonging measures. Neurologists with significant experience on ALS and palliative care were able to accurately estimate depressiveness and quality of life of ALS patients with life-prolonging measures. Less experienced neurologists' estimation differed more from patients' reports. Of all life-prolonging measures neurologists regarded invasive ventilation as the measure associated with lowest quality of life and highest depressiveness of the patients. Experienced neurologists as well as neurologists with experience in palliative care are able to better empathize with patients with a fatal illness such as ALS and support important decision processes.
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Affiliation(s)
- Helena E A Aho-Özhan
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Sarah Böhm
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Jürgen Keller
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Johannes Dorst
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Ingo Uttner
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Albert C Ludolph
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany.
| | - Dorothée Lulé
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
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30
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Martin NH, Lawrence V, Murray J, Janssen A, Higginson I, Lyall R, Burman R, Leigh PN, Al-Chalabi A, Goldstein LH. Decision Making About Gastrostomy and Noninvasive Ventilation in Amyotrophic Lateral Sclerosis. QUALITATIVE HEALTH RESEARCH 2016; 26:1366-1381. [PMID: 25918114 DOI: 10.1177/1049732315583661] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
We used thematic analysis to investigate factors affecting decision making about gastrostomy and noninvasive ventilation (NIV) by people with Amyotrophic Lateral Sclerosis (ALS) from the viewpoint of the health care professionals (HCPs) supporting them. We conducted 20 in-depth interviews with 19 HCPs nominated by people with ALS who had made a decision to accept or decline NIV or gastrostomy. We found the main themes influencing decision making were patient-centric, caregiver-related or related to HCPs' own beliefs, perspectives, and actions. HCPs felt patients should be, and were, in control of decision making, although caregivers and HCPs played a role. The patient's evaluation of quality of life, the desirability of prolonging life, and acceptance of the disease and its progression by both patient and caregiver were the most important factors identified by HCPs. HCPs should be aware of the importance of multiprofessional discussions, and the potential influences (identified above) that might require discussion with patients and caregivers.
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Affiliation(s)
| | | | | | | | | | - Rebecca Lyall
- King's College Hospital NHS Foundation Trust, London, United Kingdom
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31
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Bentley B, O'Connor M. The End-of-Life Experiences of People with Motor Neuron Disease: Family Carers' Perspectives. J Palliat Med 2016; 19:857-62. [DOI: 10.1089/jpm.2015.0538] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Brenda Bentley
- School of Health Professions, Murdoch University, Murdoch, Australia
| | - Moira O'Connor
- School of Psychology and Speech Pathology, Curtin University, Perth, Australia
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32
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Seeber AA, Pols AJ, Hijdra A, Grupstra HF, Willems DL, de Visser M. Experiences and reflections of patients with motor neuron disease on breaking the news in a two-tiered appointment: a qualitative study. BMJ Support Palliat Care 2016; 9:e8. [PMID: 26839121 DOI: 10.1136/bmjspcare-2015-000977] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Revised: 12/04/2015] [Accepted: 01/10/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND Breaking bad news should be fine-tuned to the individual patient, contain intelligible information, include emotional support and offer a tailor-made treatment plan. To achieve this goal in motor neuron disease (MND), neurologists of the amyotrophic lateral sclerosis (ALS) centre Amsterdam deliver the message on 2 separate visits within 14 days. AIM To evaluate how patients with MND react to and view disclosure of the diagnosis, in this 2-tiered approach. METHODS Non-participating observations and in-depth interviews with patients were conducted in 1 tertiary ALS referral centre. Qualitative analysis consisted of inductive analysis of observation reports and verbatim typed out interviews. RESULTS 10 2-tiered appointments were observed and 21 Dutch patients with MND interviewed. They experienced the straightforward message to be suffering from a fatal disease as devastating, yet unavoidable. The prospect of a short-term second appointment offered structure for the period immediately following the diagnosis. The time between appointments provided the opportunity for a first reorientation on their changed perspective on their life. The second appointment allowed for detailed discussions about various aspects of MND and a tailor-made treatment plan. CONCLUSIONS The 2-tiered approach fits well with the way in which Dutch patients with MND process the disclosure of their diagnosis, gather information and handle the changed perspective on their life. It may serve as a model for other life-limiting diseases.
