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Dorsemans AC, Coarelli G, Heinzmann A, Verdon B, De Luca M, Petit E, Pierron L, Levy-Soussan M, Durr A, Gargiulo M, Ewenczyk C. End-of-Life Discussions With Patients and Caregivers Affected By Neurogenetic Diseases. Neurol Clin Pract 2023; 13:e200199. [PMID: 37854177 PMCID: PMC10581072 DOI: 10.1212/cpj.0000000000200199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 09/06/2023] [Indexed: 10/20/2023]
Abstract
Background and Objectives No effective cure is available for neurogenetic diseases such as Huntington disease, spinocerebellar ataxias, and Friedreich ataxia, all of which cause progressive motor, cognitive, and psychiatric symptoms leading, in the long term, to severe communication (among other) impairments. In end-of-life situations, advanced directives (indications formulated by the patient about end-of-life choices) are one decision-making resource for relatives, caregivers, and health care professionals. Given the slowly progressive nature of these diseases, the related disabilities, and their hereditary component, patients, caregivers, and neurologists are often at a loss concerning the right course of action to take. Our study's aim was to explore patients' and caregivers' perceptions, needs, and expectations around anticipated end-of-life discussions and advanced directives. Methods DIRAGENE is an observational, cross-sectional, mixed-methods study with a patient-centered component and a primary caregiver-centered component. Observations include disease severity, psychosocial, and emotional scales; in-house questionnaires; and semidirected interviews. Results We included 124 participants, of which 81 were patients and 43 primary caregivers. Only 16% of the participants knew specifically about advanced directives and 7% had written documents vs 30% and 18% in the general French population, respectively, adjusted for age. Qualitative analysis of the interviews with 15 couples showed notable dissimilarities in ideas about advanced directives between patients and caregivers and that the underlying pathology, severity, and inheritability are less relevant factors regarding end-of-life discussions than age, environment, prior experiences with death, and history of family illness. Most patients (95%) and caregivers (98%) found that participating in the study was helpful in bringing awareness to end-of-life issues, wished to prioritize discussing them with loved ones, and requested assistance in managing them throughout the course of the disease. Discussion Being affected by severe neurogenetic diseases does not seem to prompt individuals to give much thought to end-of-life planning. However, patients and caregivers welcome comprehensive information and expect progressive support from trained health care professionals in having such discussions. Routine integration of these conversations into medical management through a holistic and adapted approach will benefit patients with illnesses with unfavorable long-term prognoses.
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Affiliation(s)
- Anne-Claire Dorsemans
- Sorbonne Université (A-CD, GC, AH, EP, AD, CE), Paris Brain Institute (ICM Institut du Cerveau), APHP, INSERM, CRNS; Université Paris Cité (A-CD, BV, MDL, MG), Laboratoire de Psychologie Clinique, Psychopathologie, Psychanalyse, Boulogne-Billancourt; Genetic Department (GC, AH, LP, MG, CE), Pitié-Salpêtrière Charles-Foix University Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP); Mobile Palliative Care Unit (ML-S), Pitié-Salpêtrière Charles-Foix University Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP); Université Paris Cité (ML-S), Team Science, Normes, Démocratie, SND UMR 8011, Sorbonne Université Lettres; and Institute of Myology (MG), Pitié-Salpêtrière University Hospital, Paris, France
| | - Giulia Coarelli
- Sorbonne Université (A-CD, GC, AH, EP, AD, CE), Paris Brain Institute (ICM Institut du Cerveau), APHP, INSERM, CRNS; Université Paris Cité (A-CD, BV, MDL, MG), Laboratoire de Psychologie Clinique, Psychopathologie, Psychanalyse, Boulogne-Billancourt; Genetic Department (GC, AH, LP, MG, CE), Pitié-Salpêtrière Charles-Foix University Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP); Mobile Palliative Care Unit (ML-S), Pitié-Salpêtrière Charles-Foix University Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP); Université Paris Cité (ML-S), Team Science, Normes, Démocratie, SND UMR 8011, Sorbonne Université Lettres; and Institute of Myology (MG), Pitié-Salpêtrière University Hospital, Paris, France
| | - Anna Heinzmann
- Sorbonne Université (A-CD, GC, AH, EP, AD, CE), Paris Brain Institute (ICM Institut du Cerveau), APHP, INSERM, CRNS; Université Paris Cité (A-CD, BV, MDL, MG), Laboratoire de Psychologie Clinique, Psychopathologie, Psychanalyse, Boulogne-Billancourt; Genetic Department (GC, AH, LP, MG, CE), Pitié-Salpêtrière Charles-Foix University Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP); Mobile Palliative Care Unit (ML-S), Pitié-Salpêtrière Charles-Foix University Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP); Université Paris Cité (ML-S), Team Science, Normes, Démocratie, SND UMR 8011, Sorbonne Université Lettres; and Institute of Myology (MG), Pitié-Salpêtrière University Hospital, Paris, France
| | - Benoit Verdon
