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Alonso JP, Ini N, Villarejo A, Belizán M, Roberti J. Amyotrophic lateral sclerosis in Argentina: unveiling the burden of treatment through patient and caregiver perspectives. Disabil Rehabil 2024:1-8. [PMID: 39072497 DOI: 10.1080/09638288.2024.2385732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 07/21/2024] [Accepted: 07/24/2024] [Indexed: 07/30/2024]
Abstract
PURPOSE To examine the burden of treatment (BoT) experienced by people with Amyotrophic Lateral Sclerosis (ALS) in Argentina. METHODS Qualitative methodological design based on semi-structured interviews. Nineteen semi-structured interviews were conducted (PwALS = 7, informal caregivers= 12). The interview guides were designed based on the literature and BoT theory. Data were analysed following a framework analysis approach. RESULTS The research highlighted the arduous journey toward obtaining a diagnosis, marked by delays influenced by healthcare system inefficiencies, lack of disease awareness and pandemic-related anxiety. Receiving the diagnosis was a destabilising experience, triggering the need to reframe self-identity, a new reality. As the disease progressed, patients encountered significant challenges in their daily activities and basic tasks, affecting their ability to work, communicate, and manage personal care. The burden extended beyond the patients to their primary caregivers. Access to specialised care, bureaucratic complexities in securing treatment, and the financial impact of managing the disease posed substantial challenges. CONCLUSION The findings offer valuable insights into the experiences of PwALS and their caregivers in Argentina. They underscore the need for increased disease awareness, improved access to specialised care, and enhanced support networks to alleviate the burdens PwALS and their families face.
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Affiliation(s)
- Juan Pedro Alonso
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
- Gino Germani Institute, CONICET, Buenos Aires, Argentina
| | - Natalí Ini
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
- CIESP - CONICET, Buenos Aires, Argentina
| | - Agustina Villarejo
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - María Belizán
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Javier Roberti
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
- CIESP - CONICET, Buenos Aires, Argentina
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Porteri C, Ienco G, Piccinni M, Pasqualetti P. Towards the implementation of law n. 219/2017 on informed consent and advance directives for patients with psychiatric disorders and dementia. Physicians' knowledge, attitudes and practices in four northern Italian health care facilities. BMC Med Ethics 2024; 25:7. [PMID: 38184541 PMCID: PMC10771689 DOI: 10.1186/s12910-023-00997-8] [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: 04/28/2023] [Accepted: 12/22/2023] [Indexed: 01/08/2024] Open
Abstract
BACKGROUND On December 2017 the Italian Parliament approved law n. 219/2017 "Provisions for informed consent and advance directives" regarding challenging legal and bioethical issues related to healthcare decisions and end-of life choices. The law promotes the person's autonomy as a right and provides for the centrality of the individual in every scenario of health care by mean of three tools: informed consent, shared care planning and advance directives. Few years after the approval of the law, we conducted a survey among physicians working in four health care facilities specific for the care of people suffering from psychiatric disorders, cognitive disorders and dementia located in the North of Italy aiming to investigate their perceived knowledge and training need, attitudes regarding law n. 219/2017 provisions, and practices of implementation of the law. METHODS A semi-structured questionnaire was developed on an online platform. The invitation to participate in the survey was sent by email to the potential participants. Information was collected by means of the online platform (Google Forms) which allows to export data in a spreadsheet (Windows Excel) to perform basic statistical analysis (frequency distributions, bar chart representation). RESULTS Twenty-five out of sixty physicians participated in the survey. None of the respondents value their knowledge of the law as very good, 10 good, 13 neither poor nor good, 1 poor and 1 very poor. All the respondents want to learn more about the law (21 yes and 4 absolutely yes). The majority of respondents agrees with the content of the law as a whole (3 absolutely agree, 13 agree), and on each provision. The question on the clarity of the concept of capacity in the law received mixed answers and this impacted on the physicians' opinion regarding the legitimacy in principle for our groups of patients to realize shared care planning and write advance directives. Thirteen physicians neither introduced the theme of shared care planning nor arranged for shared care planning and the main reason for this was that no patient was in a clinical situation to require it. When shared care planning is realized, a variability in terms of type and number of meetings, mode of tracking and communication is registered. CONCLUSIONS Our survey results indicate a need for more clarity regarding the interpretation and implementation of the law in the patient groups under study. There are in particular two related areas that deserve further discussion: (1) the question of whether these patient groups are in principle legitimized by the law to realize shared care planning or write advance directives; (2) the notion of capacity required by the law and how this notion can be declined in real-life situations.