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Affiliation(s)
- Antje A Seeber
- Department of Neurology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.,Section of Medical Ethics, Department of General Practice, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - A Jeannette Pols
- Section of Medical Ethics, Department of General Practice, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Albert Hijdra
- Department of Neurology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Hepke F Grupstra
- Department of Rehabilitation, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Dick L Willems
- Section of Medical Ethics, Department of General Practice, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Marianne de Visser
- Department of Neurology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
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33
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Christodoulou G, Goetz R, Ogino M, Mitsumoto H, Rabkin J. Opinions of Japanese and American ALS caregivers regarding tracheostomy with invasive ventilation (TIV). Amyotroph Lateral Scler Frontotemporal Degener 2015; 17:47-54. [PMID: 26343785 DOI: 10.3109/21678421.2015.1069850] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Our objective was to learn more about possible factors contributing to the higher rates of tracheostomy with invasive ventilation (TIV) for ALS patients in Japan compared with the United States by eliciting attitudes of caregivers of ALS patients in both countries. One hundred and fifty-four American caregivers from five, geographically-distributed ALS clinics and 66 Japanese caregivers from six sites in Japan completed questionnaires regarding TIV. Results showed that 33% of American caregivers were in favor of TIV for their family member compared to 53% of Japanese caregivers; 44% of American and 37% of Japanese caregivers were undecided; and 22% of American and 10% of Japanese caregivers were opposed (p <.01). Within patient-caregiver dyads, agreement in the American sample was fair, while the Japanese dyads showed poor agreement. Maintaining quality of life and patients reaching a milestone were the most common reasons for favoring TIV in the American and Japanese samples, respectively. Reasons for opposing TIV did not significantly differ. Findings suggest that caregiver preferences may influence actual choices for ALS patients. More frequent endorsement of TIV by Japanese vs. American caregivers is consistent with higher rates of TIV among Japanese patients. The results reflect the importance of caregivers' opinions in patient care.
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Affiliation(s)
| | - Raymond Goetz
- b New York State Psychiatric Institute and Department of Psychiatry , Columbia University , New York , USA
| | - Mieko Ogino
- c Department of Neurology , Kitasato University School of Medicine , Kanagawa , Japan
| | - Hiroshi Mitsumoto
- a Department of Neurology , Columbia University Medical Center , New York , USA
| | - Judith Rabkin
- b New York State Psychiatric Institute and Department of Psychiatry , Columbia University , New York , USA
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Abstract
Dealing systematically with ethical issues in amyotrophic lateral sclerosis (ALS) care requires an unbiased awareness of all the relevant ethical issues. The aim of the study was to determine systematically and transparently the full spectrum of ethical issues in ALS care. We conducted a systematic review in Medline and Google Books (restricted to English and German literature published between 1993 and 2014). We applied qualitative text analysis and normative analysis to categorise the spectrum of ethical issues in ALS care. The literature review retrieved 56 references that together mentioned a spectrum of 103 ethical issues in ALS care. The spectrum was structured into six major categories that consist of first and second-order categories of ethical issues. The systematically derived spectrum of ethical issues in ALS care presented in this paper raises awareness and understanding of the complexity of ethical issues in ALS care. It also offers a basis for the systematic development of informational and training materials for health professionals, patients and their relatives, and society as a whole. Finally, it supports a rational and fair selection of all those ethical issues that should be addressed in health policies, position papers and clinical practice guidelines. Further research is needed to identify ways to systematically select the most relevant ethical issues not only in the clinical environment, but also for the development of clinical practice guidelines.
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35
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Daly JJ, Huggins JE. Brain-computer interface: current and emerging rehabilitation applications. Arch Phys Med Rehabil 2015; 96:S1-7. [PMID: 25721542 PMCID: PMC4383183 DOI: 10.1016/j.apmr.2015.01.007] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 01/07/2015] [Accepted: 01/07/2015] [Indexed: 11/19/2022]
Abstract
A formal definition of brain-computer interface (BCI) is as follows: a system that acquires brain signal activity and translates it into an output that can replace, restore, enhance, supplement, or improve the existing brain signal, which can, in turn, modify or change ongoing interactions between the brain and its internal or external environment. More simply, a BCI can be defined as a system that translates "brain signals into new kinds of outputs." After brain signal acquisition, the BCI evaluates the brain signal and extracts signal features that have proven useful for task performance. There are 2 broad categories of BCIs: implantable and noninvasive, distinguished by invasively and noninvasively acquired brain signals, respectively. For this supplement, we will focus on BCIs that use noninvasively acquired brain signals.
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Affiliation(s)
- Janis J Daly
- Brain Rehabilitation Research Program, McKnight Brain Institute, University of Florida, Gainesville, FL; Department of Neurology, College of Medicine, University of Florida, Gainesville, FL; Brain Rehabilitation Research Center of Excellence, Gainesville, FL; North Florida/South Georgia Veterans Affairs Medical Center, Gainesville, FL.