- Sorbonne Université (A-CD, GC, AH, EP, AD, CE), Paris Brain Institute (ICM Institut du Cerveau), APHP, INSERM, CRNS; Université Paris Cité (A-CD, BV, MDL, MG), Laboratoire de Psychologie Clinique, Psychopathologie, Psychanalyse, Boulogne-Billancourt; Genetic Department (GC, AH, LP, MG, CE), Pitié-Salpêtrière Charles-Foix University Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP); Mobile Palliative Care Unit (ML-S), Pitié-Salpêtrière Charles-Foix University Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP); Université Paris Cité (ML-S), Team Science, Normes, Démocratie, SND UMR 8011, Sorbonne Université Lettres; and Institute of Myology (MG), Pitié-Salpêtrière University Hospital, Paris, France
| | - Manuella De Luca
- Sorbonne Université (A-CD, GC, AH, EP, AD, CE), Paris Brain Institute (ICM Institut du Cerveau), APHP, INSERM, CRNS; Université Paris Cité (A-CD, BV, MDL, MG), Laboratoire de Psychologie Clinique, Psychopathologie, Psychanalyse, Boulogne-Billancourt; Genetic Department (GC, AH, LP, MG, CE), Pitié-Salpêtrière Charles-Foix University Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP); Mobile Palliative Care Unit (ML-S), Pitié-Salpêtrière Charles-Foix University Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP); Université Paris Cité (ML-S), Team Science, Normes, Démocratie, SND UMR 8011, Sorbonne Université Lettres; and Institute of Myology (MG), Pitié-Salpêtrière University Hospital, Paris, France
| | - Elodie Petit
- Sorbonne Université (A-CD, GC, AH, EP, AD, CE), Paris Brain Institute (ICM Institut du Cerveau), APHP, INSERM, CRNS; Université Paris Cité (A-CD, BV, MDL, MG), Laboratoire de Psychologie Clinique, Psychopathologie, Psychanalyse, Boulogne-Billancourt; Genetic Department (GC, AH, LP, MG, CE), Pitié-Salpêtrière Charles-Foix University Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP); Mobile Palliative Care Unit (ML-S), Pitié-Salpêtrière Charles-Foix University Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP); Université Paris Cité (ML-S), Team Science, Normes, Démocratie, SND UMR 8011, Sorbonne Université Lettres; and Institute of Myology (MG), Pitié-Salpêtrière University Hospital, Paris, France
| | - Lucie Pierron
- Sorbonne Université (A-CD, GC, AH, EP, AD, CE), Paris Brain Institute (ICM Institut du Cerveau), APHP, INSERM, CRNS; Université Paris Cité (A-CD, BV, MDL, MG), Laboratoire de Psychologie Clinique, Psychopathologie, Psychanalyse, Boulogne-Billancourt; Genetic Department (GC, AH, LP, MG, CE), Pitié-Salpêtrière Charles-Foix University Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP); Mobile Palliative Care Unit (ML-S), Pitié-Salpêtrière Charles-Foix University Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP); Université Paris Cité (ML-S), Team Science, Normes, Démocratie, SND UMR 8011, Sorbonne Université Lettres; and Institute of Myology (MG), Pitié-Salpêtrière University Hospital, Paris, France
| | - Michèle Levy-Soussan
- Sorbonne Université (A-CD, GC, AH, EP, AD, CE), Paris Brain Institute (ICM Institut du Cerveau), APHP, INSERM, CRNS; Université Paris Cité (A-CD, BV, MDL, MG), Laboratoire de Psychologie Clinique, Psychopathologie, Psychanalyse, Boulogne-Billancourt; Genetic Department (GC, AH, LP, MG, CE), Pitié-Salpêtrière Charles-Foix University Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP); Mobile Palliative Care Unit (ML-S), Pitié-Salpêtrière Charles-Foix University Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP); Université Paris Cité (ML-S), Team Science, Normes, Démocratie, SND UMR 8011, Sorbonne Université Lettres; and Institute of Myology (MG), Pitié-Salpêtrière University Hospital, Paris, France
| | - Alexandra Durr
- Sorbonne Université (A-CD, GC, AH, EP, AD, CE), Paris Brain Institute (ICM Institut du Cerveau), APHP, INSERM, CRNS; Université Paris Cité (A-CD, BV, MDL, MG), Laboratoire de Psychologie Clinique, Psychopathologie, Psychanalyse, Boulogne-Billancourt; Genetic Department (GC, AH, LP, MG, CE), Pitié-Salpêtrière Charles-Foix University Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP); Mobile Palliative Care Unit (ML-S), Pitié-Salpêtrière Charles-Foix University Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP); Université Paris Cité (ML-S), Team Science, Normes, Démocratie, SND UMR 8011, Sorbonne Université Lettres; and Institute of Myology (MG), Pitié-Salpêtrière University Hospital, Paris, France
| | - Marcela Gargiulo
- Sorbonne Université (A-CD, GC, AH, EP, AD, CE), Paris Brain Institute (ICM Institut du Cerveau), APHP, INSERM, CRNS; Université Paris Cité (A-CD, BV, MDL, MG), Laboratoire de Psychologie Clinique, Psychopathologie, Psychanalyse, Boulogne-Billancourt; Genetic Department (GC, AH, LP, MG, CE), Pitié-Salpêtrière Charles-Foix University Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP); Mobile Palliative Care Unit (ML-S), Pitié-Salpêtrière Charles-Foix University Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP); Université Paris Cité (ML-S), Team Science, Normes, Démocratie, SND UMR 8011, Sorbonne Université Lettres; and Institute of Myology (MG), Pitié-Salpêtrière University Hospital, Paris, France
| | - Claire Ewenczyk
- Sorbonne Université (A-CD, GC, AH, EP, AD, CE), Paris Brain Institute (ICM Institut du Cerveau), APHP, INSERM, CRNS; Université Paris Cité (A-CD, BV, MDL, MG), Laboratoire de Psychologie Clinique, Psychopathologie, Psychanalyse, Boulogne-Billancourt; Genetic Department (GC, AH, LP, MG, CE), Pitié-Salpêtrière Charles-Foix University Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP); Mobile Palliative Care Unit (ML-S), Pitié-Salpêtrière Charles-Foix University Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP); Université Paris Cité (ML-S), Team Science, Normes, Démocratie, SND UMR 8011, Sorbonne Université Lettres; and Institute of Myology (MG), Pitié-Salpêtrière University Hospital, Paris, France