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Affiliation(s)
- Corinna Porteri
- Bioethics Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Via Pilastroni, 4, Brescia, 25125, Italy.
| | - Giulia Ienco
- Bioethics Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Via Pilastroni, 4, Brescia, 25125, Italy
| | - Mariassunta Piccinni
- Department of Political Science, Law and International Studies - SPGI, Università di Padova, Padua, Italy
| | - Patrizio Pasqualetti
- Department of Public Health and Infectious Diseases, Section of Medical Statistics, Sapienza Università di Roma, Rome, Italy
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Cipolletta S, Tomaino SCM, Brena A, Di Ciaccio P, Gentile M, Procaccio F, Cardillo M. Life beyond life: Perceptions of post-mortem organ donation and consent to donate-A focus group study in Italy. Br J Health Psychol 2023; 28:1222-1240. [PMID: 37434302 DOI: 10.1111/bjhp.12681] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 06/16/2023] [Accepted: 06/28/2023] [Indexed: 07/13/2023]
Abstract
OBJECTIVES Many factors such as personal and cultural beliefs, misinformation, fear of death and inadequate will registering procedures can influence post-mortem organ donation. The present study aimed to explore the perceptions, beliefs and information around post-mortem donation and will expression in different groups of the Italian population, to orient future interventions and raise awareness. DESIGN Qualitative research with focus groups. METHODS A total of 38 focus groups involving 353 participants including the general population (young adults: 18-39, mature adults: 40-70), local and hospital health professionals, critical area health professionals (emergency room and intensive care), registry office employees and opinion leaders, were conducted in six regions from different parts of Italy between June and November 2021. Thematic analysis was conducted with the use of Atlas.ti9. RESULTS Five overarching themes were identified: dilemmas regarding donation, resistance to donation, facilitators of donation, difficulties in terms of will expression and proposals to encourage will expression. Possible facilitators were having personal and professional experiences with organ donation, feeling useful for society, having reliable information and trust in the health care system. Potential barriers to donation were doubts and fears about brain death, bodily integrity concerns, religious beliefs, misinformation and distrust in the health care system. CONCLUSIONS These results highlighted the significance of a bottom-up perspective with regard to identifying the personal perceptions and beliefs with regard to donation, underlining the urgency of creating tailored interventions to sensitize different groups of the population in terms of promoting an informed choice and a culture of donation.
