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Young HM, Kilaberia TR, Whitney R, Link BM, Bell JF, Tonkikh O, Famula J, Oskarsson B. Needs of persons living with ALS at home and their family caregivers: A scoping review. Muscle Nerve 2023; 68:240-249. [PMID: 37248728 DOI: 10.1002/mus.27849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 05/03/2023] [Accepted: 05/04/2023] [Indexed: 05/31/2023]
Abstract
INTRODUCTION/AIMS Most persons with amyotrophic lateral sclerosis (ALS) live at home with support of family caregivers, with escalating complexity of care over the trajectory of the disease requiring resources and support to mitigate negative physical, social, and emotional outcomes. METHODS This scoping review identifies the home health/home care needs of persons with ALS and their caregivers as a basis for creating a home health medical standard. We used the PRISMA Extension for Scoping Reviews (PRISMA-ScR) to examine studies describing home care needs published between 2011 and 2021. RESULTS Our search yielded 481 articles, of which 44 were included with a total of 3592 (9-273) participants. Most studies used a cross-sectional design and 20 (45%) were rated as high quality. We grouped the needs identified as emotional/psychological, assistive devices and technology, information and education, and human resources and professional services. Most studies demonstrated persistent unmet needs and that available interventions were helpful while needs generally were not met proactively, despite the predictable trajectory. DISCUSSION This review describes biopsychosocial and equipment interventions over the trajectory of ALS with implications for anticipatory planning by clinicians, as well as policy for coverage of necessary services and supports. Interdisciplinary expert teams could develop consensus around needs across the trajectory and recommended services and supports. To make knowledge more accessible, encourage availability of services, and clarify the need for coverage of services, we aim to develop an expert consensus-based ALS home health medical standard guidance document in collaboration with the American Association of Neuromuscular and Electrodiagnostic Medicine.
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Affiliation(s)
- Heather M Young
- Family Caregiving Institute, Betty Irene Moore School of Nursing, University of California Davis, Sacramento, California, USA
| | - Tina R Kilaberia
- Silver School of Social Work, New York University, New York, New York, USA
| | - Robin Whitney
- Valley Foundation School of Nursing, San Jose State University, San Jose, California, USA
| | - Benjamin M Link
- Family Caregiving Institute, Betty Irene Moore School of Nursing, University of California Davis, Sacramento, California, USA
| | - Janice F Bell
- Family Caregiving Institute, Betty Irene Moore School of Nursing, University of California Davis, Sacramento, California, USA
| | - Orly Tonkikh
- Family Caregiving Institute, Betty Irene Moore School of Nursing, University of California Davis, Sacramento, California, USA
| | - Jessica Famula
- Family Caregiving Institute, Betty Irene Moore School of Nursing, University of California Davis, Sacramento, California, USA
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Lian L, Zheng M, He R, Lin J, Chen W, Pei Z, Yao X. Analysing the influencing factors on caregivers' burden among amyotrophic lateral sclerosis patients in China: a cross-sectional study based on data mining. BMJ Open 2022; 12:e066402. [PMID: 36130747 PMCID: PMC9494583 DOI: 10.1136/bmjopen-2022-066402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES There is significant burden on caregivers of patients with amyotrophic lateral sclerosis (ALS). However, only a few studies have focused on caregivers, and traditional research methods have obvious shortcomings in dealing with multiple influencing factors. This study was designed to explore influencing factors on caregiver burden among ALS patients and their caregivers from a new perspective. DESIGN Cross-sectional study. SETTING The data were collected at an affiliated hospital in Guangzhou, Guangdong, China. PARTICIPANTS Fifty-seven pairs of patients with ALS and their caregivers were investigated by standardised questionnaires. MAIN OUTCOME MEASURES This study primarily assessed the influencing factor of caregiver burden including age, gender, education level, economic status, anxiety, depression, social support, fatigue, sleep quality and stage of disease through data mining. Statistical analysis was performed using SPSS 24.0, and least absolute shrinkage and selection operator (LASSO) regression model was established by Python 3.8.1 to minimise the effect of multicollinearity. RESULTS According to LASSO regression model, we found 10 variables had weights. Among them, Milano-Torinos (MITOS) stage (0-1) had the highest weight (-12.235), followed by younger age group (-3.198), lower-educated group (2.136), fatigue (1.687) and social support (-0.455). Variables including sleep quality, anxiety, depression and sex (male) had moderate weights in this model. Economic status (common), economic status (better), household (city), household (village), educational level (high), sex (female), age (older) and MITOS stage (2-4) had a weight of zero. CONCLUSIONS Our study demonstrates that the severity of ALS patients is the most influencing factor in caregiver burden. Caregivers of ALS patients may suffer less from caregiver burden when the patients are less severe, and the caregivers are younger. Low educational status could increase caregiver burden. Caregiver burden is positively correlated with the degree of fatigue and negatively correlated with social support. Hopefully, more attention should be paid to caregivers of ALS, and effective interventions can be developed to relieve this burden.