| | - Jane E Huggins
- Department of Physical Medicine and Rehabilitation, Department of Biomedical Engineering, and Program of Neuroscience Graduate Program, University of Michigan, Ann Arbor, MI
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36
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Accepting or declining non-invasive ventilation or gastrostomy in amyotrophic lateral sclerosis: patients’ perspectives. J Neurol 2015; 262:1002-13. [DOI: 10.1007/s00415-015-7665-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 01/31/2015] [Accepted: 02/02/2015] [Indexed: 12/12/2022]
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37
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Decision making of amyotrophic lateral sclerosis patients on noninvasive ventilation to receive tracheostomy positive pressure ventilation. Clin Neurol Neurosurg 2014; 125:28-31. [DOI: 10.1016/j.clineuro.2014.07.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Revised: 06/30/2014] [Accepted: 07/04/2014] [Indexed: 12/14/2022]
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38
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Kageyama Y, Hirata M, Yanagisawa T, Shimokawa T, Sawada J, Morris S, Mizushima N, Kishima H, Sakura O, Yoshimine T. Severely affected ALS patients have broad and high expectations for brain-machine interfaces. Amyotroph Lateral Scler Frontotemporal Degener 2014; 15:513-9. [DOI: 10.3109/21678421.2014.951943] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Yu Kageyama
- Department of Neurosurgery, Osaka University Medical School,
Osaka, Japan
| | - Masayuki Hirata
- Department of Neurosurgery, Osaka University Medical School,
Osaka, Japan
| | | | - Toshio Shimokawa
- Department of Regional Social Management, Faculty of Life and Environmental Sciences, University of Yamanashi,
Yamanashi, Japan
| | - Jinichi Sawada
- Osaka General Medical Center,
Osaka, Japan
- Osaka Intractable Diseases Medical Information Center,
Osaka, Japan
| | - Shayne Morris
- Department of Neurosurgery, Osaka University Medical School,
Osaka, Japan
| | - Nozomi Mizushima
- Interfaculty Initiative in Information Studies, The University of Tokyo,
Tokyo, Japan
| | - Haruhiko Kishima
- Department of Neurosurgery, Osaka University Medical School,
Osaka, Japan
| | - Osamu Sakura
- Interfaculty Initiative in Information Studies, The University of Tokyo,
Tokyo, Japan
| | - Toshiki Yoshimine
- Department of Neurosurgery, Osaka University Medical School,
Osaka, Japan
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Ando H, Williams C, Angus RM, Thornton EW, Chakrabarti B, Cousins R, Piggin LH, Young CA. Why don't they accept non-invasive ventilation?: insight into the interpersonal perspectives of patients with motor neurone disease. Br J Health Psychol 2014; 20:341-59. [PMID: 24796270 DOI: 10.1111/bjhp.12104] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Revised: 04/04/2014] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Although non-invasive ventilation (NIV) can benefit survival and quality of life, it is rejected by a substantial proportion of people with motor neurone disease (MND). The aim of this study was to understand why some MND patients decline or withdraw from NIV. METHOD Nine patients with MND (male = 7, mean age = 67 years) participated in this study. These patients, from a cohort of 35 patients who were offered NIV treatment to support respiratory muscle weakness, did not participate in NIV treatment when it was clinically appropriate. Semi-structured interviews and interpretative phenomenological analysis (IPA) were employed to explore these patient's experience of MND and their thoughts and understanding of NIV treatment. RESULTS Using IPA, four themes were identified: preservation of the self, negative perceptions of NIV, negative experience with health care services, and not needing NIV. Further analysis identified the fundamental issue to be the maintenance of perceived self, which was interpreted to consist of the sense of autonomy, dignity, and quality of life. CONCLUSIONS The findings indicate psychological reasons for disengagement with NIV. The threat to the self, the sense of loss of control, and negative views of NIV resulting from anxiety were more important to these patients than prolonging life in its current form. These findings suggest the importance of understanding the psychological dimension involved in decision-making regarding uptake of NIV and a need for sensitive holistic evaluation if NIV is declined. Statement of contribution What is already known on this subject? Non-invasive ventilation is widely used as an effective symptomatic therapy in MND, yet about a third of patients decline the treatment. Psychological disturbance generated by NIV use leads to negative experiences of the treatment. Decision-making about treatment potentials is complex and unique to each individual affected by perceived impact of disease. What does this study add? A decision concerning NIV uptake was influenced by perceived impact on individuals' sense of self. Sense of self was influenced by the maintenance of autonomy, dignity, and quality of life. Individuals' sense of self was identified to have been challenged by the disease, NIV, and their experience of health care service.
