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Pollack LR, Downey L, Nomitch JT, Lee RY, Engelberg RA, Weiss NS, Kross EK, Khandelwal N. Factors Associated with Costly Hospital Care among Patients with Dementia and Acute Respiratory Failure. Ann Am Thorac Soc 2024; 21:907-915. [PMID: 38323911 PMCID: PMC11160134 DOI: 10.1513/annalsats.202308-694oc] [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: 08/10/2023] [Accepted: 02/05/2024] [Indexed: 02/08/2024] Open
Abstract
Rationale: Understanding contributors to costly and potentially burdensome care for patients with dementia is of interest to healthcare systems and may facilitate efforts to promote goal-concordant care. Objective: To identify risk factors, in particular whether an early goals-of-care discussion (GOCD) took place, for high-cost hospitalization among patients with dementia and acute respiratory failure. Methods: We conducted an electronic health record-based retrospective cohort study of 298 adults with dementia hospitalized with respiratory failure (receiving ⩾48 h of mechanical ventilation) within an academic healthcare system. We collected demographic and clinical characteristics, including clinical markers of advanced dementia (weight loss, pressure ulcers, hypernatremia, mobility limitations) and intensive care unit (ICU) service (medical, surgical, neurologic). We ascertained whether a GOCD was documented within 48 hours of ICU admission. We used logistic regression to identify patient characteristics associated with high-cost hospitalization measured using the hospital system accounting database and defined as total cost in the top third of the sample (⩾$145,000). We examined a path model that included hospital length of stay as a final mediator between exposure variables and high-cost hospitalization. Results: Patients in the sample had a median age of 71 (IQR, 62-79) years. Approximately half (49%) were admitted to a medical ICU, 29% to a surgical ICU, and 22% to a neurologic ICU. More than half (59%) had a clinical indicator of advanced dementia. A minority (31%) had a GOCD documented within 48 hours of ICU admission; those who did had a 50% lower risk of a high-cost hospitalization (risk ratio, 0.50; 95% confidence interval, 0.2-0.8). Older age, limited English proficiency, and nursing home residence were associated with a lower likelihood of high-cost hospitalization, whereas greater comorbidity burden and admission to a surgical or neurologic ICU compared with a medical ICU were associated with a higher likelihood of high-cost hospitalization. Conclusions: Early GOCDs for patients with dementia and respiratory failure may promote high-value care by ensuring aggressive and costly life support interventions are aligned with patients' goals. Future work should focus on increasing early palliative care delivery for patients with dementia and respiratory failure, in particular in surgical and neurologic ICU settings.
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Affiliation(s)
- Lauren R. Pollack
- Division of Pulmonary, Critical Care, and Sleep Medicine
- Cambia Palliative Care Center of Excellence, UW Medicine, Seattle, Washington
| | - Lois Downey
- Cambia Palliative Care Center of Excellence, UW Medicine, Seattle, Washington
| | - Jamie T. Nomitch
- Division of Pulmonary, Critical Care, and Sleep Medicine
- Cambia Palliative Care Center of Excellence, UW Medicine, Seattle, Washington
| | - Robert Y. Lee
- Division of Pulmonary, Critical Care, and Sleep Medicine
- Cambia Palliative Care Center of Excellence, UW Medicine, Seattle, Washington
| | - Ruth A. Engelberg
- Division of Pulmonary, Critical Care, and Sleep Medicine
- Cambia Palliative Care Center of Excellence, UW Medicine, Seattle, Washington
| | | | - Erin K. Kross
- Division of Pulmonary, Critical Care, and Sleep Medicine
- Cambia Palliative Care Center of Excellence, UW Medicine, Seattle, Washington
| | - Nita Khandelwal
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington; and
- Cambia Palliative Care Center of Excellence, UW Medicine, Seattle, Washington
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Paladino J, Ritchie C. Meeting the Communication and Care Planning Needs of Patients and Caregivers Affected by Dementia from the Time of Diagnosis. J Palliat Med 2024. [PMID: 38770630 DOI: 10.1089/jpm.2024.0144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024] Open
Affiliation(s)
- Joanna Paladino
- Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Christine Ritchie
- Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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Thomas PT, Kumar GS, Baby P, Vengalil S, Srijithesh PR, Yamini BK, Netravathi M, Yadav R, Pandian RD, Gupta A, Alladi S, Nalini A. Outpatient Neuropalliative Care Services in a Tertiary Hospital Setting. Ann Indian Acad Neurol 2024; 27:332-334. [PMID: 38819430 DOI: 10.4103/aian.aian_901_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 02/13/2024] [Indexed: 06/01/2024] Open
Affiliation(s)
- Priya T Thomas
- Department of Psychiatric Social Work, NIMHANS, Bengaluru, Karnataka, India
| | - Gargi S Kumar
- Department of Neuropalliative and Supportive Care Project, NIMHANS, Bengaluru, Karnataka, India
| | - Priya Baby
- Department of College of Nursing, NIMHANS, Bengaluru, Karnataka, India
| | - Seena Vengalil
- Department of Neurology, NIMHANS, Bengaluru, Karnataka, India
| | - P R Srijithesh
- Department of Neurology, NIMHANS, Bengaluru, Karnataka, India
| | - B K Yamini
- Department of Speech Pathology and Audiology, NIMHANS, Bengaluru, Karnataka, India
| | - M Netravathi
- Department of Neurology, NIMHANS, Bengaluru, Karnataka, India
| | - Ravi Yadav
- Department of Neurology, NIMHANS, Bengaluru, Karnataka, India
| | | | - Anupam Gupta
- Department of Neurorehabilitation, NIMHANS, Bengaluru, Karnataka, India
| | - Suvarna Alladi
- Department of Neurology, NIMHANS, Bengaluru, Karnataka, India
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Filipe CB, Carreira NR, Reis-Pina P. Optimizing breathlessness management in amyotrophic lateral sclerosis: insights from a comprehensive systematic review. BMC Palliat Care 2024; 23:100. [PMID: 38622643 PMCID: PMC11020819 DOI: 10.1186/s12904-024-01429-z] [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: 01/11/2024] [Accepted: 04/08/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND Breathlessness is a prevalent symptom affecting the quality of life (QOL) of Amyotrophic Lateral Sclerosis (ALS) patients. This systematic review explored the interventions for controlling breathlessness in ALS patients, emphasizing palliative care (PALC), non-invasive ventilation (NIV), opioids, and non-pharmacological strategies. METHODS A comprehensive search of PubMed, Cochrane Library, and Web of Science databases was conducted. Eligibility criteria encompassed adults with ALS or motor neuron disease experiencing breathlessness. Outcomes included QOL and symptom control. Study designs comprised qualitative studies, cohort studies, and randomized controlled trials. RESULTS Eight studies were included, most exhibiting low bias risk, comprising one randomized controlled trial, three cohort studies, two comparative retrospective studies, and two qualitative studies (interviews). Most studies originated from Europe, with one from the United States of America. The participants totaled 3423, with ALS patients constituting 95.6%. PALC consultations significantly improved symptom assessment, advance care planning, and discussions about goals of care. NIV demonstrated efficacy in managing breathlessness, with considerations for device limitations. Opioids were effective, though predominantly studied in non-ALS patients. Non-pharmacological strategies varied in efficacy among patients. CONCLUSION The findings underscore the need for individualized approaches in managing breathlessness in ALS. PALC, NIV, opioids, and non-pharmacological strategies each play a role, with unique considerations. Further research, especially ALS-specific self-management studies, is warranted.
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Affiliation(s)
- Catarina Bico Filipe
- Faculty of Medicine, University of Lisbon, Avenida Professor Egas Moniz, Lisboa, 1649-028, Portugal
| | - Nuno Reis Carreira
- Faculty of Medicine, University of Lisbon, Avenida Professor Egas Moniz, Lisboa, 1649-028, Portugal
- North Lisboa Hospital Centre, Santa Maria Hospital, Lisboa, Portugal
| | - Paulo Reis-Pina
- Faculty of Medicine, University of Lisbon, Avenida Professor Egas Moniz, Lisboa, 1649-028, Portugal.
- Bento Menni Palliative Care Unit, Sintra, Portugal.
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Plys E, Grunberg VA, Vranceanu AM. Advancing Methodological Rigor for Psychosocial Aspects of Neuropalliative Care Interventions. J Palliat Care 2024; 39:92-96. [PMID: 38343071 PMCID: PMC10986462 DOI: 10.1177/08258597241232490] [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] [Indexed: 03/06/2024]
Abstract
Background: Neurological disorders (NDs) have unique biopsychosocial-spiritual features that impact patients and their families. As a result, the subspeciality of neuropalliative care (NPC) emerged within the past decade and has grown exponentially in research and practice. Given the cognitive, emotional, and behavioral changes associated with NDs, psychosocial components (eg, coping skills) of NPC interventions are essential for improving the quality of life for patients and families. However, psychosocial components of NPC interventions warrant more rigorous testing to improve their evidence base and their likelihood of implementation and dissemination. Aim: In this commentary, we provide methodological recommendations with the goal of improving scientific knowledge and rigor for psychosocial components of multicomponent NPC interventions in clinical trials. Results: We emphasize the need for transparent reporting of psychosocial intervention components; using established models of intervention development to guide the development and testing of multicomponent NPC interventions; identifying mechanisms of action for psychosocial outcomes; and choosing psychometrically sound measures for mechanisms and outcomes. Conclusions: Given the importance of psychosocial care to the holistic NPC model, rigorous testing of psychosocial components of NPC interventions is a high priority for clinical investigators to advance the evidence base and practice of NPC.