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Affiliation(s)
- Ling Lian
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University; Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, No.58 Zhongshan Road 2, Guangzhou, 510080, China
| | - Minying Zheng
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University; Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, No.58 Zhongshan Road 2, Guangzhou, 510080, China
| | - Ruojie He
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University; Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, No.58 Zhongshan Road 2, Guangzhou, 510080, China
| | - Jianing Lin
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University; Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, No.58 Zhongshan Road 2, Guangzhou, 510080, China
| | - Weineng Chen
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University; Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, No.58 Zhongshan Road 2, Guangzhou, 510080, China
| | - Zhong Pei
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University; Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, No.58 Zhongshan Road 2, Guangzhou, 510080, China
| | - Xiaoli Yao
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University; Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, No.58 Zhongshan Road 2, Guangzhou, 510080, China
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Brewah H, Borrett K, Tavares N, Jarrett N. Perceptions of people with motor neurone disease, families and HSCPs: a literature review. Br J Community Nurs 2022; 27:188-198. [PMID: 35353593 DOI: 10.12968/bjcn.2022.27.4.188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Motor neurone disease or amyotrophic lateral sclerosis is a rapidly progressive terminal neurodegenerative condition caused by degeneration of the upper and lower motor neurones in the central nervous system of the brain. The effects of motor neurone disease are multifaceted, leading to many adjustments in everyday life. This literature review asked what the experiences of people living with motor neurone disease was before and during the COVID-19 pandemic and during the COVID-19 pandemic, especially in terms of their condition and the support they received from health and social care services. A key theme identified was lack of knowledge among professionals when they cared for people living with motor neurone disease and their families. This lack of knowledge often resulted in delayed diagnosis and poor standards of care. COVID-19 impacted on the care of people living with motor neurone disease and their families, and there is a paucity of evidence on how services were perceived by these groups during the COVID-19 pandemic. The experiences of people living with motor neurone disease and their families are currently missing in the literature. In conclusion, further studies are required to include care of people living with motor neurone disease and their families.