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Affiliation(s)
| | | | - Alessandra Brena
- Department of General Psychology, University of Padua, Padua, Italy
| | - Paola Di Ciaccio
- Centro Nazionale Trapianti, Istituto Superiore di Sanità (ISS), Rome, Italy
| | - Margherita Gentile
- Centro Nazionale Trapianti, Istituto Superiore di Sanità (ISS), Rome, Italy
| | | | - Massimo Cardillo
- Centro Nazionale Trapianti, Istituto Superiore di Sanità (ISS), Rome, Italy
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4
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Martin Schaff C, Kurent JE, Kolodziejczak S, Milic M, Foster LA, Mehta AK. Neuroprognostication for Patients with Amyotrophic Lateral Sclerosis: An Updated, Evidence-Based Review. Semin Neurol 2023; 43:776-790. [PMID: 37751856 DOI: 10.1055/s-0043-1775595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Abstract
Amyotrophic lateral sclerosis (ALS) is a rapidly progressive neurodegenerative disorder that presents and progresses in various ways, making prognostication difficult. Several paradigms exist for providers to elucidate prognosis in a way that addresses not only the amount of time a patient has to live, but also a patient's quality of their life moving forward. Prognostication, with regard to both survivability and quality of life, is impacted by several features that include, but are not limited to, patient demographics, clinical features on presentation, and over time, access to therapy, and access to multidisciplinary clinics. An understanding of the impact that these features have on the life of a patient with ALS can help providers to develop a better and more personalized approach for patients related to their clinical prognosis after a diagnosis is made. The ultimate goal of prognostication is to empower patients with ALS to take control and make decisions with their care teams to ensure that their goals are addressed and met.
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Affiliation(s)
| | - Jerome E Kurent
- Department of Neurology and Medicine, Medical University of South Carolina, Charleston, South Carolina
- Department of Neurology, ALS Multidisciplinary Clinic, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina
| | - Sherry Kolodziejczak
- ALS Clinic Treatment Center of Excellence, Crestwood Medical Center, Huntsville, Alabama
| | - Michelle Milic
- Division of Pulmonary, Critical Care, and Sleep Medicine, MedStar Georgetown University Hospital, Washington, District of Columbia
- Division of Palliative Care Medicine, MedStar Georgetown University Hospital, Washington, District of Columbia
| | - Laura A Foster
- Department of Neurology, University of Colorado School of Medicine, Aurora, Colorado
| | - Ambereen K Mehta
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Palliative Care Program, Division of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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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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Shoesmith C. Palliative care principles in ALS. HANDBOOK OF CLINICAL NEUROLOGY 2023; 191:139-155. [PMID: 36599506 DOI: 10.1016/b978-0-12-824535-4.00007-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease associated with progressive dysphagia, dysarthria, extremity weakness, and dyspnea. Although there are some disease-modifying pharmacological treatments available which can modestly slow disease progression, the disease is relentlessly progressive and is ultimately fatal. Patients living with ALS should be supported using the principles of palliative care, and in particular, the use of a holistic approach to support the patients and their families. Evidence would support management of patients living with ALS by a multidisciplinary ALS specialty clinic. These multidisciplinary clinics will help support the multitude of symptoms a patient living with ALS can experience, including dysphagia, communication impairments, dexterity impairments, mobility deficits, and respiratory insufficiency. Formal involvement of specialist-trained palliative practitioners can occur throughout the course of the illness, or when the patient is open to their involvement. There are several models of palliative care that can be followed, including integration of palliative care into the multidisciplinary ALS clinic, separate involvement of a palliative care specialty team, home-based palliative care, telemedicine supported care, and hospice care. Key components of palliative care in ALS are goals-of-care discussions advance directive planning, symptoms management, and end-of-life support.
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Affiliation(s)
- Christen Shoesmith
- Department of Clinical Neurological Sciences, Division of Neurology, London Health Sciences Centre, London, ON, Canada.
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Alquati S, Ghirotto L, De Panfilis L, Autelitano C, Bertocchi E, Artioli G, Sireci F, Tanzi S, Sacchi S. Negotiating the Beginning of Care: A Grounded Theory Study of Health Services for Amyotrophic Lateral Sclerosis. Brain Sci 2022; 12:brainsci12121623. [PMID: 36552083 PMCID: PMC9775577 DOI: 10.3390/brainsci12121623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/17/2022] [Accepted: 11/24/2022] [Indexed: 11/29/2022] Open
Abstract
A range of professional figures are needed to preserve the quality of life of people with amyotrophic lateral sclerosis. This study aimed to explore the beginning of the care process as negotiated by people with amyotrophic lateral sclerosis, their caregivers, and healthcare professionals. We designed the study according to the constructivist Grounded Theory method, collecting data through open-ended, semi-structured interviews, employing theoretical sampling and constant comparison, and performing conceptual coding as data analysis. By naming the core category "off-beat interfacing", we were able to show how the demands of the professionals concerned did not correspond to the ability of people with ALS and their proxies to process information, deal with requests, and be at ease in making decisions at the beginning of the shared care pathway. Three categories were generated: (i) navigating different paths, (ii) offering and experiencing a standard, non-personalized pathway, and (iii) anticipating decisions. The network of services must be organized according to guidelines, but must also contemplate a patient-family-centered approach that permits more personalized assistance.