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Affiliation(s)
- Evan Plys
- Center for Health Outcomes and Interdisciplinary Research, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Victoria A. Grunberg
- Center for Health Outcomes and Interdisciplinary Research, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Division of Newborn Medicine, MassGeneral for Children, Boston, MA, USA
| | - Ana-Maria Vranceanu
- Center for Health Outcomes and Interdisciplinary Research, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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Panicker P, Iype T, Appireddy R, Ajithan A, Lijimol AS, Sasikumar A, Dileep R, Vijaya N, Booth C, Rajagopal MR. Palliative care needs of stroke patients at a tertiary care center in South India. J Neurosci Rural Pract 2024; 15:349-356. [PMID: 38746512 PMCID: PMC11090594 DOI: 10.25259/jnrp_7_2024] [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: 01/05/2024] [Accepted: 03/03/2024] [Indexed: 05/16/2024] Open
Abstract
Objectives Stroke survivors have palliative care needs in multiple domains, which are overlooked. Accurate estimation of these is pivotal in ensuring proper rehabilitation and planning interventions to improve quality of life (QoL). We aimed to assess the palliative care needs of stroke patients in various domains in a structured manner at the neurology service of a tertiary care center in South India. Materials and Methods Seventy-five consecutive stroke patients presenting to the neurology service were recruited over six months with assessment across various domains including symptom burden, physical domain, activities of daily living (ADL), psychiatric/psychological domain, and QoL at baseline and with follow-up at one month and three months. Results Despite improvement in the conventional stroke impairment measures among stroke survivors, there were significant unmet needs across various domains; 98% were severely or entirely dependent on ADL at three-month follow-up; and pain and insomnia were the most frequent (33% incidence) troubling symptoms encountered. There were substantial mental health related issues. The QoL measurement tools employed were the stroke impact assessment questionnaire (SIAQ), a novel tool and the World Health Organization Quality Of Life Brief Version (WHO-QOL-BREF). SIAQ scores at one month showed that 19 patients (42.22%) had their QoL severely affected, and 36 patients (80%) showed the same trend at the three-month follow-up. WHO-BREF scores showed that 27 (62%) did not report good QoL, and 32 (73%) were found not to be satisfied with their health at a one-month follow-up. Conclusion There is a significant burden of unmet palliative care needs among stroke survivors in India across various domains.
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Affiliation(s)
- Praveen Panicker
- Department of Neurology, Government Medical College, Thiruvananthapuram, Kerala, India
| | - Thomas Iype
- Department of Neurology, Government Medical College, Thiruvananthapuram, Kerala, India
| | - Ramana Appireddy
- Department of Neurology, Queens University, Queens University School of Medicine, Kingston, Ontario, Canada
| | - Ayana Ajithan
- Department of Palliative Care, Pallium India, Thiruvananthapuram, Kerala, India
| | - A. S. Lijimol
- Department of Palliative Care, Pallium India, Thiruvananthapuram, Kerala, India
| | - Asha Sasikumar
- Department of Nursing, Government Medical College Thiruvananthapuram, Medical College, Thiruvananthapuram, Kerala, India
| | - R. Dileep
- Department of Neurology, Government Medical College, Thiruvananthapuram, Kerala, India
| | - Nirmala Vijaya
- Department of Palliative Care, Pallium India, Thiruvananthapuram, Kerala, India
| | - Chris Booth
- Department of Oncology, Queens University, Queens University School of Medicine, Kingston, Ontario, Canada
| | - M. R. Rajagopal
- Department of Palliative Care, Pallium India, Thiruvananthapuram, Kerala, India
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Sarmet M, Santos DB, Mangilli LD, Million JL, Maldaner V, Zeredo JL. Chronic respiratory failure negatively affects speech function in patients with bulbar and spinal onset amyotrophic lateral sclerosis: retrospective data from a tertiary referral center. LOGOP PHONIATR VOCO 2024; 49:17-26. [PMID: 35767076 DOI: 10.1080/14015439.2022.2092209] [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: 03/22/2021] [Revised: 02/04/2022] [Accepted: 06/15/2022] [Indexed: 10/17/2022]
Abstract
Background: Although dysarthria and respiratory failure are widely described in literature as part of the natural history of Amyotrophic lateral sclerosis (ALS), the specific interaction between them has been little explored.Aim: To investigate the relationship between chronic respiratory failure and the speech of ALS patients.Materials and methods: In this cross-sectional retrospective study we reviewed the medical records of all patients diagnosed with ALS that were accompanied by a tertiary referral center. In order to determine the presence and degree of speech impairment, the Amyotrophic Lateral Sclerosis Functional Rating Scale-revised (ALSFRS-R) speech sub-scale was used. Respiratory function was assessed through spirometry and through venous blood gasometry obtained from a morning peripheral venous sample. To determine whether differences among groups classified by speech function were significant, maximum and mean spirometry values of participants were compared using multivariate analysis of variance (MANOVA) with Tukey's post hoc test.Results: Seventy-five cases were selected, of which 73.3% presented speech impairment and 70.7% respiratory impairment. Respiratory and speech functions were moderately correlated (seated FVC r = 0.64; supine FVC r = 0.60; seated FEV1 r = 0.59 and supine FEV1 r = 0.54, p < .001). Multivariable logistic regression revealed that the following variables were significantly associated with the presence of speech impairment after adjusting for other risk factors: seated FVC (odds ratio [OR] = 0.862) and seated FEV1 (OR = 1.106). The final model was 81.1% predictive of speech impairment. The presence of daytime hypercapnia was not correlated to increasing speech impairment.Conclusion: The restrictive pattern developed by ALS patients negatively influences speech function. Speech is a complex and multifactorial process, and lung volume presents a pivotal role in its function. Thus, we were able to find that lung volumes presented a significant correlation to speech function, especially in those with bulbar onset and respiratory impairment. Neurobiological and physiological aspects of this relationship should be explored in further studies with the ALS population.
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Affiliation(s)
- Max Sarmet
- Graduate Department of Health Science and Technology, University of Brasília (UnB), Brasília, Brazil
- Hospital de Apoio de Brasília (HAB), Tertiary Referral Center of Neuromuscular Diseases, Brasília, Brazil
| | - Dante Brasil Santos
- Hospital de Apoio de Brasília (HAB), Tertiary Referral Center of Neuromuscular Diseases, Brasília, Brazil
- UniEvangélica, Graduate Program of Human Movement and Rehabilitation, Anápolis, Brazil
| | | | - Janae Lyon Million
- Department of Human Biology, University of California Santa Cruz, Santa Cruz, CA, United States of America
| | - Vinicius Maldaner
- Hospital de Apoio de Brasília (HAB), Tertiary Referral Center of Neuromuscular Diseases, Brasília, Brazil
- UniEvangélica, Graduate Program of Human Movement and Rehabilitation, Anápolis, Brazil
| | - Jorge L Zeredo
- Graduate Department of Health Science and Technology, University of Brasília (UnB), Brasília, Brazil
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Wilson E, Baker A, Stockley L, Allgar V, Richfield E. Place of death in Parkinson's disease and related disorders in England and Wales: post-pandemic trends and implications for care planning. Age Ageing 2024; 53:afae048. [PMID: 38497239 DOI: 10.1093/ageing/afae048] [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: 07/07/2023] [Indexed: 03/19/2024] Open
Abstract
BACKGROUND With growing emphasis on palliative care for neurodegenerative conditions, understanding trends in place of death helps improve quality of end-of-life care for people with Parkinson's disease and related disorders (PDRDs), focusing allocation of resources and training and identifying inequalities. OBJECTIVES Review national and regional place of death trends for people with PDRD including pre- and post-pandemic trends. METHODS Mortality data for England and Wales (March 2018 and July 2022) were analysed with summary statistics and interrupted time series, exploring place of death for those who died with PDRD, with and without coexisting dementia, with reference to all deaths in England and Wales. RESULTS Of 2,415,566 adult deaths, 56,790 included mention of PDRD. Hospital deaths were most common in people with PDRD (39.17%), followed by care homes (38.84%). People with PDRD were half as likely to die in hospice compared with the general population (2.03 vs 4.94%). Proportion of care home deaths fell significantly after March 2020 (40.6-37%, P = 0.035). Regionally, London was an outlier with a lower proportion of deaths occurring in care homes with a higher proportion of hospital deaths. CONCLUSION Place of death for people with PDRD is changing, with more hospice and home deaths. People with PDRD, particularly those with co-existent dementia, are less likely to access inpatient hospice care than the general population. Since the COVID-19 pandemic, the proportion of care home deaths has reduced significantly with an increase in home deaths, with implications for service and resource allocation.
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Affiliation(s)
- Elisabeth Wilson
- Medicine for Older People, North Bristol NHS Trust, Bristol BS105NB, UK
| | - Amy Baker
- Medical Statistics Group, Peninsula Medical School, University of Plymouth, Plymouth Science Park, Plymouth PL6 8BX, UK
| | - Lauren Stockley
- Medical Statistics Group, Peninsula Medical School, University of Plymouth, Plymouth Science Park, Plymouth PL6 8BX, UK
| | - Victoria Allgar
- Medical Statistics Group, Peninsula Medical School, University of Plymouth, Plymouth Science Park, Plymouth PL6 8BX, UK
| | - Edward Richfield
- Medicine for Older People, North Bristol NHS Trust, Bristol BS105NB, UK
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Garon M, Weck C, Rosqvist K, Odin P, Schrag A, Krikmann Ü, Pedrosa DJ, Antonini A, Lorenzl S, Martins Pereira S, Paal P. A systematic practice review: Providing palliative care for people with Parkinson's disease and their caregivers. Palliat Med 2024; 38:57-68. [PMID: 38054428 PMCID: PMC10798024 DOI: 10.1177/02692163231214408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
BACKGROUND People with Parkinson's disease has significant and increasing physical, psychosocial and spiritual needs, as well as problems with coordination and continuity of care. Despite the benefits that palliative care could offer, there is no consensus on how it should be delivered. AIM The aim of this study is to provide a pragmatic overview of the evidence to make clinical recommendations to improve palliative care for people with Parkinson's disease and their caregivers. DESIGN A systematic review method was adopted to determine the strength of evidence, supported by feedback from an expert panel, to generate the 'do', 'do not do' and 'do not know' recommendations for palliative care. DATA SOURCES Searches were conducted via OVID to access CINAHL, MEDLINE, EMBASE and the Cochrane Library from 01/01/2006 to 31/05/2021. An additional search was conducted in December 2022. The search was limited to articles that included empirical studies of approaches to enabling palliative care. RESULTS A total of 62 studies met inclusion criteria. There is evidence that education about palliative care and movement disorders is essential. palliative care should be multi-disciplinary, individualised and coordinated. Proactive involvement and support of caregivers throughout the illness is recommended. Limited data provide referral indicators for palliative care integration. Discussions about advance care planning should be held early. CONCLUSIONS Consideration of palliative care integration based on symptom burden and personal preferences, coordination and continuity of care are needed to maintain the quality of life of people with Parkinson's disease and their caregivers.