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Affiliation(s)
- Helen Brewah
- Queen's Nurse, Florence Nightingale Scholar and PhD student, University of Portsmouth
| | - Kevin Borrett
- Mental Health Governance Lead, Solent NHS Trust, and PhD Supervisor, University of Portsmouth
| | - Nuno Tavares
- Supervisor and Senior Teaching Fellow, Faculty of Science and Health, University of Portsmouth
| | - Nikki Jarrett
- Course Lead for Professional Doctorate in Health and Social Care, University of Portsmouth
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Warrier MG, Thomas PT, Sadasivan A, Nashi S, Vengalil S, Nalini A. Development of Guidelines for Spouses Engaged in Home-Based Care of Persons With Motor Neuron Disease From Indian Context. J Patient Exp 2022; 9:23743735221077535. [PMID: 35128043 PMCID: PMC8814983 DOI: 10.1177/23743735221077535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background: The caregivers of persons with motor neuron disease (MND) have several needs that are usually not voiced on any platform. Aim: To explore the lived experience of spouses of persons with MND, identify their needs and develop guidelines for better home-based care. Method: An exploratory study with 3-point in-depth interviews among 13 participants was conducted. Participants were the spouses of persons with MND under treatment at a national quaternary referral center. The interpretative phenomenological analysis identified participants’ needs. These needs, with literature review synthesis, guided the drafting of guidelines, which was validated by experts. Results: The needs were emotional, social, care systems, and skills. The guidelines developed contained 2 sections (1) Information for the spouses: understanding MND, communication, symptom management, marital relationship, palliative care, and everyday life made easier. (2) Well-being of the spouse caregivers: well-being of the spouse caregivers, self-care, mental health, supporting carers in palliative care, where to find help.Conclusion: The guidelines can be developed as a manual for the caregivers and for training healthcare professionals working with neurodegenerative conditions.
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Affiliation(s)
| | | | | | | | | | - A Nalini
- Department of Neurology, NIMHANS, Bangalore, India
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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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Shoesmith C, Abrahao A, Benstead T, Chum M, Dupre N, Izenberg A, Johnston W, Kalra S, Leddin D, O'Connell C, Schellenberg K, Tandon A, Zinman L. Canadian best practice recommendations for the management of amyotrophic lateral sclerosis. CMAJ 2021; 192:E1453-E1468. [PMID: 33199452 DOI: 10.1503/cmaj.191721] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Christen Shoesmith
- London Health Sciences Centre (Shoesmith), London, Ont.; Sunnybrook Health Sciences Centre (Abrahao, Izenberg, Tandon, Zinman), Toronto, Ont.; Dalhousie University (Benstead, Leddin), Halifax, NS; McMaster University (Chum), Hamilton, Ont.; CHU de Québec-Université Laval (Dupre), Québec, Que.; University of Alberta (Johnston, Kalra), Edmonton, Alta.; Stan Cassidy Centre for Rehabilitation (O'Connell), Fredericton, NB; University of Saskatchewan (Schellenberg), Saskatoon, Sask.
| | - Agessandro Abrahao
- London Health Sciences Centre (Shoesmith), London, Ont.; Sunnybrook Health Sciences Centre (Abrahao, Izenberg, Tandon, Zinman), Toronto, Ont.; Dalhousie University (Benstead, Leddin), Halifax, NS; McMaster University (Chum), Hamilton, Ont.; CHU de Québec-Université Laval (Dupre), Québec, Que.; University of Alberta (Johnston, Kalra), Edmonton, Alta.; Stan Cassidy Centre for Rehabilitation (O'Connell), Fredericton, NB; University of Saskatchewan (Schellenberg), Saskatoon, Sask
| | - Tim Benstead