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Affiliation(s)
- Hikari Ando
- Department of Psychology, Liverpool Hope University, UK; Chest Centre, Aintree University Hospital, Liverpool, UK; The Walton Centre NHS Foundation Trust, Liverpool, UK
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Rabkin J, Ogino M, Goetz R, McElhiney M, Hupf J, Heitzman D, Heiman-Patterson T, Miller R, Katz J, Lomen-Hoerth C, Imai T, Atsuta N, Morita M, Tateishi T, Matsumura T, Mitsumoto H. Japanese and American ALS patient preferences regarding TIV (tracheostomy with invasive ventilation): A cross-national survey. Amyotroph Lateral Scler Frontotemporal Degener 2014; 15:185-91. [DOI: 10.3109/21678421.2014.896928] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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41
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Sánchez-López C, Perestelo-Pérez L, Ramos-Pérez C, López-Bastida J, Serrano-Aguilar P. Calidad de vida relacionada con la salud en pacientes con esclerosis lateral amiotrófica. Neurologia 2014; 29:27-35. [DOI: 10.1016/j.nrl.2013.02.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Revised: 02/07/2013] [Accepted: 02/08/2013] [Indexed: 12/12/2022] Open
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Health-related quality of life in patients with amyotrophic lateral sclerosis. NEUROLOGÍA (ENGLISH EDITION) 2014. [DOI: 10.1016/j.nrleng.2013.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Ando H, Chakrabarti B, Angus RM, Cousins R, Thornton EW, Young CA. Experience of long-term use of non-invasive ventilation in motor neuron disease: an interpretative phenomenological analysis. BMJ Support Palliat Care 2013; 4:50-6. [DOI: 10.1136/bmjspcare-2013-000494] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Quality of life in fatal disease: the flawed judgement of the social environment. J Neurol 2013; 260:2836-43. [PMID: 23989341 DOI: 10.1007/s00415-013-7068-y] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Revised: 08/01/2013] [Accepted: 08/03/2013] [Indexed: 12/13/2022]
Abstract
Decisions to prolong or shorten life in fatal diseases like amyotrophic lateral sclerosis are strongly influenced by healthy individuals, such as caregivers and physicians. Furthermore, many believe that amyotrophic lateral sclerosis (ALS) patients should decide ahead of time on advanced directives to circumvent confounding effects of subsequent cognitive impairments. The ability of healthy persons (caregivers and age-matched healthy subjects) to anticipate patients' quality of life (QoL), depression and vital decisions was determined in a cross-sectional approach. Eighty-nine ALS patients, 86 caregivers and 102 age-matched healthy subjects were asked to judge ALS patients' QoL and depression and the patients' wish for hastened death. Patients judged their own, the caregivers judged that of the patient under their care, healthy subjects were asked to judge that of a virtual patient. Additionally, healthy persons were asked to judge their own QoL and depression. Patients reported a satisfactory well-being and a low wish for hastened death. Healthy persons rated the patients' QoL significantly lower and the rate of depression significantly higher. The wish for hastened death was significantly lower in the patient group compared to what healthy subjects thought the patient would wish. The assessment by others was closely related to the persons' own well-being. Significant differences were identified between caregiver's perspectives and the patient's own perception of their psychological well-being. Our data suggest that caregivers and the general public significantly underestimate the QoL of ALS patients. A positive affective state can indeed be preserved in a progressive, fatal disease.
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Faull C, Rowe Haynes C, Oliver D. Issues for palliative medicine doctors surrounding the withdrawal of non-invasive ventilation at the request of a patient with motor neurone disease: a scoping study: Table 1. BMJ Support Palliat Care 2013; 4:43-9. [DOI: 10.1136/bmjspcare-2013-000470] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Ozanne AO, Graneheim UH, Strang S. Finding meaning despite anxiety over life and death in amyotrophic lateral sclerosis patients. J Clin Nurs 2013; 22:2141-9. [DOI: 10.1111/jocn.12071] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2012] [Indexed: 12/11/2022]
Affiliation(s)
- Anneli O Ozanne
- Department of Neurology; Institute of Neuroscience and Physiology; Sahlgrenska University Hospital; Gothenburg Sweden
| | | | - Susann Strang
- Institute of Health and Care Sciences; Sahlgrenska University Hospital; Gothenburg Sweden
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Sakellariou D, Boniface G, Brown P. Experiences of living with motor neurone disease: a review of qualitative research. Disabil Rehabil 2013; 35:1765-73. [DOI: 10.3109/09638288.2012.753118] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Vrijsen B, Testelmans D, Belge C, Robberecht W, Van Damme P, Buyse B. Non-invasive ventilation in amyotrophic lateral sclerosis. Amyotroph Lateral Scler Frontotemporal Degener 2013; 14:85-95. [DOI: 10.3109/21678421.2012.745568] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Grigg-Damberger MM, Wagner LK, Brown LK. Sleep Hypoventilation in Patients with Neuromuscular Diseases. Sleep Med Clin 2012. [DOI: 10.1016/j.jsmc.2012.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Bahus MK, Steen PA, Førde R. Law, ethics and clinical judgment in end-of-life decisions—How do Norwegian doctors think? Resuscitation 2012; 83:1369-73. [DOI: 10.1016/j.resuscitation.2012.04.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2012] [Revised: 03/23/2012] [Accepted: 04/10/2012] [Indexed: 11/27/2022]
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