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Affiliation(s)
- Michela Garon
- Parkinson and Movement Disorders Unit, Study Center for Neurodegeneration (CESNE), Department of Neuroscience, University of Padua, Via Giustiniani 2, 35128, Padua, Italy
- Padua Neuroscience Center (PNC), University of Padua, 35131, Padua, Italy
- Parkinson’s Disease and Movement Disorders Unit, Center for Rare Neurological Diseases (ERN-RND), Department of Neurosciences, University of Padova, Padova, Italy
| | - Christiane Weck
- Institute of Palliative Care, Paracelsus Medical University, Salzburg, Austria
| | - Kristina Rosqvist
- Division of Neurology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Neurology, Rehabilitation Medicine, Memory and Geriatrics, Skane University Hospital, Lund, Sweden
| | - Per Odin
- Division of Neurology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Neurology, Rehabilitation Medicine, Memory and Geriatrics, Skane University Hospital, Lund, Sweden
| | - Anette Schrag
- Department of Clinical Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Ülle Krikmann
- Department of Neurology and Neurosurgery, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
| | - David J Pedrosa
- Philipps University Marburg, Marburg, Germany
- Center for Mind, Brain and Behavior, Marburg, German
| | - Angelo Antonini
- Parkinson and Movement Disorders Unit, Study Center for Neurodegeneration (CESNE), Department of Neuroscience, University of Padua, Via Giustiniani 2, 35128, Padua, Italy
- Padua Neuroscience Center (PNC), University of Padua, 35131, Padua, Italy
- Parkinson’s Disease and Movement Disorders Unit, Center for Rare Neurological Diseases (ERN-RND), Department of Neurosciences, University of Padova, Padova, Italy
| | - Stefan Lorenzl
- Institute of Palliative Care, Paracelsus Medical University, Salzburg, Austria
| | - Sandra Martins Pereira
- Ethics and Sustainability Research Area: Palliative Care Research, CEGE: Research Centre in Management and Economics, Católica Porto Business School, Universidade Católica Portuguesa, Porto, Portugal
| | - Piret Paal
- Institute of Palliative Care, Paracelsus Medical University, Salzburg, Austria
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Swerts D, Araújo A, Vulcano P, Prado B, Miyake C, Docema R, Hwang H, Peres M. Neuropalliative care in a tertiary-level hospital. BMJ Support Palliat Care 2023:spcare-2023-004499. [PMID: 38123312 DOI: 10.1136/spcare-2023-004499] [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: 07/15/2023] [Accepted: 11/29/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVES Palliative care in neurology is a recent specialty to improve the quality of life of patients with severe neurological diseases. This study aims to determine the frequency of neurological inpatients who had indication of palliative care, and evaluate the symptomatology, demographic profile, the need for supportive measures, advance directives for life and medical history of patients in a tertiary hospital in Brazil. METHODS This cross-sectional analytical study evaluated all patients admitted to the neurological semi-intensive care unit (ICU) at Hospital Israelita Albert Einstein with neurological conditions from February through August 2022. The Palliative Performance Scale (weight loss greater than 5% associated with body changes and a negative response to the question: 'Would you be surprised if the patient died within 1 year?') was used to indicate palliative care. Patients were divided into three groups: patients with palliative care needs (groupindication), patients without palliative care needs (groupwithout indication) and patients who received at least one assessment of a palliative care team (grouppalliative). Demographic data were analysed using the Χ2 test for qualitative and Kruskal-Wallis test for quantitative variables. RESULTS Of the 198 patients included in the study, 115 (58%) had palliative care needs. Only 6.9% received assessment by the palliative care team, and 9.56% had advance directives in their medical records. Patients in groupindication had a higher prevalence of symptoms, such as fatigue, depression, shortness of breath and lack of appetite, and required more supportive measures, such as oxygen therapy, enteral/parenteral nutrition, admissions at ICU and days in hospital. CONCLUSION Despite the high demand for palliative care in neurology, few patients receive this treatment, resulting in decreased quality of care. Therefore, greater integration and discussion of palliative care in neurology are needed.
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Affiliation(s)
- Diego Swerts
- Department of Neurology, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - Ana Araújo
- Department of Neurology, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - Polyana Vulcano
- Department of Neurology, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - Bernard Prado
- Palliative, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - Caroline Miyake
- Department of Neurology, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - Rafael Docema
- Department of Neurology, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - Hye Hwang
- Department of Neurology, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - Mario Peres
- Department of Neurology, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
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McDarby M, Silverstein HI, Rosa WE, Parker PA, Carpenter BD. Patient and caregiver questions and clinician responses during initial outpatient neuropalliative care appointments. PEC INNOVATION 2023; 3:100207. [PMID: 37700766 PMCID: PMC10494256 DOI: 10.1016/j.pecinn.2023.100207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 08/23/2023] [Accepted: 08/30/2023] [Indexed: 09/14/2023]
Abstract
Objective Open communication during appointments exemplifies person-centered care. The current study characterized questions asked by persons with neurologic illnesses and their caregivers-and clinicians' responses to those questions-during initial outpatient palliative care appointments. Methods We coded type (direct or indirect) and topic of questions stated by patients and their caregivers in audio recordings from 38 initial outpatient palliative care appointments. We also coded the completeness and quality features of clinicians' responses. Results Patients and caregivers stated 556 total questions; most were direct questions (79.7%) and primarily about symptoms, treatment, and lifestyle issues. Clinicians responded to more than 90% of all questions. Responses to both question types were similar in completeness and quality, but clinicians more frequently offered support in response to direct questions and gave recommendations in response to indirect questions. Conclusion Persons with neurologic illnesses and their caregivers use different question types to obtain information about symptoms and treatment during initial palliative care appointments. Results may guide clinician training and patient education for optimizing information exchange in palliative care. Innovation This study is the first to explore patient and caregiver use of indirect questions in neuropalliative care appointments and the quality of clinicians' responses to those questions.
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Affiliation(s)
- Meghan McDarby
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
| | - Hannah I. Silverstein
- Department of Psychological and Brain Sciences, Washington University in St. Louis, St. Louis, MO, United States of America
| | - William E. Rosa
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
| | - Patricia A. Parker
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
| | - Brian D. Carpenter
- Department of Psychological and Brain Sciences, Washington University in St. Louis, St. Louis, MO, United States of America
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Harrison DJ, Wu E, Singh R, Ghaith S, Suarez-Meade P, Brown NJ, Sherman WJ, Robinson MT, Lin MP, Lawton MT, Quinones-Hinojosa A. Primary and Specialist Palliative Care in Neurosurgery: A Narrative Review and Bibliometric Analysis of Glioblastoma and Stroke. World Neurosurg 2023; 180:e250-e257. [PMID: 37739173 DOI: 10.1016/j.wneu.2023.09.048] [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: 09/07/2023] [Accepted: 09/10/2023] [Indexed: 09/24/2023]
Abstract
OBJECTIVE Due to the increased demand for palliative care (PC) in recent years, a model has been proposed to divide PC into primary PC and specialist PC. This article aimed to delineate the indications for primary and specialist PC within 2 common neurosurgical conditions-glioblastoma (GBM) and stroke. METHODS A systematic review and bibliometric analysis was conducted to better appreciate the practice trends in PC utilization for GBM and stroke patients using several databases. RESULTS There were 70 studies on PC for GBM, the majority of which related to patient preference (22 [31%]). During 1999-2022, there was significant growth in publications per year on this topic at a rate of approximately 0.3 publications per year (P < 0.01). There were 44 studies on PC for stroke, the majority of which related to communication strategies (14 [32%]). During 1999-2022, there was no significant growth in stroke publications per year (P = 0.22). CONCLUSIONS Due to the progressively disabling neurological course of GBM, we suggest that a specialty PC team be used in conjunction with the neurosurgical team early in the disease trajectory while patients are still able to communicate their preferences, goals, and values. In contrast, short-term and long-term stages of management of stroke have differing implications for PC needs, with the short-term stage necessitating adept, time-sensitive communication between the patient, family, and care teams. Thus, we propose that primary PC should be included as a core competency in neurosurgery training, among other stroke specialists.
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Affiliation(s)
| | - Emily Wu
- Department of Neurosurgery, Mayo Clinic, Phoenix, Arizona, USA
| | - Rohin Singh
- Department of Neurosurgery, Mayo Clinic, Phoenix, Arizona, USA
| | - Summer Ghaith
- Department of Neurosurgery, Mayo Clinic, Phoenix, Arizona, USA
| | | | - Nolan J Brown
- Department of Neurosurgery, Mayo Clinic, Phoenix, Arizona, USA
| | - Wendy J Sherman
- Department of Neurology, Mayo Clinic, Jacksonville, Florida, USA
| | - Maisha T Robinson
- Department of Neurology, Mayo Clinic, Jacksonville, Florida, USA; Division of Palliative Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Michelle P Lin
- Department of Neurology, Mayo Clinic, Jacksonville, Florida, USA
| | - Michael T Lawton
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
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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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Ramsburg H, Creutzfeldt CJ. Integrating Palliative Care into the Neurointensive Care Unit. Neurocrit Care 2023; 39:555-556. [PMID: 37173561 DOI: 10.1007/s12028-023-01739-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 03/28/2023] [Indexed: 05/15/2023]
Affiliation(s)
- Hanna Ramsburg
- M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, PA, USA
| | - Claire J Creutzfeldt
- Department of Neurology, Harborview Medical Center and University of Washington, Seattle, WA, USA.