- London Health Sciences Centre (Shoesmith), London, Ont.; Sunnybrook Health Sciences Centre (Abrahao, Izenberg, Tandon, Zinman), Toronto, Ont.; Dalhousie University (Benstead, Leddin), Halifax, NS; McMaster University (Chum), Hamilton, Ont.; CHU de Québec-Université Laval (Dupre), Québec, Que.; University of Alberta (Johnston, Kalra), Edmonton, Alta.; Stan Cassidy Centre for Rehabilitation (O'Connell), Fredericton, NB; University of Saskatchewan (Schellenberg), Saskatoon, Sask
| | - Marvin Chum
- London Health Sciences Centre (Shoesmith), London, Ont.; Sunnybrook Health Sciences Centre (Abrahao, Izenberg, Tandon, Zinman), Toronto, Ont.; Dalhousie University (Benstead, Leddin), Halifax, NS; McMaster University (Chum), Hamilton, Ont.; CHU de Québec-Université Laval (Dupre), Québec, Que.; University of Alberta (Johnston, Kalra), Edmonton, Alta.; Stan Cassidy Centre for Rehabilitation (O'Connell), Fredericton, NB; University of Saskatchewan (Schellenberg), Saskatoon, Sask
| | - Nicolas Dupre
- London Health Sciences Centre (Shoesmith), London, Ont.; Sunnybrook Health Sciences Centre (Abrahao, Izenberg, Tandon, Zinman), Toronto, Ont.; Dalhousie University (Benstead, Leddin), Halifax, NS; McMaster University (Chum), Hamilton, Ont.; CHU de Québec-Université Laval (Dupre), Québec, Que.; University of Alberta (Johnston, Kalra), Edmonton, Alta.; Stan Cassidy Centre for Rehabilitation (O'Connell), Fredericton, NB; University of Saskatchewan (Schellenberg), Saskatoon, Sask
| | - Aaron Izenberg
- London Health Sciences Centre (Shoesmith), London, Ont.; Sunnybrook Health Sciences Centre (Abrahao, Izenberg, Tandon, Zinman), Toronto, Ont.; Dalhousie University (Benstead, Leddin), Halifax, NS; McMaster University (Chum), Hamilton, Ont.; CHU de Québec-Université Laval (Dupre), Québec, Que.; University of Alberta (Johnston, Kalra), Edmonton, Alta.; Stan Cassidy Centre for Rehabilitation (O'Connell), Fredericton, NB; University of Saskatchewan (Schellenberg), Saskatoon, Sask
| | - Wendy Johnston
- London Health Sciences Centre (Shoesmith), London, Ont.; Sunnybrook Health Sciences Centre (Abrahao, Izenberg, Tandon, Zinman), Toronto, Ont.; Dalhousie University (Benstead, Leddin), Halifax, NS; McMaster University (Chum), Hamilton, Ont.; CHU de Québec-Université Laval (Dupre), Québec, Que.; University of Alberta (Johnston, Kalra), Edmonton, Alta.; Stan Cassidy Centre for Rehabilitation (O'Connell), Fredericton, NB; University of Saskatchewan (Schellenberg), Saskatoon, Sask
| | - Sanjay Kalra
- London Health Sciences Centre (Shoesmith), London, Ont.; Sunnybrook Health Sciences Centre (Abrahao, Izenberg, Tandon, Zinman), Toronto, Ont.; Dalhousie University (Benstead, Leddin), Halifax, NS; McMaster University (Chum), Hamilton, Ont.; CHU de Québec-Université Laval (Dupre), Québec, Que.; University of Alberta (Johnston, Kalra), Edmonton, Alta.; Stan Cassidy Centre for Rehabilitation (O'Connell), Fredericton, NB; University of Saskatchewan (Schellenberg), Saskatoon, Sask
| | - Desmond Leddin
- London Health Sciences Centre (Shoesmith), London, Ont.; Sunnybrook Health Sciences Centre (Abrahao, Izenberg, Tandon, Zinman), Toronto, Ont.; Dalhousie University (Benstead, Leddin), Halifax, NS; McMaster University (Chum), Hamilton, Ont.; CHU de Québec-Université Laval (Dupre), Québec, Que.; University of Alberta (Johnston, Kalra), Edmonton, Alta.; Stan Cassidy Centre for Rehabilitation (O'Connell), Fredericton, NB; University of Saskatchewan (Schellenberg), Saskatoon, Sask
| | - Colleen O'Connell
- London Health Sciences Centre (Shoesmith), London, Ont.; Sunnybrook Health Sciences Centre (Abrahao, Izenberg, Tandon, Zinman), Toronto, Ont.; Dalhousie University (Benstead, Leddin), Halifax, NS; McMaster University (Chum), Hamilton, Ont.; CHU de Québec-Université Laval (Dupre), Québec, Que.; University of Alberta (Johnston, Kalra), Edmonton, Alta.; Stan Cassidy Centre for Rehabilitation (O'Connell), Fredericton, NB; University of Saskatchewan (Schellenberg), Saskatoon, Sask