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Sokol LL, Nance M, Kluger BM, Yeh C, Paulsen JS, Smith AK, Bega D. Factors Associated With the Place of Death in Huntington Disease: Analysis of Enroll-HD. J Palliat Med 2023; 26:915-921. [PMID: 36706436 PMCID: PMC10316529 DOI: 10.1089/jpm.2022.0143] [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] [Accepted: 12/12/2022] [Indexed: 01/28/2023] Open
Abstract
Background: Most people prefer to die at home. Hospice is the standard in end-of-life care for people with Huntington disease (HD), a neurodegenerative genetic disorder that affects people in middle adulthood. Yet, we have little knowledge regarding the place of death for people with HD. Therefore, the current state of knowledge limits HD clinicians' ability to conduct high-quality goals of care conversations. Objectives: We sought to determine the factors associated with the place of death in people with HD. Design: We obtained cross-sectional data from Enroll-HD and included participants with a positive HD mutation of 36 or more CAG repeats. Results: Out of 16,120 participants in the Enroll-HD study, 536 were reported as deceased. The mean age at death was 60. The leading place of death was home (29%), followed by the hospital (23%). The adjusted odds ratio (aOR) of dying at a skilled nursing facility was significantly lower for those partnered (aOR: 0.48, confidence interval [95% CI]: 0.26-0.86). The aOR for dying on hospice compared to home was increased in a person with some college and above (aOR: 2.40, 95% CI: 1.21-4.75). Conclusions: Our data further suggest that models that predict the place of death for serious illnesses do not appear to generalize to HD. The distribution in the places of death within HD was not uniform. Our findings may assist HD clinicians in communication during goals of care conversations.
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Affiliation(s)
- Leonard L. Sokol
- The Ken and Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- McGaw Bioethics Scholars Program, Center for Bioethics and Humanities, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Division of Palliative Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Martha Nance
- Struthers Parkinson's Center, Golden Valley, Minnesota, USA
- Hennepin County Medical Center, Minneapolis, Minnesota, USA
| | - Benzi M. Kluger
- Departments of Neurology and Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Chen Yeh
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jane S. Paulsen
- Department of Neurology, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Alexander K. Smith
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Danny Bega
- The Ken and Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Division of Movement Disorders, The Ken and Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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3
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Boersema-Wijma DJ, van Duijn E, Heemskerk AW, van der Steen JT, Achterberg WP. Palliative care in advanced Huntington's disease: a scoping review. BMC Palliat Care 2023; 22:54. [PMID: 37138329 PMCID: PMC10155365 DOI: 10.1186/s12904-023-01171-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 04/12/2023] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND As Huntington's disease (HD) is a progressive disease for which there is no cure yet, patients in the advanced stage of HD may benefit from palliative care. OBJECTIVE To review the literature focusing on palliative care in advanced stage HD, and the level of evidence. METHODS Publications between 1993 and October 29th, 2021 from 8 databases (Embase, Web of Science, Cochrane, Emcare, PsycINFO, Academic Search Premier, PMC PubMed Central and Pubmed) were included. The literature was deductively classified based on topics that are part of the definition of palliative care, or as care-related topics that emerged from the literature. Levels of evidence I (high) - V (low) were determined as defined by the Joanna Briggs Institute. RESULTS Our search resulted in 333 articles, 38 of which were included. The literature covered four domains of palliative care: physical care, psychological care, spiritual care, and social care. Four other topics in the literature were: advance care planning, end-of-life needs assessments, pediatric HD care, and need for health care services. Most literature was underpinned by a low level of evidence, except for the topics on social care (Level III-V), advance care planning (Level II-V) and end-of-life needs assessments (Level II-III). CONCLUSIONS To deliver adequate palliative care in advanced HD, both general and HD-specific symptoms and problems need to be addressed. As the level of evidence in existing literature is low, further research is essential to improve palliative care and to meet patient's wishes and needs.
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Affiliation(s)
- Dorine J Boersema-Wijma
- Department of Public Health and Primary care, Leiden University Medical Center, Hippocratespad 21, Leiden, 2333 ZD, the Netherlands.