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15
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Gursahani R. Neuropalliative Care for India: Who, What, When, Where, Why, How? THE NATIONAL MEDICAL JOURNAL OF INDIA 2023; 35:321-324. [PMID: 37167521 DOI: 10.25259/nmji_35_6_321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Affiliation(s)
- Roop Gursahani
- Department of Neurology P.D. Hinduja National Hospital Mahim, Mumbai, Maharashtra, India
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16
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Mercadante S, Al-Husinat L. Palliative Care in Amyotrophic Lateral Sclerosis. J Pain Symptom Manage 2023; 66:e485-e499. [PMID: 37380145 DOI: 10.1016/j.jpainsymman.2023.06.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 05/25/2023] [Accepted: 06/21/2023] [Indexed: 06/30/2023]
Abstract
Amyotrophic lateral sclerosis (ALS) is an incurable neurodegenerative disease of the motor neurons. Given the evolutive characteristics of this disease, palliative care principles should be a foundation of ALS care. A multidisciplinary medical intervention is of paramount importance in the different phases of disease. The involvement of the palliative care team improves quality of life and symptoms, and prognosis. Early initiation is of paramount importance to ensuring patient-centered care, when the patient has still the capability to communicate effectively and participate in his medical care. Advance care planning supports patients and family members in understanding and sharing their preferences according to their personal values and life goals regarding future medical treatment. The principal problems which require intensive supportive care include cognitive disturbances, psychological distress, pain, sialorrhrea, nutrition, and ventilatory support. Communication skills of health-care professionals are mandatory to manage the inevitability of death. Palliative sedation has peculiar aspects in this population, particularly with the decision of withdrawing ventilatory support.
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Affiliation(s)
- Sebastiano Mercadante
- Main Regional Center of Pain Relief and Supportive/Palliative Care (S.M.), La Maddalena Cancer Center, Palermo, Italy; Regional Home Care Program, SAMOT (S.M.), Palermo, Italy.
| | - Lou'i Al-Husinat
- Department of Clinical Medical Sciences (L.A.H.), Yarmouk University, Irbid, Jordan
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17
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Kamp MA, Golla H, Dinc N, Goldbrunner R, Senft C, Hellmich M, Voltz R. Letter to the Editor Regarding: "Palliative Care Effects on Survival in Glioblastoma: Who Receives Palliative Care?". World Neurosurg 2023; 178:270-272. [PMID: 37803664 DOI: 10.1016/j.wneu.2023.06.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 06/14/2023] [Indexed: 10/08/2023]
Affiliation(s)
- Marcel A Kamp
- Center for Palliative and Neuro-palliative Care, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Rüdersdorf bei Berlin, Germany.
| | - Heidrun Golla
- Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Nazife Dinc
- Center of Neuro-Oncology, Department of Neurosurgery, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
| | - Ronald Goldbrunner
- Center for Neurosurgery, Department of General Neurosurgery, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Christian Senft
- Center of Neuro-Oncology, Department of Neurosurgery, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
| | - Martin Hellmich
- Institute of Medical Statistics and Computational Biology (IMSB), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Raymond Voltz
- Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany; Clinical Trials Centre Cologne (CTCC), Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany; Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany; Center for Health Services Research (ZVFK), Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
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18
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Kluger BM, Hudson P, Hanson LC, Bužgovà R, Creutzfeldt CJ, Gursahani R, Sumrall M, White C, Oliver DJ, Pantilat SZ, Miyasaki J. Palliative care to support the needs of adults with neurological disease. Lancet Neurol 2023; 22:619-631. [PMID: 37353280 DOI: 10.1016/s1474-4422(23)00129-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 03/08/2023] [Accepted: 03/27/2023] [Indexed: 06/25/2023]
Abstract
Neurological diseases cause physical, psychosocial, and spiritual or existential suffering from the time of their diagnosis. Palliative care focuses on improving quality of life for people with serious illness and their families by addressing this multidimensional suffering. Evidence from clinical trials supports the ability of palliative care to improve patient and caregiver outcomes by the use of outpatient or home-based palliative care interventions for people with motor neuron disease, multiple sclerosis, or Parkinson's disease; inpatient palliative care consultations for people with advanced dementia; telephone-based case management for people with dementia in the community; and nurse-led discussions with decision aids for people with advanced dementia in long-term care. Unfortunately, most people with neurological diseases do not get the support that they need for their palliative care under current standards of healthcare. Improving this situation requires the deployment of routine screening to identify individual palliative care needs, the integration of palliative care approaches into routine neurological care, and collaboration between neurologists and palliative care specialists. Research, education, and advocacy are also needed to raise standards of care.
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Affiliation(s)
- Benzi M Kluger
- University of Rochester Medical Center, Rochester, NY, USA.
| | - Peter Hudson
- The University of Melbourne, Fitzroy, VIC, Australia; St Vincent's Hospital, Melbourne, Fitzroy, VIC, Australia; Vrije Universiteit Brussel, Brussel, Belgium
| | - Laura C Hanson
- University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Radka Bužgovà
- Department of Nursing and Midwifery, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | | | - Roop Gursahani
- Hinduja Hospital & Medical Research Centre, Mumbai, Maharashtra, India
| | - Malenna Sumrall
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Charles White
- University of Rochester Medical Center, Rochester, NY, USA
| | | | - Steven Z Pantilat
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
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Abdul-Rahman T, Badar SM, Ali MA, Kundu M, Ademeta E, Awuah WA. The current state of neuropalliative care in developing countries. Where are we now? Postgrad Med J 2023:7193771. [PMID: 37302084 DOI: 10.1093/postmj/qgad031] [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: 03/09/2023] [Accepted: 03/25/2023] [Indexed: 06/13/2023]
Abstract
The need for improved palliative care in developing countries is great. Of 58 million people who die every year, 45 million die in developing countries. An estimated 60% (27 million) of these people in poor nations would benefit from palliative care, and this number is growing as chronic diseases such as cancer rise rapidly. Yet a combination of highly restrictive policies on opioid prescription and a lack of awareness within the medical profession conspire to deprive patients of palliative care. Human rights advocates argue that this neglect is a breach of human rights that is tantamount to torture. This editorial explores the neuropalliative approach and addresses the current state of neuropalliative care in developing countries.
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Affiliation(s)
- Toufik Abdul-Rahman
- Toufik's World Medical Association, Medical Institute, Sumy State University, Sumy 40007, Ukraine
| | - Sarah M Badar
- The University of the West of Scotland, Environmental Health Research, Lanarkshire G720LH, United Kingdom
| | - Mohammed Ahsan Ali
- University School of Medicine, Ross University School of Medicine, Miramar, FL 33027, United States
| | - Mrinmoy Kundu
- Institute of Medical Sciences and SUM Hospital, Bhubaneswar 751003, India
| | - Esther Ademeta
- Toufik's World Medical Association, Medical Institute, Sumy State University, Sumy 40007, Ukraine
| | - Wireko Andrew Awuah
- Toufik's World Medical Association, Medical Institute, Sumy State University, Sumy 40007, Ukraine
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20
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Trahair ED, Mantri S. Examining the Role of Narrative in Palliative Care for Parkinson Disease: Changing the Story. Neurol Clin Pract 2023; 13:e200150. [PMID: 37081942 PMCID: PMC10112858 DOI: 10.1212/cpj.0000000000200150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 02/10/2023] [Indexed: 04/22/2023]
Abstract
Recent years have seen growing interest in neuropalliative care as a subspecialty. Simultaneously, the rise of narrative medicine in patient support groups and clinician training programs offers a way to listen deeply to the stories of those living with chronic illness and may inform corresponding health interventions. This commentary examines the ways in which an understanding of illness narrative schemata, particularly the so-called "chaos narrative," can contribute to patient and care partner distress, which in turn can be alleviated by a palliative care approach. Through examples of stories of people with Parkinson disease and their care partners, the article emphasizes the intersections between narrative medicine, neurology, and palliative care. Specific opportunities for bringing narrative medicine into the clinic are discussed.
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Affiliation(s)
- Esme D Trahair
- Department of Neurology (EDT, SM); and Trent Center for Bioethics, Humanities, and History of Medicine (EDT, SM), Duke University School of Medicine, Durham, NC
| | - Sneha Mantri
- Department of Neurology (EDT, SM); and Trent Center for Bioethics, Humanities, and History of Medicine (EDT, SM), Duke University School of Medicine, Durham, NC
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21
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Lima TACD, Bruno FP, Gushken F, Degani-Costa LH, Novaes NP. Breaking bad news in neurology: assessing training, perceptions, and preparedness among residency programs in Brazil. EINSTEIN-SAO PAULO 2023; 21:eAO0036. [PMID: 37075459 PMCID: PMC10118364 DOI: 10.31744/einstein_journal/2023ao0036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 08/30/2022] [Indexed: 04/03/2023] Open
Abstract
OBJECTIVE • Neurology trainees and program directors recognized a lack of structured breaking bad news training. • Program directors reported that many factors hinder the implementation of breaking bad news education. • Trainees felt capable of breaking bad news, but most did not have lectures, simulations, nor feedback. • Trainees acknowledged negative feelings when breaking bad news, including sadness and helplessness. We aimed to evaluate how breaking bad news training was implemented in neurology residency programs in Brazil and to assess the perception and preparedness of trainees and program directors. METHODS We performed a cross-sectional descriptive study. Neurology trainees and program directors were recruited from the Brazilian Academy of Neurology registry through convenience sampling. Participants answered a survey evaluating the breaking bad news training at their institution and their preparedness and perception towards the topic. RESULTS We collected 172 responses from 47 neurology institutions from all five socio-demographic regions of Brazil. More than 77% of trainees were dissatisfied with their breaking bad news training, and around 92% of program directors believed their programs required substantial improvement. Approximately 31% of neurology trainees reported never having a lecture about communicating bad news, 66% reported never having a simulated training, and nearly 61% never received feedback regarding their communication abilities. Moreover, 59% of program directors acknowledged that feedback was not a standard practice and nearly 32% reported the absence of any specific training. CONCLUSION This study suggested that the breaking bad news training in neurology residencies across Brazil is deficient and highlighted challenges to achieve this core competency. Program directors and trainees recognized the importance of the topic, and program directors acknowledged that many factors hinder the ability to implement formal training. Given the relevance of such a skill to patient care, every effort should be made to provide structured training opportunities during residency.