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Affiliation(s)
- Sara Alquati
- Palliative Care Unit, Azienda USL—IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Luca Ghirotto
- Qualitative Research Unit, Azienda USL—IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
- Correspondence:
| | | | - Cristina Autelitano
- Palliative Care Unit, Azienda USL—IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Elisabetta Bertocchi
- Palliative Care Unit, Azienda USL—IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Giovanna Artioli
- Department of Medicine and Surgery, University of Parma, 43125 Parma, Italy
| | - Francesca Sireci
- Neurology Unit, Azienda USL—IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Silvia Tanzi
- Palliative Care Unit, Azienda USL—IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Simona Sacchi
- Palliative Care Unit, Azienda USL—IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
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Porteri C, Ienco G, Turla EM, Petrini C, Pasqualetti P. Italian law n. 219/2017 on consent and advance directives: survey among Ethics Committees on their involvement and possible role. BMC Med Ethics 2022; 23:114. [PMID: 36384647 PMCID: PMC9670375 DOI: 10.1186/s12910-022-00858-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 11/06/2022] [Indexed: 11/17/2022] Open
Abstract
Background On December 2017 the Italian Parliament approved law n. 219/2017 “Provisions for informed consent and advance directives” regarding challenging legal and bioethical issues related to healthcare decisions and end-of-life choices. The law does not contain an explicit reference to Ethics Committees (ECs), but they could still play a role in implementing the law. Methods A questionnaire-based survey was performed among the ECs of the Italian Institute for Research and Care belonging to the Network of neuroscience and neurorehabilitation, with the aim of (1) knowing whether the ECs participated and, if so, how in the process of implementation of law n. 219/2017 in the referring institutes; (2) investigating the point of view of the ECs regarding their possible involvement in the process; (3) exploring the contribution ECs can provide to give effective implementation to the law principles and provisions. Results Seventeen ECs out of thirty took part in the survey; the characteristics of the responding and non-responding committees are similar, so the responding ECs can be regarded as representative of all ECs in the Network. Nine ECs did not discuss the law in anyway: the main reason for this is that the referring institutions (6) and the health care professionals (3) did not ask for an EC intervention. Nevertheless, the large majority of the ECs believe that their involvement in the implementation of the law as a whole is appropriate (8) or absolutely appropriate (6), while 3 of them are neutral. No EC believes that the involvement is inappropriate. The aspect of the law on which the 14 ECs converge in considering the EC involvement appropriate/absolutely appropriate is the one related to the health facilities obligation to guarantee the full and proper implementation of the principles of the law. Conclusions Our survey confirms that ECs believe they can play a role in the implementation of law n. 219/2017, although this does not entirely correspond to what the committees have actually done in reality. This role could be better exercised by ECs specifically established for clinical practice, which would have a composition, functioning and a mandate better suited to the purpose. This supports the call for a national regulation of ECs for clinical practice. Supplementary Information The online version contains supplementary material available at 10.1186/s12910-022-00858-w.