- Huntington Center of Expertise Topaz Overduin, Nachtegaallaan 5, Katwijk, 2225 SX, the Netherlands.
| | - Erik van Duijn
- Huntington Center of Expertise Topaz Overduin, Nachtegaallaan 5, Katwijk, 2225 SX, the Netherlands
| | - Anne-Wil Heemskerk
- Department of Public Health and Primary care, Leiden University Medical Center, Hippocratespad 21, Leiden, 2333 ZD, the Netherlands
- Huntington Center of Expertise Topaz Overduin, Nachtegaallaan 5, Katwijk, 2225 SX, the Netherlands
| | - Jenny T van der Steen
- Department of Public Health and Primary care, Leiden University Medical Center, Hippocratespad 21, Leiden, 2333 ZD, the Netherlands
- Radboudumc Alzheimer center and Department of Primary and Community Care, Radboud university medical center, Geert Grooteplein Noord 21, Nijmegen, 6500 HB, the Netherlands
| | - Wilco P Achterberg
- Department of Public Health and Primary care, Leiden University Medical Center, Hippocratespad 21, Leiden, 2333 ZD, the Netherlands
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Sokol LL, Troost JP, Bega D, Kluger BM, Prigerson HG, Nance M, Frank S, Perlmutter JS, Dayalu P, Cella D, Carlozzi NE. Advance Care Planning and Health-Related Quality of Life in Huntington Disease: Results from a Multicenter National Study. Palliat Med Rep 2023; 4:79-88. [PMID: 36969738 PMCID: PMC10036076 DOI: 10.1089/pmr.2022.0034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2023] [Indexed: 03/26/2023] Open
Abstract
Objective: With Huntington disease (HD), a fatal neurodegenerative disease where the prevalence of suicidal thoughts and behavior (STB) remains elevated as compared to other neurological disorders, it is unknown whether STB and health-related quality of life (HRQoL) affect plans for the end of life or more broadly, advance care planning (ACP). Conversely, it is unknown whether ACP would provoke future changes to STB and HRQoL. Therefore, we sought to evaluate whether STB and HRQoL patient-reported outcomes (PROs) contribute to ACP and whether ACP relates to changes in STB and HRQoL at 24 months. Methods: HD-validated clinician- and patient-assessments (i.e., HRQoL PROs) were obtained at baseline enrollment, 12 and 24 months through our multi-center study (HDQLIFE™) throughout the United States among people with premanifest, early-stage, and late-stage manifest HD. We used linear mixed-effects models to determine the relationships between STB and HRQoL at baseline and HDQLIFE End of Life Planning at follow-up. Separate linear mixed-effects models were used to assess the relationship between HDQLIFE End of Life Planning at baseline, and HRQoL and STB at 12 and 24 months. False discovery rate adjustments were used to account for multiple comparisons. Results: At baseline enrollment, STB and HRQoL were not related to HDQLIFE End of Life Planning at 12 or 24 months. Similarly, at baseline, HDQLIFE End of Life Planning demonstrated no association with STB or HRQoL at 12 or 24 months. Interpretation: STB and HRQoL PROs do not significantly affect patient engagement with ACP. Most importantly, engaging in ACP does not cause untoward effects on HRQoL or STB for this rare neurodegenerative disease where the lifetime prevalence of STB approaches 30%.
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Affiliation(s)
- Leonard L. Sokol
- The Ken and Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- McGaw Bioethics Scholars Program, Center for Bioethics and Humanities, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Division of Palliative Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
- Address correspondence to: Leonard L. Sokol, MD, Division of Palliative Medicine, Department of Medicine, University of California, San Francisco, Box 0125, 521 Parnassus Avenue, Floor 5, San Francisco, CA 94143, USA.
| | - Jonathan P. Troost
- Michigan Institute for Clinical and Health Research, University of Michigan, Ann Arbor, Michigan, USA
| | - Danny Bega
- The Ken and Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Benzi M. Kluger
- Department of Neurology, University of Rochester Medical Center, Rochester, New York, USA
- Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Holly G. Prigerson
- Cornell Center for Research on End-of-Life Care, Weill Cornell Medicine, New York, New York, USA
| | - Martha Nance
- Struthers Parkinson's Center, Golden Valley, Minnesota, USA
| | - Samuel Frank
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Joel S. Perlmutter
- Neurology, Radiology, Neuroscience, Physical Therapy and Occupational Therapy, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Praveen Dayalu
- Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA
| | - David Cella
- The Ken and Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Noelle E. Carlozzi
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
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Farag M, Salanio DM, Hearst C, Rae D, Tabrizi SJ. Advance Care Planning in Huntington's Disease. J Huntingtons Dis 2023; 12:77-82. [PMID: 36970913 DOI: 10.3233/jhd-220559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Advance care planning (ACP) is a useful tool that benefits adult patients, care providers, and surrogate decision makers, through providing opportunities for patients to consider, express, and formalize their beliefs, preferences, and wishes pertaining to decisions regarding future medical care at a time when they retain decision-making capacity. Early and timely consideration of ACP discussions is paramount in Huntington's disease (HD) given the potential challenges in ascertaining decision-making capacity in the advanced stages of the disease. ACP helps to empower and extend patient autonomy, providing clinicians and surrogate decision makers with reassurance that management is consistent with a patient's expressed wishes. Regular follow up is vital to establish consistency of decisions and wishes. We outline the framework of the dedicated ACP clinic integrated within our HD service to highlight the importance of a patient-centred and tailored care plan that fulfils the patient's expressed goals, preferences, and values.