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Drees C, Hixon AM, Sillau S, Lopez-Esquibel N, Spitz M, Mohler R, Baca C, Fetrow K, Brown MG, Vaughan C. Physician distress when treatments fail. Survey on physician distress when treating persons with drug-resistant epilepsy and knowledge of neuropalliative care. Epilepsy Behav 2023; 140:108925. [PMID: 36774670 DOI: 10.1016/j.yebeh.2022.108925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 09/02/2022] [Accepted: 09/18/2022] [Indexed: 02/12/2023]
Abstract
OBJECTIVE Drug-resistant epilepsy can be difficult to cure and may pose emotional challenges for epilepsy providers. Neuropalliative care (NPC) can augment quality of life (QOL) in persons with neurological diseases and may add meaningful elements to the treatment repertoire of epilepsy specialists even if seizures continue. However, NPC has not been widely implemented in epilepsy. Our study aimed to determine whether physicians of persons with drug-resistant epilepsy (PWDRE) experience distress when faced with treatment failure (Engel class ≥ 2), either failure of medications-only (PWDREmo) or of both medications and surgery (procedures with curative intent (PWDREms)). Furthermore, we evaluated physician knowledge about and referrals to NPC following treatment failures to help improve patient QOL despite ongoing seizures. METHODS An anonymous online survey was distributed to US epilepsy physicians through the American Epilepsy Society website and personal email to assess levels of distress experienced when caring for PWDREmo and PWDREms (7-point Likert scale ["1" = "no distress", "7" = "most distress ever felt"]), and knowledge and use of NPC. RESULTS Eighty-two physicians completed the survey. Most experienced distress when epilepsy treatments failed: 59% felt moderate distress (≥4) with PWDREmo (median "4", mean 3.74, range 1-7), 90% suffered moderate to severe distress (5, 5.17, 1-7) with PWDREms. Distress over PWDREms was significantly greater than distress over PWDREmo (p < 0.0001). Forty-three percent reported confidence in their knowledge about NPC. Only 15% were likely to refer PWDREmo to NPC, while 44% would consider it for PWDREms. CONCLUSION Among survey responders, physician distress was high when confronted with treatment failures, especially the failure of epilepsy surgery. Fewer than half of responders were likely to refer patients to NPC. Further research is necessary to determine extent, reasons, and effects of physician distress and whether improved understanding of and patient access to NPC would help alleviate physician distress when faced with treatment failures in PWDRE.
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Affiliation(s)
- Cornelia Drees
- Department of Neurology, University of Colorado, Denver, United States(2); Department of Neurology, Mayo Clinic Arizona, Phoenix, United States(3).
| | - Alison M Hixon
- Department of Neurology, University of Colorado, Denver, United States(2); Barnes-Jewish Hospital, Washington University, St. Louis, United States(3).
| | - Stefan Sillau
- Department of Neurology, University of Colorado, Denver, United States(2).
| | | | - Mark Spitz
- Department of Neurology, University of Colorado, Denver, United States(2).
| | - Ryan Mohler
- Department of Neurology, University of Colorado, Denver, United States(2)
| | - Christine Baca
- Department of Neurology, University of Colorado, Denver, United States(2); Department of Neurology, Virginia Commonwealth University, Richmond, United States(3).
| | - Kirsten Fetrow
- Department of Neurology, University of Colorado, Denver, United States(2); Department of Pediatrics, Children's Hospital Colorado, University of Colorado, Denver, United States(3).
| | - Mesha-Gay Brown
- Department of Neurology, University of Colorado, Denver, United States(2); Department of Neurology, Centura Health, Denver, United States(3).
| | - Christina Vaughan
- Department of Neurology, University of Colorado, Denver, United States(2).
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23
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Effects of Palliative Care for Progressive Neurologic Diseases: A Systematic Review and Meta-Analysis. J Am Med Dir Assoc 2023; 24:171-184. [PMID: 36481217 DOI: 10.1016/j.jamda.2022.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 10/30/2022] [Accepted: 11/01/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To determine the association of palliative care for progressive neurologic diseases with patient- and caregiver-centered outcomes. DESIGN Systematic review and meta-analysis of randomized controlled trials and quasi-experimental studies, including pilot studies. SETTING AND PARTICIPANTS Adults with progressive neurologic diseases (dementia, multiple sclerosis, Parkinson's disease, motor neuron disease, multiple system atrophy, and progressive supranuclear palsy) and their caregivers. METHODS MEDLINE, EMBASE, CINAHL PLUS, Cochrane CENTRAL, and PubMed were searched from inception to September 2021. Two reviewers independently screened studies, extracted data, and assessed risk of bias using the Cochrane risk of bias tools. Narrative synthesis was conducted. Patient quality of life (QoL), symptom burden, caregiver burden, and satisfaction with care were meta-analyzed using a random-effects model. RESULTS Fifteen trials provided data on 3431 patients (mean age, 73.9 years). Compared with usual care, palliative care was statistically significantly associated with lower symptom burden [standardized mean difference (SMD), -0.34 (95% Cl, -0.59 to -0.09)] and higher caregiver satisfaction [SMD, 0.41 (95% Cl, 0.12 to 0.71)] and patient satisfaction [SMD, 0.43 (95% Cl, -0.01 to 0.87)]. However, the associations were not significant after excluding studies with high risk of bias. Insignificant associations of palliative care with caregiver burden [SMD, -0.09 (95% Cl, -0.21 to 0.03)] and patient QoL [SMD, 0.19 (95% Cl, -0.07 to 0.44)] were observed. CONCLUSIONS AND IMPLICATIONS Palliative care is likely to improve symptom burden and satisfaction with care among patients with progressive neurologic diseases and their caregivers, while its effects on QoL and caregiver burden remains inconclusive. Specific intervention components including interdisciplinary team, palliative care physicians, home visits, and spiritual care appeared to be associated with increased effects on improving palliative outcomes. More rigorous designed studies are warranted to examine the effects of neuropalliative care, effective intervention components, optimal timing, and symptom triggers of palliative care referrals.
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24
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Ng M, Crooms RC, Ankuda C. Palliative Care and Neurology Needs in Patients With and Without COVID-19. Am J Hosp Palliat Care 2023; 40:244-249. [PMID: 35574974 PMCID: PMC9111909 DOI: 10.1177/10499091221102554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic led to increased neurology and palliative care needs. We compare the characteristics of COVID-19 positive vs negative patients who received consultation by neurology and palliative care services during the 2020 COVID-19 surge in New York City to see how the groups differ in their consultation needs and to identify opportunities to improve care. METHODS This retrospective analysis was performed within a multi-center hospital system in New York City, USA over a 2-month period (15 March to 15 May, 2020) which represented the peak of the first COVID-19 wave. Hospitalized patients who received a consultation from neurology and palliative care services were included. The patients were classified according to COVID-19 status (positive or negative based on PCR testing). Data abstracted from chart review included demographic data, details of neurology and palliative care consultations, duration of admission, ICU admission, intubation, code status, and death. RESULTS The study included 70 patients who tested positive for COVID-19 and 39 patients who tested negative for a total of 109 patients. Compared to the patients who tested negative for COVID-19, the patients who tested positive for COVID-19 were more likely to have palliative care consultation for management of goals of care (70 [100%] vs 33 [84.6%], P = .003) and less likely for management of symptoms (2 [2.9%] vs 7 [17.9%], P = .02). CONCLUSION The findings emphasize the need for collaboration between palliative care and neurology, which was heightened during the COVID-19 pandemic. There was a particular need for communication surrounding goals of care.
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Affiliation(s)
- Melissa Ng
- Department of Neurology, 5925Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rita C Crooms
- Department of Neurology, 5925Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Brookdale Department of Geriatrics and Palliative Medicine, 5925Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Claire Ankuda
- Brookdale Department of Geriatrics and Palliative Medicine, 5925Icahn School of Medicine at Mount Sinai, New York, NY, USA
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25
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Ng M, McFarlin J, Holloway RG, Miyasaki J, Kramer NM. Emerging Subspecialties in Neurology: Cortical Careers in Neuropalliative Care. Neurology 2023; 100:158-161. [PMID: 36266043 DOI: 10.1212/wnl.0000000000201514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 09/20/2022] [Indexed: 02/05/2023] Open
Abstract
Serious neurologic illnesses are associated with significant palliative care (PC) needs, including symptom management, complex decision-making, support for caregivers, and end-of-life care. While all neurologists are responsible for the provision of primary PC, there is an increasing need for trained neurologists with expertise in palliative medicine to manage refractory symptoms, mitigate conflict around goals of care, and provide specialized end-of-life care. This has led to the emergence of neuropalliative care (NPC) as a subspecialty. There are different ways to acquire PC skills, incorporate them into one's neurology practice, and develop a neuropalliative carer. We interviewed 3 leaders in the field of NPC, Dr. Robert Holloway, Dr. Jessica McFarlin, and Dr. Janis Miyasaki, who are all neurologists with different subspecialties and training pathways working in academic centers. They share their career paths, their advice for neurology trainees interested in pursuing a career in NPC, and their thoughts on the future of the field.