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De Leo D, Congregalli B, Guarino A, Zammarrelli J, Valle A, Paoloni S, Cipolletta S. Communicating Unexpected and Violent Death: The Experiences of Police Officers and Health Care Professionals. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11030. [PMID: 36078746 PMCID: PMC9518522 DOI: 10.3390/ijerph191711030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 08/31/2022] [Accepted: 08/31/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The notification of unexpected and violent death represents a challenging experience for police officers and health workers. These professionals are exposed to very intense emotions during this task. AIM We aimed to investigate the degree of preparation, and the emotions and attitudes of police officers and health professionals while communicating such a death. METHOD An ad hoc online questionnaire was created and disseminated through Qualtrics software. The participants were recruited through the institutional channels of Police, the College of Physicians, the ONG De Leo Fund and the Department of General Psychology of the University of Padua. In this qualitative study, thematic content analysis was used to examine the responses. RESULTS A total of 155 individuals participated in the study (44 females, 111 males): 102 individuals were police officers, 23 were doctors and were 30 nurses. Five main themes were identified: (1) how the communication took place; (2) the experiences during the communication; (3) the difficulties encountered; (4) coping strategies, and (5) forms of support. Most communications were performed in person, and most represented an intense emotional experience for the notifiers. There is a generalised lack of specific preparation and training for this practice. The recipient's characteristics (culture of origin, language, age, health conditions, psychological vulnerability) may add to the difficulties of the notification process. Professionals unload their tension by practicing sport, relying on their hobbies or interacting socially. The presence of other colleagues during and after the death notification is usually able to alleviate the burden of the communication. CONCLUSIONS Communication modalities can have a profound impact on the recipients and intensify the trauma of the loss; however, they also have the possibility of mitigating it. The notification of a violent and unexpected death remains a difficult and challenging task for the notifier, which is potentially stressful and emotionally charged. The topic is of great relevance and more research should be promoted in this area.
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Affiliation(s)
- Diego De Leo
- Australian Institute for Suicide Research and Prevention, Griffith University, Brisbane, QLD 4122, Australia
- Slovene Center for Suicide Research, Primorska University, 6000 Koper, Slovenia
- De Leo Fund, 35137 Padua, Italy
| | | | | | | | - Anna Valle
- Autonomous Syndicate of Police (SAP), 00184 Rome, Italy
| | | | - Sabrina Cipolletta
- Department of General Psychology, University of Padua, 35100 Padua, Italy
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Cipolletta S, Entilli L, Filisetti S. Uncertainty, shock and anger: Recent loss experiences of first‐wave
COVID
‐19 pandemic in Italy. JOURNAL OF COMMUNITY & APPLIED SOCIAL PSYCHOLOGY 2022; 32:983-997. [PMID: 35571876 PMCID: PMC9083240 DOI: 10.1002/casp.2604] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 01/12/2022] [Accepted: 01/20/2022] [Indexed: 12/27/2022]
Abstract
The aim of this study is to explore qualitatively bereavement experiences of family members who have lost a significant other to coronavirus disease 2019 (COVID‐19) in relation to mourners' needs and resources. Twenty individuals bereaved by the first wave of COVID‐19 from the most heavily impacted Italian region were interviewed via video call between 1 and 3 months after their loss. Through a thematic analysis, four main themes were identified: reconstructions of the loss experience, responses to grief, resources and looking forward. The suddenness of the death and lack of farewell by means of a funeral prevented participants from realizing the loss and undertaking a meaning‐making process. When anger was the main reaction to the loss, mourners focussed all their attention on denouncing medical and government institutions. Acceptance occurred particularly in those who found a way to share their grief and use it as a turning point. Participants relied mainly on informal support offered virtually, but mourners may have sought out in‐person comfort in the long term. The results of this study propose new insights for COVID‐19 bereavement support and trace the path for health promotion within a community shook by a communal grief experience. Please refer to the Supplementary Material section to find this article's Community and Social Impact Statement
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Affiliation(s)
| | - Lorenza Entilli
- Department of General Psychology University of Padua Padua Italy
| | - Sara Filisetti
- Department of General Psychology University of Padua Padua Italy
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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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