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Affiliation(s)
- Mena Farag
- Huntington's Disease Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
- The National Hospital for Neurology and Neurosurgery (NHNN), London, UK
| | - Desiree M Salanio
- Huntington's Disease Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
- The National Hospital for Neurology and Neurosurgery (NHNN), London, UK
| | - Cara Hearst
- Huntington's Disease Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
- The National Hospital for Neurology and Neurosurgery (NHNN), London, UK
| | - Daniela Rae
- Huntington's Disease Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
- The National Hospital for Neurology and Neurosurgery (NHNN), London, UK
| | - Sarah J Tabrizi
- Huntington's Disease Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
- The National Hospital for Neurology and Neurosurgery (NHNN), London, UK
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Harrison MB, Morrissey DL, Dalrymple WA, D'Abreu A, Daly FN. Primary Palliative Care in Huntington's Disease. Mov Disord Clin Pract 2022; 10:55-63. [PMID: 36698999 PMCID: PMC9847290 DOI: 10.1002/mdc3.13589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 09/12/2022] [Accepted: 09/23/2022] [Indexed: 01/28/2023] Open
Abstract
Background Palliative care practices, including communication about patient-centered goals of care and advance care planning (ACP), have the potential to enhance care throughout the course of Huntington's disease (HD) and related disorders. The goal of our project was to develop a pilot program that integrates primary palliative care practices with interdisciplinary care for HD. Objectives (1) To train HD team members to facilitate goals of care and ACP conversations at all stages of HD; (2) To create materials for care planning in HD focused on patient-centered goals of care and health-related quality of life; and (3) To modify clinic workflow to include goals of care and ACP discussions. Methods We defined planning domains to expand care planning beyond end-of-life concerns. We created a patient and family guide to advance care planning in HD. We conducted VitalTalk communications training with the HD team. We modified the interdisciplinary clinic workflow to include ACP and developed an EMR template for documentation. Results After communication training, more team members felt well prepared to discuss serious news (12.5% to 50%) and manage difficult conversations (25% to 62.5%). The proportion of clinic visits including advance care planning discussions increased from 12.5% to 30.6% during the pilot phase. Conclusions Provision of primary palliative care for HD in an interdisciplinary clinic is feasible. Integration of palliative care practices into HD specialty care requires additional training and modification of clinic operations.
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Affiliation(s)
| | - Dana L. Morrissey
- Department of NeurologyUniversity of VirginiaCharlottesvilleVirginiaUSA
| | - W. Alex Dalrymple
- Department of NeurologyUniversity of VirginiaCharlottesvilleVirginiaUSA
| | - Anelyssa D'Abreu
- Department of NeurologyUniversity of VirginiaCharlottesvilleVirginiaUSA
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Pham Nguyen TP, Bravo L, Gonzalez-Alegre P, Willis AW. Geographic Barriers Drive Disparities in Specialty Center Access for Older Adults with Huntington's Disease. J Huntingtons Dis 2022; 11:81-89. [PMID: 35253771 DOI: 10.3233/jhd-210489] [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: 11/15/2022]
Abstract
BACKGROUND Huntington's Disease Society of America Centers of Excellence (HDSA COEs) are primary hubs for Huntington's disease (HD) research opportunities and accessing new treatments. Data on the extent to which HDSA COEs are accessible to individuals with HD, particularly those older or disabled, are lacking. OBJECTIVE To describe persons with HD in the U.S. Medicare program and characterize this population by proximity to an HDSA COE. METHODS We conducted a cross-sectional study of Medicare beneficiaries ages ≥65 with HD in 2017. We analyzed data on benefit entitlement, demographics, and comorbidities. QGis software and Google Maps Interface were employed to estimate the distance from each patient to the nearest HDSA COE, and the proportion of individuals residing within 100 miles of these COEs at the state level. RESULTS Among 9,056 Medicare beneficiaries with HD, 54.5% were female, 83.0% were white; 48.5% were ≥65 years, but 64.9% originally qualified for Medicare due to disability. Common comorbidities were dementia (32.4%) and depression (35.9%), and these were more common in HD vs. non-HD patients. Overall, 5,144 (57.1%) lived within 100 miles of a COE. Race/ethnicity, sex, age, and poverty markers were not associated with below-average proximity to HDSA COEs. The proportion of patients living within 100 miles of a center varied from < 10% (16 states) to > 90% (7 states). Most underserved states were in the Mountain and West Central divisions. CONCLUSION Older Medicare beneficiaries with HD are frequently disabled and have a distinct comorbidity profile. Geographical, rather than sociodemographic factors, define the HD population with limited access to HDSA COEs.