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Affiliation(s)
- Melissa Ng
- From the Department of Neurology (M.N.), Icahn School of Medicine at Mount Sinai; Department of Neurology (J. McFarlin), University of Kentucky; Department of Neurology (R.G.H.), University of Rochester Medical Center; Department of Medicine (R.G.H.), Palliative Care, University of Rochester Medical Center; Department of Medicine (J. Miyasaki), Division of Neurology, University of Alberta; Department of Neurology (N.M.K.), Rush University; and Department of Internal Medicine (N.M.K.), Rush University.
| | - Jessica McFarlin
- From the Department of Neurology (M.N.), Icahn School of Medicine at Mount Sinai; Department of Neurology (J. McFarlin), University of Kentucky; Department of Neurology (R.G.H.), University of Rochester Medical Center; Department of Medicine (R.G.H.), Palliative Care, University of Rochester Medical Center; Department of Medicine (J. Miyasaki), Division of Neurology, University of Alberta; Department of Neurology (N.M.K.), Rush University; and Department of Internal Medicine (N.M.K.), Rush University
| | - Robert G Holloway
- From the Department of Neurology (M.N.), Icahn School of Medicine at Mount Sinai; Department of Neurology (J. McFarlin), University of Kentucky; Department of Neurology (R.G.H.), University of Rochester Medical Center; Department of Medicine (R.G.H.), Palliative Care, University of Rochester Medical Center; Department of Medicine (J. Miyasaki), Division of Neurology, University of Alberta; Department of Neurology (N.M.K.), Rush University; and Department of Internal Medicine (N.M.K.), Rush University
| | - Janis Miyasaki
- From the Department of Neurology (M.N.), Icahn School of Medicine at Mount Sinai; Department of Neurology (J. McFarlin), University of Kentucky; Department of Neurology (R.G.H.), University of Rochester Medical Center; Department of Medicine (R.G.H.), Palliative Care, University of Rochester Medical Center; Department of Medicine (J. Miyasaki), Division of Neurology, University of Alberta; Department of Neurology (N.M.K.), Rush University; and Department of Internal Medicine (N.M.K.), Rush University
| | - Neha M Kramer
- From the Department of Neurology (M.N.), Icahn School of Medicine at Mount Sinai; Department of Neurology (J. McFarlin), University of Kentucky; Department of Neurology (R.G.H.), University of Rochester Medical Center; Department of Medicine (R.G.H.), Palliative Care, University of Rochester Medical Center; Department of Medicine (J. Miyasaki), Division of Neurology, University of Alberta; Department of Neurology (N.M.K.), Rush University; and Department of Internal Medicine (N.M.K.), Rush University
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26
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Brizzi K. Outpatient neuropalliative care. HANDBOOK OF CLINICAL NEUROLOGY 2023; 191:29-48. [PMID: 36599513 DOI: 10.1016/b978-0-12-824535-4.00002-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Palliative care is an approach to patient care that focuses on enhancing quality of life through relief of physical, emotional, and spiritual sources of distress and patient-tailored discussions about goals of care. The palliative care approach can be delivered by any provider, and can occur alongside disease-modifying therapies. For patients with a serious neurologic illness or a neurodegenerative disease, neuropalliative care is a growing field focused on providing high-quality palliative care to neurology patients. There are three models of neuropalliative care delivery in the outpatient setting: a consultative model with a palliative care specialist, an integrated model with an embedded palliative care provider, and a primary palliative care model with the patient's neurology provider. The main components of an outpatient palliative care visit include symptom assessment and treatment, communication about serious illness, advance care planning, and assessment of caregiver needs. For patients with advanced illness, palliative care can help facilitate timely referral to hospice. Through a palliative care approach, outpatient care for patients with serious neurologic disease or neurodegenerative disease can focus on the issues most important to the patient, promote improved illness understanding and planning, and can improve the overall quality of care.
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Affiliation(s)
- Kate Brizzi
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States; Department of Medicine, Massachusetts General Hospital, Boston, MA, United States.
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Abstract
The diagnosis of a brain tumor is a life-changing event for patients and families. High-grade gliomas (especially glioblastomas) are incurable, and long-term survival is limited. Metastatic brain lesions comprise the majority of intracranial neoplasms and are a significant source of morbidity and mortality in patients with systemic cancer. Response to treatment, prognosis, and survival depends not only on the underlying pathology, but more importantly on recently defined molecular features. Other crucial predictors of survival include age and performance status. Among patients with primary brain tumors, neurologic decline and psychological distress contribute to a high symptom burden and impaired quality of life (QoL) throughout the disease trajectory. While many symptoms in central nervous system (CNS) and non-CNS cancers overlap, others predominate in the brain tumor population, including seizures, headaches, depression, fatigue, and treatment-induced toxicity, all of which can be addressed with palliative interventions. Patients, families, and caregivers also report disproportionately high supportive care needs, which frequently differ from those of other systemic cancers. In addition, progressive neurologic decline often results in impaired communication and decision-making capacity at the end of life. Early palliative care (PC) integration has become more common in systemic cancers, but remains limited in neuro-oncology. These factors combined contribute to a uniquely challenging disease course that may benefit from a multidisciplinary approach with early involvement of specialized (PC) to address tumor-related symptoms and improve QoL. We review how to approach patients with brain tumors and address prognosis, symptom management, and advance care planning with the goal of improving QoL for patients, families, and caregivers.
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Affiliation(s)
- Tobias Walbert
- Department of Neurology, Hermelin Brain Tumor Center, Henry Ford Health, Detroit, MI, United States; Department of Neurosurgery, Hermelin Brain Tumor Center, Henry Ford Health, Detroit, MI, United States; Department of Neurology, Wayne State University, Detroit, MI, United States
| | - Natalie E Stec
- Department of Neurology, Hermelin Brain Tumor Center, Henry Ford Health, Detroit, MI, United States.
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28
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Corcoran J, Huang AH, Miyasaki JM, Tarolli CG. Palliative care in Parkinson disease and related disorders. HANDBOOK OF CLINICAL NEUROLOGY 2023; 191:107-128. [PMID: 36599503 DOI: 10.1016/b978-0-12-824535-4.00017-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Although neuropalliative care is a relatively new field, there is increasing evidence for its use among the degenerative parkinsonian syndromes, including idiopathic Parkinson disease, progressive supranuclear palsy, multiple system atrophy, dementia with Lewy bodies, and corticobasal syndrome. This chapter outlines the current state of evidence for palliative care among individuals with the degenerative parkinsonian syndromes with discussion surrounding: (1) disease burden and needs across the conditions; (2) utility, timing, and methods for advance care planning; (3) novel care models for the provision of palliative care; and 4) end-of-life care issues. We also discuss currently unmet needs and unanswered questions in the field, proposing priorities for research and the assessment of implemented care models.
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Affiliation(s)
- Jennifer Corcoran
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, United States
| | - Andrew H Huang
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, United States
| | - Janis M Miyasaki
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Christopher G Tarolli
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, United States.
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29
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Rent S, Bidegain M, Lemmon ME. Neonatal neuropalliative care. HANDBOOK OF CLINICAL NEUROLOGY 2023; 191:185-199. [PMID: 36599508 PMCID: PMC10615113 DOI: 10.1016/b978-0-12-824535-4.00008-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Neonatal neuropalliative care is directed toward patients and families impacted by serious, life limiting, or debilitating neurologic illness in the antenatal and newborn period. This chapter will outline key considerations for clinicians hoping to provide a neuropalliative care approach antenatally, at birth, and in the neonatal intensive care unit. We focus on three core domains: (1) family-centered communication and care, (2) prognostication and decision-making, and (3) pain and symptom management. In each domain, we outline key considerations in the antenatal period, at birth, and in the neonatal intensive care unit. We also address special considerations in care at the end of life and in varied cultural and practice contexts. We conclude with suggestions for future research and key considerations for neonatal clinicians who wish to incorporate a neuropalliative approach to care into their practice.
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Affiliation(s)
- Sharla Rent
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, United States
| | - Margarita Bidegain
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, United States
| | - Monica E Lemmon
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, United States; Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States.
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30
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Towards clinical application of implantable brain-computer interfaces for people with late-stage ALS: medical and ethical considerations. J Neurol 2023; 270:1323-1336. [PMID: 36450968 PMCID: PMC9971103 DOI: 10.1007/s00415-022-11464-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 10/26/2022] [Accepted: 10/27/2022] [Indexed: 12/05/2022]
Abstract
Individuals with amyotrophic lateral sclerosis (ALS) frequently develop speech and communication problems in the course of their disease. Currently available augmentative and alternative communication technologies do not present a solution for many people with advanced ALS, because these devices depend on residual and reliable motor activity. Brain-computer interfaces (BCIs) use neural signals for computer control and may allow people with late-stage ALS to communicate even when conventional technology falls short. Recent years have witnessed fast progression in the development and validation of implanted BCIs, which place neural signal recording electrodes in or on the cortex. Eventual widespread clinical application of implanted BCIs as an assistive communication technology for people with ALS will have significant consequences for their daily life, as well as for the clinical management of the disease, among others because of the potential interaction between the BCI and other procedures people with ALS undergo, such as tracheostomy. This article aims to facilitate responsible real-world implementation of implanted BCIs. We review the state of the art of research on implanted BCIs for communication, as well as the medical and ethical implications of the clinical application of this technology. We conclude that the contribution of all BCI stakeholders, including clinicians of the various ALS-related disciplines, will be needed to develop procedures for, and shape the process of, the responsible clinical application of implanted BCIs.
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31
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Kramer NM, Besbris J, Hudoba C. Education in neuropalliative care. HANDBOOK OF CLINICAL NEUROLOGY 2023; 191:259-272. [PMID: 36599512 DOI: 10.1016/b978-0-12-824535-4.00006-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The importance and value of providing palliative care for patients with neurologic disease is increasingly recognized. While palliative and neuropalliative specialists may be well-positioned to provide this care, there is a shortage of specialists to address these needs. As a result, much of the upfront palliative care will naturally be provided by the treating neurologist. It is imperative that all neurologists receive quality training in primary palliative care skills. As the subspecialty of neuropalliative care grows, the need for specialty neuropalliative education has arisen. This chapter reviews existing educational initiatives and common neuropalliative-oriented career tracks and identifies opportunities for growth along the continuum of medical education and beyond.