| | - Kerri Schellenberg
- London Health Sciences Centre (Shoesmith), London, Ont.; Sunnybrook Health Sciences Centre (Abrahao, Izenberg, Tandon, Zinman), Toronto, Ont.; Dalhousie University (Benstead, Leddin), Halifax, NS; McMaster University (Chum), Hamilton, Ont.; CHU de Québec-Université Laval (Dupre), Québec, Que.; University of Alberta (Johnston, Kalra), Edmonton, Alta.; Stan Cassidy Centre for Rehabilitation (O'Connell), Fredericton, NB; University of Saskatchewan (Schellenberg), Saskatoon, Sask
| | - Anu Tandon
- London Health Sciences Centre (Shoesmith), London, Ont.; Sunnybrook Health Sciences Centre (Abrahao, Izenberg, Tandon, Zinman), Toronto, Ont.; Dalhousie University (Benstead, Leddin), Halifax, NS; McMaster University (Chum), Hamilton, Ont.; CHU de Québec-Université Laval (Dupre), Québec, Que.; University of Alberta (Johnston, Kalra), Edmonton, Alta.; Stan Cassidy Centre for Rehabilitation (O'Connell), Fredericton, NB; University of Saskatchewan (Schellenberg), Saskatoon, Sask
| | - Lorne Zinman
- London Health Sciences Centre (Shoesmith), London, Ont.; Sunnybrook Health Sciences Centre (Abrahao, Izenberg, Tandon, Zinman), Toronto, Ont.; Dalhousie University (Benstead, Leddin), Halifax, NS; McMaster University (Chum), Hamilton, Ont.; CHU de Québec-Université Laval (Dupre), Québec, Que.; University of Alberta (Johnston, Kalra), Edmonton, Alta.; Stan Cassidy Centre for Rehabilitation (O'Connell), Fredericton, NB; University of Saskatchewan (Schellenberg), Saskatoon, Sask
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Brunori P, Celani MG, Bignamini AA, Carlini M, Papetti R, Ercolani MV, Baiocco L, Armato G, Cantisani TA. People with amyotrophic lateral sclerosis and their caregivers: what matters most? BMJ Support Palliat Care 2021:bmjspcare-2020-002741. [PMID: 33832968 DOI: 10.1136/bmjspcare-2020-002741] [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: 10/22/2020] [Revised: 02/08/2021] [Accepted: 02/15/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVES The aim of this study is to collect the perspectives and values of people affected by amyotrophic lateral sclerosis (ALS) and their carers to offer clinicians, researchers and policymakers aspects which are precious in prioritising future research questions and reshaping care service organisations in a participatory approach. DESIGN AND SETTING Cohort study using ALS Umbria, the electronic database in Italy. PARTICIPANTS Eleven patients and 33 carers who agreed to participate in the study were divided into six focus groups by 'status' (patient or carer) and by four severity levels of 'burden of disease'. METHODS A semiquantitative analysis was undertaken. Each recorded group discussion was transcribed into text file and independently read by two psychologists and two ALS specialists to blindly identify needs, emotions and medical issues, which are the key semantic meanings expressed. Any disagreement in interpretation was resolved through consultation among authors. RESULTS Carers pronounced significantly more words related to patient's disease burden they cared. 40% of subjects expressed the need for 'assistance', regardless of the disease burden. 'Anger' alone represented more than 1/4 of all expressed emotions and was more common in patients than in carers (73% vs 36%, p=0.077). The most frequent medical issue expressed by 1/3 of participants was 'difficulty in communication'. CONCLUSION This study has given voice to the expectations of those affected by the burden of ALS. 'Welfare assistance', 'anger management' and resolution of 'difficulties in communication' represent issues that need to be analysed in a common prioritised research agenda with sensible and shared outcome measures to implement patient-centred medicine.