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Affiliation(s)
- Thanh Phuong Pham Nguyen
- Center for Pharmacoepidemiology Research and Training, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Department of Neurology Translational Center for Excellence for Neuroepidemiology and Neurological Outcomes Research, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Licia Bravo
- Xavier University of Louisiana, New Orleans, LA, USA.,Penn Access Summer Scholars Program, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Pedro Gonzalez-Alegre
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Raymond G. Perelman Center for Cellular & Molecular Therapy, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Allison W Willis
- Center for Pharmacoepidemiology Research and Training, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Department of Neurology Translational Center for Excellence for Neuroepidemiology and Neurological Outcomes Research, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.,Leonard Davis Institute of Health Economics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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8
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Advance Directive Documentation in a Huntington’s Disease Clinic: A Retrospective Chart Review. Tremor Other Hyperkinet Mov (N Y) 2022; 12:4. [PMID: 35136703 PMCID: PMC8815436 DOI: 10.5334/tohm.676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 01/13/2022] [Indexed: 11/20/2022] Open
Abstract
Background: Advance care planning (ACP) benefits patients and caregivers, yet it is underutilized and little is known about ACP in Huntington’s disease (HD) clinics. This study sought to determine the percentage of charts with AD documentation within an HD clinic. Methods: A retrospective chart review was conducted on a randomly selected sample of charts within an HD clinic. HD patients ≥18 y/o with a positive genetic test (≥40 CAG repeats) seen between January 2018 and June 2021 were included. Charts were reviewed for documentation of ADs either in provider notes or in the electronic medical records (EMR). Results: Ninety-one charts were reviewed (n = 91). Twenty-two charts (24.2%) mentioned a completed AD within a provider’s note; however, only nine (9.9%) had an AD available in the EMR. Cognitive status, primary insurance type, presence of dysphagia, and stage of disease were associated with documentation of completed ADs within a provider’s note. Discussion: The rate of completed ADs mentioned in a provider’s note (24.2%) was significantly lower than rates of AD completion in a previous study within the HD population (38%). Additional studies focused on improving rates AD completion are needed. Highlights Most patients with Huntington’s disease do not have documentation of completed advance directives (ADs) within their medical chart. In a retrospective chart review 24.2% of patients seen in a specialty HD clinic had documentation of ADs in a provider’s note and 9.9% had ADs available within the EMR.
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9
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El-Sourady M, Martin S, Wong HN, Carroll T. A Scoping Review of Palliative Care for Adults with Huntington's Disease: Current Practice and Future Directions. J Palliat Med 2021; 25:488-505. [PMID: 34847736 DOI: 10.1089/jpm.2021.0308] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Context: Huntington's disease (HD) is a neurodegenerative disorder characterized by mid-life onset, cognitive decline, and behavioral disturbance. Objective: We conducted a review of the end-of-life (EOL) experience of HD patients and their families. Methods: We searched 5 electronic databases. Eligible studies were published in English and contained outcomes related to PC, end-of-life (EOL), advance directives (ADs), symptom management, or hospice use for HD adults. Results: We screened 1566 studies, assessed 244 studies, and included 27 studies. Symptom Prevalence: Decedent data showed greater likelihood of pneumonia, choking, nutritional deficiencies, and skin ulcers. HD patients in hospice experienced pain, anxiety, nausea, and dyspnea. Psychiatric symptoms included dysphoria, agitation, irritability, apathy, and anxiety. Psychosis is associated with worse cognition, function, and behavioral disturbance. Symptom Management: Electroconvulsive therapy (ECT) and venlafaxine improved depression. Suicidal ideation improved with talking, self-management, medication, and discussing EOL wishes. Tetrabenazine improved chorea. Experience as Illness Progressed: HD patients require home care within two years of diagnosis. Only one study reported use of palliative care services (4%). HD patients are admitted to the hospital late in disease course and are often discharged to long-term care facilities (LTCF). Advance Care Planning: Two studies created tools to navigate EOL decisions. Most HD patients had EOL wishes; only familiarity with HD predicted having EOL wishes. Few had ADs or discussed EOL wishes with their families. Clinicians drive EOL discussions. Views on physician-assisted death (PAD) and euthanasia varied widely. Conclusions: Research is needed to further assess the PC needs of HD patients and to provide care recommendations.
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Affiliation(s)
- Maie El-Sourady
- Division of General Internal Medicine, Department of Medicine, Vanderbilt University, Nashville, Tennessee, USA
| | - Sara Martin
- Division of General Internal Medicine, Department of Medicine, Vanderbilt University, Nashville, Tennessee, USA
| | - Hong-Nei Wong
- Lane Medical Library & Knowledge Management Center, Stanford University School of Medicine, Stanford, California, USA
| | - Thomas Carroll
- Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA
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10
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Sokol LL, Bega D, Yeh C, Kluger BM, Lum HD. Disparities in Palliative Care Utilization Among Hospitalized People With Huntington Disease: A National Cross-Sectional Study. Am J Hosp Palliat Care 2021; 39:516-522. [PMID: 34291654 DOI: 10.1177/10499091211034419] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND People with Huntington's disease (HD) often become institutionalized and more frequently die away from the home setting. The reasons behind differences in end-of-life care are poorly understood. Less than 5% of people with HD report utilization of palliative care (PC) or hospice services, regardless of the lack of curative therapies for this neurodegenerative disease. It is unknown what factors are associated with in-patient specialty PC consultation in this population and how PC might be related to discharge disposition. OBJECTIVES To determine what HD-specific (e.g., psychosis) and serious illness-specific factors (e.g., resuscitation preferences) are associated with PC encounters in people with HD and explore how PC encounters are associated with discharge disposition. DESIGN We analyzed factors associated with PC consultation for people with HD using discharge data from the National Inpatient Sample and the Nationwide Inpatient Sample (NIS), Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality. An anonymized, cross-sectional, and stratified sample of 20% of United States hospitalizations from 2007 through 2014 were included using ICD-9 codes. RESULTS 8521 patients with HD were admitted to the hospital. Of those, 321 (3.8%) received specialty PC. Payer type, (specifically private insurer or other insurer as compared to Medicare), income, (specifically the top quartile as compared to the bottom quartile), mortality risk, D.N.R., aspiration pneumonia, and depression were significantly associated with PC in a multivariate model. Among those who received PC, the odds ratio (OR) of discharge to a facility was 0.43 (95% CI, 0.32-0.58), whereas the OR of discharge to home with services was 2.25 (95% CI 1.57-3.23), even after adjusting for possible confounders. CONCLUSIONS Among patients with HD, economic factors, depression, and serious illness-specific factors were associated with PC, and PC was associated with discharge disposition. These findings have implications for the adaptation of inpatient PC models to meet the needs of persons with HD.