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Affiliation(s)
- Neha M Kramer
- Department of Internal Medicine, Section of Palliative Medicine, Rush University Medical Center, Chicago, IL, United States; Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, United States.
| | - Jessica Besbris
- Departments of Neurology and Supportive Care Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Christine Hudoba
- Department of Internal Medicine, Section of Palliative Medicine, Rush University Medical Center, Chicago, IL, United States
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32
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Hausammann R, Maslias E, Amiguet M, Jox RJ, Borasio GD, Michel P. Goals of care changes after acute ischaemic stroke: decision frequency and predictors. BMJ Support Palliat Care 2022:bmjspcare-2022-003531. [PMID: 36379688 DOI: 10.1136/spcare-2022-003531] [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: 01/19/2022] [Accepted: 10/27/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Little is known about the factors leading to a change in goals of care (CGC) in patients with an acute ischaemic stroke (AIS). Our aim was to analyse the proportion and outcome of such patients and identify medical predictors of a CGC during acute hospitalisation. METHODS We retrospectively reviewed all patients who had an AIS over a 13-year period from the prospectively constructed Acute Stroke Registry and Analysis of Lausanne. We compared patients with a CGC during the acute hospital phase to all other patients and identified associated clinical and radiological variables using logistic regression analysis. RESULTS A CGC decision was taken in 440/4264 (10.3%) consecutive patients who had an AIS. The most powerful acute phase predictors of a CGC were transit through the intensive care unit, older age, pre-existing disability, higher stroke severity and initial decreased level of consciousness. Adding subacute phase variables, we also identified active oncological disease, fever and poor recanalisation as predictors. 76.6% of the CGC patients died in the stroke unit and 1.0% of other patients, and 30.5% of patients with a CGC received a palliative care consultation. At 12 months, 93.6% of patients with CGC had died, compared with 10.1% of non-CGC patients. CONCLUSIONS Over three-quarters of AIS patients with CGC died in hospital, but less than a third received a palliative care consultation. The identified clinical and radiological predictors of a CGC may allow physicians to initiate timely the decision-making process for a possible CGC.
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Affiliation(s)
| | - Errikos Maslias
- Stroke Center, Neurology Service, Department of Clinical Neuroscience, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | | | - Ralf J Jox
- Palliative and Supportive Care Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Gian Domenico Borasio
- Palliative and Supportive Care Service, Lausanne University Hospital and University of Lausanne, Lausanne, Vaud, Switzerland
| | - Patrik Michel
- Stroke Center, Neurology Service, Department of Clinical Neuroscience, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
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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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Harrison KL, Garrett SB, Halim M, Sideman AB, Allison TA, Dohan D, Naasan G, Miller BL, Smith AK, Ritchie CS. “I Didn’t Sign Up for This”: Perspectives from Persons Living with Dementia and Care Partners on Challenges, Supports, and Opportunities to Add Geriatric Neuropalliative Care to Dementia Specialty Care. J Alzheimers Dis 2022; 90:1301-1320. [DOI: 10.3233/jad-220536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: In the United States, dementia specialty centers affiliated with centers of excellence for research hold promise as locations to develop innovative, holistic care in care systems otherwise siloed by discipline or payer. Objective: We conducted foundational research to inform development of patient-and family-centered palliative care interventions for dementia specialty centers. Methods: We interviewed persons living with dementia (PLWD), current, and former care partners (CP) recruited from a specialty dementia clinic and purposively selected for variation across disease syndrome and stage. A framework method of thematic analysis included coding, analytic matrices, and pattern mapping. Results: 40 participants included 9 PLWD, 16 current CPs, and 15 former CPs of decedents; 48% impacted by Alzheimer’s disease dementia. While help from family, support groups and adult day centers, paid caregiving, and sensitive clinical care were invaluable to PLWD, CPs, or both, these supports were insufficient to navigate the extensive challenges. Disease-oriented sources of distress included symptoms, functional impairment and falls, uncertainty and loss, and inaccessible care. Social and relational challenges included constrained personal and professional opportunities. The obligation and toll of giving or receiving caregiving were challenging. Clinical care challenges for PLWD and/or CPs included care fragmentation, insufficient guidance to inform planning and need for expert interdisciplinary clinical care at home. Conclusion: Findings highlight the breadth and gravity of gaps, which surpass the disciplinary focus of either behavioral neurology or palliative care alone. Results can inform the development of novel interventions to add principles of geriatrics and neuropalliative care to dementia care.
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Affiliation(s)
- Krista L. Harrison
- Division of Geriatrics, University of California, San Francisco, San Francisco, CA, USA
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA
- Global Brain Health Institute, University of California, San Francisco, CA, USA
| | - Sarah B. Garrett
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA
| | - Madina Halim
- Division of Geriatrics, University of California, San Francisco, San Francisco, CA, USA
| | - Alissa Bernstein Sideman
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA
- Global Brain Health Institute, University of California, San Francisco, CA, USA
- Department of Humanities and Social Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Theresa A. Allison
- Division of Geriatrics, University of California, San Francisco, San Francisco, CA, USA
- San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA
- Department of Family & Community Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Daniel Dohan
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA
- Department of Humanities and Social Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Georges Naasan
- The Barbara and Maurice Deane Center for Wellness and Cognitive Health, Department of Neurology, Mount Sinai Hospitals, Icahn School of Medicine, New York, NY, USA
| | - Bruce L. Miller
- Global Brain Health Institute, University of California, San Francisco, CA, USA
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA
| | - Alexander K. Smith
- Division of Geriatrics, University of California, San Francisco, San Francisco, CA, USA
- San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA
| | - Christine S. Ritchie
- Division of Geriatrics, University of California, San Francisco, San Francisco, CA, USA
- The Mongan Institute and the Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Boston, MA, USA
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35
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Plys E, Vaughan CL, Kutner JS, Berk J, Kolva E. Interdisciplinary neuropalliative care: A unique and valuable clinical training experience for geropsychology trainees. GERONTOLOGY & GERIATRICS EDUCATION 2022; 43:551-563. [PMID: 34044751 PMCID: PMC8626543 DOI: 10.1080/02701960.2021.1925891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
To address workforce issues in professional geropsychology, clinical training sites must offer opportunities to build skills for working with older adults and aging families. Neuropalliative care (NPC) may offer a valuable learning environment for geropsychology trainees to develop professional competencies, while positively contributing to patient care. This article describes a novel clinical rotation for an advanced geropsychology trainee in an interdisciplinary specialty NPC clinic. A co-assessment model emerged as a useful strategy for integrating the trainee into the established NPC team. Two case examples illustrate the co-assessment's ability to enhance: collaboration within the clinic; psychological care for patients and care partners; and opportunities for the trainee to build competencies related to assessment, intervention, teams, and consultation. This paper concludes with a discussion of the benefits of NPC as a clinical training rotation for geropsychology trainees, as well as practical considerations for implementation in other clinics.
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Affiliation(s)
- Evan Plys
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine
- Department of Psychiatry, University of Colorado School of Medicine
| | - Christina L. Vaughan
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine
- Department of Neurology, University of Colorado School of Medicine
| | - Jean S. Kutner
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine
| | - Julie Berk
- Department of Neurology, University of Colorado School of Medicine
| | - Elissa Kolva
- Division of Medical Oncology, Department of Medicine, University of Colorado School of Medicine
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McHugh DC, George BP, Bender MT, Horowitz RK, Kaufman DC, Holloway RG, Roberts DE. Reversal of Advanced Directives in Neurologic Emergencies. Neurohospitalist 2022; 12:651-658. [PMID: 36147771 PMCID: PMC9485691 DOI: 10.1177/19418744221097348] [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: 10/03/2023] Open
Abstract
Objective Patients with advanced directives or Medical Orders for Life-Sustaining Treatment (MOLST), including "Do Not Resuscitate" (DNR) and/or "Do Not Intubate" (DNI), may be candidates for procedural interventions when presenting with acute neurologic emergencies. Such interventions may limit morbidity and mortality, but typically they require MOLST reversal. We investigated outcomes of patients with MOLST reversal for treatment of neurologic emergencies. Methods We conducted a retrospective chart review from July 1, 2019 to April 30, 2021 of patients with MOLST reversal treated in our NeuroMedicine Intensive Care Unit. Variables collected include neurologic disease, MOLST reversal decision maker, procedural interventions, and outcomes. Results Twenty-seven patients (18 female, median age 78 years (IQR 73-85 years), median baseline modified Rankin score 1 [IQR 0-2.5] were identified with MOLST reversal. The most common pre-procedural MOLST was DNR/DNI (n=22, 81%), and 93% (n=25) pre-procedural MOLSTs were completed by the patient. MOLSTs were reversed by surrogates in n=23 cases (85%). The median time from MOLST completion to MOLST reversal was 603 days (IQR 45 days to 4 years). The most common neurologic emergency was ischemic stroke (n=14, 52%). Most patients died (n=14, 52%), 26% (n=7) were discharged to skilled nursing, and 22% (n=6) returned to home or assisted living. Conclusions In neurologic emergencies, urgent shared decision making is needed to ensure goal-concordant care, which may result in reversal of existing advanced directives. Outcomes of patients with MOLST reversal were heterogeneous, emphasizing the importance of deliberate patient-centered care weighing the risks and benefits of each intervention.
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Affiliation(s)
- Daryl C. McHugh
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | - Benjamin P. George
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | - Matthew T. Bender
- Department of Neurosurgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Robert K. Horowitz
- Department of Medicine, Division of Palliative Care, University of Rochester Medical Center, Rochester, NY, USA
| | - David C. Kaufman
- Critical Care Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Robert G. Holloway
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | - Debra E. Roberts
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
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37
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Shlobin NA, Garcia RM, Bernstein M. Neuropalliative care for the neurosurgeon: a primer. J Neurosurg 2022; 137:850-858. [PMID: 34920433 DOI: 10.3171/2021.9.jns211872] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 09/16/2021] [Indexed: 11/06/2022]
Abstract
Many neurosurgical conditions are incurable, leading to disability or severe symptoms, poor quality of life, and distress for patients and families. The field of neuropalliative care (NPC) addresses the palliative care (PC) needs of individuals living with neurological conditions. Neurosurgeons play an important role within multidisciplinary NPC teams because of their understanding of the natural history of and treatment strategies for neurosurgical conditions, longitudinal patient-physician relationships, and responsibility for neurosurgical emergencies. Moreover, patients with neurosurgical conditions have unique PC needs given the trajectories of neurosurgical diseases, the realities of prognostication, psychosocial factors, communication strategies, and human behavior. PC improves outcomes among neurosurgical patients. Despite the importance of NPC, neurosurgeons often lack formal training in PC skills, which include identifying patients who require PC, assessing a patient's understanding and preferences regarding illness, educating patients, building trust, managing symptoms, addressing family and caregiver needs, discussing end-of-life care, and recognizing when to refer patients to specialists. The future of NPC involves increasing awareness of the approach's importance, delineating priorities for neurosurgeons with regard to NPC, increasing emphasis on PC skills during training and practice, expanding research efforts, and adjusting reimbursement structures to incentivize the provision of NPC by neurosurgeons.