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Affiliation(s)
- Paola Brunori
- Neurophysiopathology, Perugia Hospital, Perugia, Italy
| | | | | | | | | | | | - Luisa Baiocco
- Neurophysiopathology, Perugia Hospital, Perugia, Italy
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Tobin K, Maguire S, Corr B, Normand C, Hardiman O, Galvin M. Discrete choice experiment for eliciting preference for health services for patients with ALS and their informal caregivers. BMC Health Serv Res 2021; 21:213. [PMID: 33750360 PMCID: PMC7941893 DOI: 10.1186/s12913-021-06191-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 02/18/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Amyotrophic Lateral Sclerosis (ALS) is a progressive neurodegenerative condition with a mean life expectancy of 3 years from first symptom. Understanding the factors that are important to both patients and their caregivers has the potential to enhance service delivery and engagement, and improve efficiency. The Discrete Choice Experiment (DCE) is a stated preferences method which asks service users to make trade-offs for various attributes of health services. This method is used to quantify preferences and shows the relative importance of the attributes in the experiment, to the service user. METHODS A DCE with nine choice sets was developed to measure the preferences for health services of ALS patients and their caregivers and the relative importance of various aspects of care, such as timing of care, availability of services, and decision making. The DCE was presented to patients with ALS, and their caregivers, recruited from a national multidisciplinary clinic. A random effects probit model was applied to estimate the impact of each attribute on a participant's choice. RESULTS Patients demonstrated the strongest preferences about timing of receiving information about ALS. A strong preference was also placed on seeing the hospice care team later rather than early on in the illness. Patients also indicated their willingness to consider the use of communication devices. Grouping by stage of disease, patients who were in earlier stages of disease showed a strong preference for receipt of extensive information about ALS at the time of diagnosis. Caregivers showed a strong preference for engagement with healthcare professionals, an attribute that was not prioritised by patients. CONCLUSIONS The DCE method can be useful in uncovering priorities of patients and caregivers with ALS. Patients and caregivers have different priorities relating to health services and the provision of care in ALS, and patient preferences differ based on the stage and duration of their illness. Multidisciplinary teams must calibrate the delivery of care in the context of the differing expectations, needs and priorities of the patient/caregiver dyad.
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Affiliation(s)
- Katy Tobin
- Global Brain Health Institute, School of Medicine, Trinity College Dublin, Dublin, Ireland.
| | - Sinead Maguire
- Department of Neurology, National Neuroscience Centre, Beaumont Hospital, Dublin, Ireland
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Bernie Corr
- Department of Neurology, National Neuroscience Centre, Beaumont Hospital, Dublin, Ireland
| | - Charles Normand
- Centre for Health Policy and Management, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Orla Hardiman
- Department of Neurology, National Neuroscience Centre, Beaumont Hospital, Dublin, Ireland
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
- FutureNeuro SFI Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Miriam Galvin
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
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Unmet supportive care needs mediate the relationship between functional status and quality of life in patients with amyotrophic lateral sclerosis. Palliat Support Care 2020; 17:650-654. [PMID: 31104645 DOI: 10.1017/s1478951519000221] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The aims of this study were to identify the unmet care needs and to examine the mediating effect of unmet supportive care needs in the relationship between functional status and quality of life (QOL) in Korean patients with amyotrophic lateral sclerosis (ALS). METHOD This was a cross-sectional study conducted among 186 patients with ALS recruited from a tertiary hospital in Seoul, South Korea. ALS patients' functional status, unmet supportive care needs, and QOL were assessed by Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised, the Amyotrophic Lateral Sclerosis Supportive Care Needs Instrument, and the Amyotrophic Lateral Sclerosis Specific Quality of Life - Revised Instrument, respectively. Mediation analysis was tested using Baron and Kenny's regression analysis and a Sobel test. RESULT The mean score for functional status was 33.35 ± 8.89; for unmet supportive care needs it was 2.40 ± 0.66; and for QOL it was 4.95 ± 1.29. Functional status was significantly correlated with unmet care needs and QOL. Unmet care needs satisfaction demonstrated a complete mediating effect on the relationship between functional status and QOL of the patients with ALS (β = -0.53, p < 0.001) and the effect was significant (Sobel test; Z = 5.48, p < 0.001). SIGNIFICANCE OF RESULTS Although QOL was negatively affected by the functional status in our sample, the relationship was fully mediated via unmet supportive care needs. Because there is no cure for ALS, and the condition is rapidly progressive with a lethal outcome, providing care by meeting patients' needs is a critical aspect of caring for these patients. Early assessment of supportive care needs, providing services, and referring ALS patients to appropriate resources could enhance their QOL.