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Affiliation(s)
- Leonard L Sokol
- The Ken and Ruth Davee Department of Neurology, 12244Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,McGaw Bioethics Scholars Program, Center for Bioethics and Humanities, 12244Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Danny Bega
- The Ken and Ruth Davee Department of Neurology, 12244Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Division of Movement Disorders, The Ken and Ruth Davee Department of Neurology, 12244Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Chen Yeh
- Department of Preventive Medicine, 12244Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Benzi M Kluger
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA.,Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Hillary D Lum
- Eastern Colorado VA Geriatric Research Education and Clinical Center, Rocky Mountain Regional VA Medical Center, Aurora, CO, USA.,Division of Geriatric Medicine, University of Colorado School of Medicine, Aurora, CO, USA
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11
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Sokol LL, Troost JP, Kluger BM, Applebaum AJ, Paulsen JS, Bega D, Frank S, Hauser JM, Boileau NR, Depp CA, Cella D, Carlozzi NE. Meaning and purpose in Huntington's disease: a longitudinal study of its impact on quality of life. Ann Clin Transl Neurol 2021; 8:1668-1679. [PMID: 34288600 PMCID: PMC8351386 DOI: 10.1002/acn3.51424] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 06/14/2021] [Accepted: 06/15/2021] [Indexed: 12/31/2022] Open
Abstract
Objective Previous work in Huntington’s disease (HD) has shown that a sense of meaning and purpose (M&P) is positively associated with positive affect and well‐being (PAW); however, it was unknown whether HD‐validated patient‐reported outcomes (PROs) influence this association and how M&P impacts PROs in the future. Our study was designed to examine if HD‐validated PROs moderate the relationship between M&P and PAW and to evaluate if baseline M&P predicts 12‐ and 24‐month changes in HD‐validated PROs. Methods This was a longitudinal, multicenter study to develop several PROs (e.g., specific for the physical, emotional, cognitive, and social domains) for people with HD (HDQLIFE). The sample consisted of 322 people with HD (n = 50 prodromal, n = 171 early‐stage manifest, and n = 101 late‐stage manifest HD). A single, multivariate linear mixed‐effects model was performed with PAW as the outcome predicted by main effects for M&P and several moderators (i.e., an HD‐validated PRO) and interactions between M&P and a given PRO. Linear‐mixed models were also used to assess if baseline M&P predicted HD‐validated PROs at 12 and 24 months. Results Higher M&P was positively associated with higher PAW regardless of the magnitude of symptom burden, as represented by HD‐validated PROs, and independent of disease stage. In our primary analysis, baseline M&P predicted increased PAW and decreased depression, anxiety, anger, emotional/behavioral disruptions, and cognitive decline at 12 and 24 months across all disease stages. Interpretation These findings parallel those seen in the oncology population and have implications for adapting and developing psychotherapeutic and palliative HD interventions.
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Affiliation(s)
- Leonard L Sokol
- The Ken and Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Center for Bioethics and Humanities, McGaw Bioethics Scholars Program, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jonathan P Troost
- Michigan Institute for Clinical and Health Research, University of Michigan, Ann Arbor, Michigan, USA
| | - Benzi M Kluger
- Departments of Neurology and Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Allison J Applebaum
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jane S Paulsen
- Department of Neurology, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Danny Bega
- The Ken and Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Samuel Frank
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Joshua M Hauser
- Department of Medicine, Feinberg School of Medicine and Palliative Care Service, Jesse Brown VA Medical Center, Chicago, Illinois, USA
| | - Nicholas R Boileau
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
| | - Colin A Depp
- Department of Psychiatry, University of California, San Diego, California, USA
| | - David Cella
- The Ken and Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Noelle E Carlozzi
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
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12
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Shah R, Lee SC, Strasser RB, Grossman C. An Australian Neuro-Palliative perspective on Huntington's disease: a case report. BMC Palliat Care 2021; 20:53. [PMID: 33794853 PMCID: PMC8017854 DOI: 10.1186/s12904-021-00744-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 03/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Huntington's Disease (HD) is an incurable, progressive neuro-degenerative disease. For patients with HD access to palliative care services is limited, with dedicated Neuro-Palliative Care Services rare in Australia. We discuss the experiences of and benefits to a patient with late-stage HD admitted to our Neuro-Palliative Care service. CASE PRESENTATION We present the case of a patient with a 16-year history of HD from time of initial genetic testing to admission to our Neuro-Palliative Care service with late-stage disease. CONCLUSIONS Given the prolonged, fluctuating and heterogenous HD trajectory, measures need to be implemented to improve earlier access to multi-specialty integrative palliative care services. Given the good outcomes of our case, we strongly advocate for the role of specialised Neuro-Palliative Care services to bridge the gap between clinical need and accessibility.
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Affiliation(s)
- Rajvi Shah
- Calvary Health Care Bethlehem, Melbourne, Australia.
| | - Sarah Cm Lee
- Calvary Health Care Bethlehem, Melbourne, Australia
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13
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End-of-Life Care Terminology: A Scoping Review. ANS Adv Nurs Sci 2021; 44:148-156. [PMID: 33181566 DOI: 10.1097/ans.0000000000000334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The purpose of this scoping review is to present an overview of terms found in publications associated with end-of-life care management that can impact decision making by patients, health care providers, and researchers. Connotative terminology and syntax can influence the decision-making approach and process. We examined 49 publications for positive, negative, and neutral connotations. We consistently found negative terminology in the publications. To advance the development of nursing knowledge regarding end-of-life care, researchers should be aware of their biases of terminology and syntax use. We propose modifications to language used in end-of-life care planning models and literature can improve care congruency.
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14
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Abstract
PURPOSE OF REVIEW This review summarizes the current state of evidence for palliative care (PC) in movement disorders, describes the application of PC to clinical practice, and suggests future research directions. RECENT FINDINGS PC needs are common in persons living with movement disorders and their families from the time of diagnosis through end-of-life and contribute to quality of life. Early advance care planning is preferred by patients, impacts outcomes and is promoted by PC frameworks. Systematic assessment of non-motor symptoms, psychosocial needs and spiritual/existential distress may address gaps in current models of care. Several complementary and emerging models of PC may be utilized to meet the needs of this population. A PC approach may identify and improve important patient and caregiver-centered outcomes. As a relatively new application of PC, there is a need for research to adapt, develop and implement approaches to meet the unique needs of this population.
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Affiliation(s)
- Zachary A Macchi
- Department of Neurology, University of Colorado, Aurora, CO Building 400, Mail Stop F429, 12469 E 17th Place, Aurora, CO, 80045, USA.
| | - Christopher G Tarolli
- Department of Neurology, University of Rochester, Rochester, NY, USA
- Center for Health + Technology, University of Rochester, Rochester, NY, USA
| | - Benzi M Kluger
- Department of Neurology, University of Rochester, Rochester, NY, USA
- Center for Health + Technology, University of Rochester, Rochester, NY, USA
- Department of Medicine, Palliative Care Division, University of Rochester, Rochester, NY, USA
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15
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Ekkel MR, Depla MFIA, Verschuur EML, Veenhuizen RB, Hertogh CMPM, Onwuteaka-Philipsen BD. Gaining insight into the views of outpatients with Huntington's disease regarding their future and the way they deal with their poor prognosis: a qualitative study. BMC Palliat Care 2021; 20:12. [PMID: 33435952 PMCID: PMC7802313 DOI: 10.1186/s12904-020-00706-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 12/28/2020] [Indexed: 11/10/2022] Open
Abstract
Background Huntington’s disease (HD) has a poor prognosis. Decision-making capacity and communication ability may become lost as the disease progresses. Therefore, HD patients are encouraged to engage in advance care planning (ACP). To improve ACP for HD patients, there is a need to better understand how these patients face their poor prognosis. Aim To gain insight into the views of HD patients who receive outpatient care regarding their future and the way they deal with the poor prognosis of their disease. Methods A qualitative study using semi-structured interviews with 12 patients with HD (7 outpatient clinic, 3 day care, 2 assisted living facility). Audio-recorded interviews were transcribed verbatim. Through reading and re-reading interviews, writing memos and discussions in the research team, strategies were identified. Results Three strategies emerged for facing a future with HD. Participants saw the future: 1) as a period that you have to prepare for; 2) as a period that you would rather not think about; 3) as a period that you do not have to worry about yet. Participants could adopt more than one strategy at a time. Even though participants realized that they would deteriorate and would need more care in the future, they tried to keep this knowledge ‘at a distance’, with the motivation of keeping daily life as manageable as possible. Conclusions Official ACP guidelines recommend discussing goals and preferences for future treatment and care, but patients tend to want to live in the present. Further research is needed to elucidate the best approach to deal with this discrepancy. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-020-00706-x.
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Affiliation(s)
- Marina R Ekkel
- Department of Medicine for Older People, Amsterdam Public Health Research Institute (APH), Amsterdam UMC, Vrije Universiteit Amsterdam, PO Box 7057, 1007 MB, Amsterdam, The Netherlands.
| | - Marja F I A Depla
- Department of Medicine for Older People, Amsterdam Public Health Research Institute (APH), Amsterdam UMC, Vrije Universiteit Amsterdam, PO Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - Els M L Verschuur
- School of Health Studies, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Ruth B Veenhuizen
- Department of Medicine for Older People, Amsterdam Public Health Research Institute (APH), Amsterdam UMC, Vrije Universiteit Amsterdam, PO Box 7057, 1007 MB, Amsterdam, The Netherlands.,Huntington Expert Centre Atlant, Apeldoorn, The Netherlands
| | - Cees M P M Hertogh
- Department of Medicine for Older People, Amsterdam Public Health Research Institute (APH), Amsterdam UMC, Vrije Universiteit Amsterdam, PO Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - Bregje D Onwuteaka-Philipsen
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute (APH), Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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