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Arias Rojas EM, Carreño Moreno SP, Chaparro Díaz OL. Incertidumbre ante la enfermedad crónica. Revisión integrativa. REVISTA LATINOAMERICANA DE BIOÉTICA 2018. [DOI: 10.18359/rlbi.3575] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Este estudio tiene como objetivo integrar la evidencia acerca de la incertidumbre ante la enfermedad en el paciente con enfermedad crónica y su cuidador familiar, guiados por la teoría de la incertidumbre ante la enfermedad. Para esto se realizó una síntesis integrativa de la literatura durante los años 2007 a 2017. Se usaron las bases de datos Medline, Science Direct, Ovid Nursing, Scielo, Scopus, CINAHL y Psycinfo en los idiomas inglés y español. Para realizar la síntesis integrativa se incluyeron 46 publicaciones, con 21 estudios de tipo cualitativo, 19 cuantitativo, 2 mixtos y 4 revisiones. Los estudios se realizaron en su mayoría en pacientes con cáncer, enfermedades neurodegenerativas, fallos orgánicos, falla cardiaca, EPOC y en cuidados paliativos de distintas enfermedades. Dentro de las principales conclusiones del estudio se plantea que la persona con enfermedad crónica y su cuidador familiar desarrollan incertidumbre ante la enfermedad crónica debido a falencias en la educación acerca de la enfermedad y el cuidado, así como el soporte social que reciben del equipo de salud y de sus redes de apoyo.
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Disability in amyotrophic lateral sclerosis compared with traumatic brain injury using the World Health Organization Disability Assessment Schedule 2.0 and the International Classification of Functioning minimal generic set. Int J Rehabil Res 2018; 41:224-229. [PMID: 30095553 DOI: 10.1097/mrr.0000000000000292] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
We compared the functioning of two neurological patient groups, amyotrophic lateral sclerosis (ALS) and traumatic brain injury (TBI), using brief and validated International Classification of Functioning (ICF)-based tools. A 12-item World Health Organization Disability Assessment Schedule (WHODAS 2.0) questionnaire was mailed to ALS and TBI patients and their significant others 2 weeks before their appointment at an outpatient clinic of a university hospital. In addition, a neurologist filled in the ICF minimal generic set. Two years after diagnosis, no significant differences between the two diagnosis groups were found in overall functioning or in working ability using either patient or proxy WHODAS or physician-rated minimal generic set. In single items, however, clear differences were found. Patients and significant others rated household activities, mobility, and self-care as more impaired in the group with ALS, and learning, concentrating, and maintaining friendships in the group with TBI. There were no differences between the two diagnosis groups in the WHODAS items emotional functions, engaging in community, relating with strangers, or in working ability. Both brief ICF-based generic scales, WHODAS and the ICF generic set, could show differences between these patient groups with severe disability. The results of this study should promote assessment of disability with WHODAS 2.0 in ALS and TBI.
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