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Affiliation(s)
- Nathan A Shlobin
- 1Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Roxanna M Garcia
- 1Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Mark Bernstein
- 2Division of Neurosurgery, Toronto Western Hospital, University of Toronto; and
- 3Temmy Latner Center for Palliative Care, Mount Sinai Hospital, University of Toronto, Ontario, Canada
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38
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Minelli C, Luvizutto GJ, Cacho RDO, Neves LDO, Magalhães SCSA, Pedatella MTA, de Mendonça LIZ, Ortiz KZ, Lange MC, Ribeiro PW, de Souza LAPS, Milani C, da Cruz DMC, da Costa RDM, Conforto AB, Carvalho FMM, Ciarlini BS, Frota NAF, Almeida KJ, Schochat E, Oliveira TDP, Miranda C, Piemonte MEP, Lopes LCG, Lopes CG, Tosin MHDS, Oliveira BC, de Oliveira BGRB, de Castro SS, de Andrade JBC, Silva GS, Pontes-Neto OM, de Carvalho JJF, Martins SCO, Bazan R. Brazilian practice guidelines for stroke rehabilitation: Part II. ARQUIVOS DE NEURO-PSIQUIATRIA 2022; 80:741-758. [PMID: 36254447 PMCID: PMC9685826 DOI: 10.1055/s-0042-1757692] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 05/18/2022] [Indexed: 10/14/2022]
Abstract
The Brazilian Practice Guidelines for Stroke Rehabilitation - Part II, developed by the Scientific Department of Neurological Rehabilitation of the Brazilian Academy of Neurology (Academia Brasileira de Neurologia, in Portuguese), focuses on specific rehabilitation techniques to aid recovery from impairment and disability after stroke. As in Part I, Part II is also based on recently available evidence from randomized controlled trials, systematic reviews, meta-analyses, and other guidelines. Part II covers disorders of communication, dysphagia, postural control and balance, ataxias, spasticity, upper limb rehabilitation, gait, cognition, unilateral spatial neglect, sensory impairments, home rehabilitation, medication adherence, palliative care, cerebrovascular events related to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, the future of stroke rehabilitation, and stroke websites to support patients and caregivers. Our goal is to provide health professionals with more recent knowledge and recommendations for better rehabilitation care after stroke.
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Affiliation(s)
- Cesar Minelli
- Hospital Carlos Fernando Malzoni, Matão SP, Brazil
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Neurociências e Ciências do Comportamento, Ribeirão Preto SP, Brazil
- Instituto Você sem AVC, Matão SP, Brazil
| | - Gustavo José Luvizutto
- Universidade Federal do Triângulo Mineiro, Departamento de Fisioterapia Aplicada, Uberaba MG, Brazil
| | - Roberta de Oliveira Cacho
- Universidade Federal do Rio Grande do Norte, Faculdade de Ciências da Saúde do Trairi, Santa Cruz RN, Brazil
| | | | | | - Marco Túlio Araújo Pedatella
- Hospital Israelita Albert Einstein, Unidade Goiânia, Goiânia GO, Brazil
- Hospital Santa Helena, Goiânia GO, Brazil
- Hospital Encore, Goiânia GO, Brazil
- Hospital Estadual Geral de Goiânia Dr. Alberto Rassi, Goiânia GO, Brazil
- Hospital de Urgência de Goiânia, Goiânia, GO, Brazil
| | - Lucia Iracema Zanotto de Mendonça
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Divisão de Neurologia, São Paulo SP, Brazil
- Pontíficia Universidade Católica de São Paulo, Faculdade de Ciências Humanas e da Saúde, São Paulo SP, Brazil
| | - Karin Zazo Ortiz
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Fala, Linguagem e Ciências Auditivas, São Paulo SP, Brazil
| | | | | | | | - Cristiano Milani
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Hospital das Clínicas, Serviço de Neurologia Vascular e Emergências Neurológicas, Ribeirão Preto SP, Brazil
| | | | | | - Adriana Bastos Conforto
- Universidade de São Paulo, Hospital das Clínicas, Divisão de Neurologia Clínica, São Paulo SP, Brazil
- Hospital Israelita Albert Einstein, São Paulo SP, Brazil
| | | | - Bruna Silva Ciarlini
- Universidade de Fortaleza, Programa de Pos-Graduação em Ciências Médicas, Fortaleza CE, Brazil
| | | | | | - Eliane Schochat
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, São Paulo SP, Brazil
| | - Tatiana de Paula Oliveira
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, São Paulo SP, Brazil
| | - Camila Miranda
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, São Paulo SP, Brazil
| | - Maria Elisa Pimentel Piemonte
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, São Paulo SP, Brazil
| | - Laura Cardia Gomes Lopes
- Universidade Estadual de São Paulo, Faculdade de Medicina de Botucatu, Hospital das Clínicas, Departamento de Neurologia, Psicologia e Psiquiatria, São Paulo SP, Brazil
| | | | | | | | | | | | | | | | - Octávio Marques Pontes-Neto
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Neurociências e Ciências do Comportamento, Ribeirão Preto SP, Brazil
| | | | - Sheila C. Ouriques Martins
- Rede Brasil AVC, Porto Alegre RS, Brazil
- Hospital Moinhos de Vento, Departamento de Neurologia, Porto Alegre RS, Brazil
- Hospital de Clínicas de Porto Alegre, Departamento de Neurologia, Porto Alegre RS, Brazil
| | - Rodrigo Bazan
- Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, Botucatu SP, Brazil
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Jensen I, Bretschneider A, Stiel S, Wegner F, Höglinger GU, Klietz M. Analysis of Parkinson's Disease Outpatient Counselling for Advance Directive Creation: A Cross-Sectional Questionnaire-Based Survey of German General Practitioners and Neurologists. Brain Sci 2022; 12:brainsci12060749. [PMID: 35741634 PMCID: PMC9221250 DOI: 10.3390/brainsci12060749] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/01/2022] [Accepted: 06/06/2022] [Indexed: 02/05/2023] Open
Abstract
A major proportion of people with Parkinson’s disease (PwP) in Germany has written an advance directive (AD). Unfortunately, these ADs are unclear for PD-specific endpoints. We previously established consensus-based recommendations for disease-specific content of an AD in PwP. However, the implementation of those recommendations and the consulting of AD creation and modification in PwP remains to be evaluated. This study aimed to investigate the practical use of PD-specific recommendations for ADs in outpatient settings. A total of 87 physicians (45 general practitioners (GPs) and 42 neurologists, 10% response rate) answered a self-constructed semiquantitative questionnaire. The participants were asked to evaluate the suggested PD-specific recommendations for ADs and the supply of palliative care in the outpatient setting. Overall, the vast majority of treating physicians agreed on the usefulness of the newly constructed PD-specific recommendations. Consultations to discuss information about PD-specific ADs were scarce with short durations. Only 24% of participating physicians implemented the PD-specific recommendations in their daily practice. GPs and neurologists agreed on the benefit of disease-specific recommendations for ADs. In future, a more general integration of these recommendations in routine care might improve specific AD creation of PwP and advanced care planning.
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Affiliation(s)
- Ida Jensen
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany; (A.B.); (F.W.); (G.U.H.); (M.K.)
- Correspondence:
| | - Almut Bretschneider
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany; (A.B.); (F.W.); (G.U.H.); (M.K.)
| | - Stephanie Stiel
- Institute for General Practice and Palliative Care, Hannover Medical School, 30625 Hannover, Germany;
| | - Florian Wegner
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany; (A.B.); (F.W.); (G.U.H.); (M.K.)
| | - Günter U. Höglinger
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany; (A.B.); (F.W.); (G.U.H.); (M.K.)
| | - Martin Klietz
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany; (A.B.); (F.W.); (G.U.H.); (M.K.)
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40
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Sharma M, Leslie-Mazwi TM. Evaluating Collaterals in Stroke: A Search for the Whole Picture. Neurology 2022; 98:955-956. [PMID: 35483897 DOI: 10.1212/wnl.0000000000200730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 03/28/2022] [Indexed: 11/15/2022] Open
Affiliation(s)
- Malveeka Sharma
- From the Department of Neurology, University of Washington, Seattle.
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41
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Shemme AJ, Phillips JN, Bloise R, Koehler TJ, Gorelick PB, Francis BA. The Impact of a Neurocritical Care and Neuropalliative Collaboration on Intensive Care Unit Outcomes. Am J Hosp Palliat Care 2022; 39:687-694. [PMID: 35040688 DOI: 10.1177/10499091211060055] [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: 11/16/2022] Open
Abstract
BACKGROUND Neurocritical care (NCC) and neuropalliative care (NPC) clinicians provide care in specialized intensive care units (ICU). There is a paucity of data regarding the impact of NCC and NPC collaboration in smaller, community-focused settings. OBJECTIVE To determine the clinical impact of introducing a NCC/NPC collaborative model in a mixed ICU community-based teaching hospital. DESIGN Retrospective pre/post cohort study. SUBJECTS Patients ≥18 years of age admitted to the ICU who received neurology and palliative care consultations between September 1, 2015 and August 31, 2017 at a 300 bed community-focused hospital were included. INTERVENTION The addition of a NCC/NPC collaborative model took place in September of 2016. The time periods before (9/1/2015 to 8/31/2016) and after (9/1/2016 to 8/31/2017) the addition were compared. RESULTS A total of 274 admissions (pre: 130, post: 144) were included. There were significantly more NCC consultations provided in the post-period (44.6% vs 57.6%; P = .03). NPC consultation increased (55.4% vs 66.7%; P = .056) Median LOS was significantly shorter after implementation of the collaborative model (11 vs 8 days; P = .01). Median ICU LOS was also shorter by 1 ICU-day in the post-period, though this was not statistically significant (P = .23). Mortality rates were similar (P = .95). CONCLUSIONS Our findings suggest NCC/NPC collaboration in a community-focused teaching hospital was associated with more NCC consultations, as well as shorter LOS without increasing mortality. These data highlight the importance of supporting collaborative models of care in community settings. Further research is warranted.
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Affiliation(s)
- Andersen J Shemme
- Department of Neurology, 24752Hauenstein Neurosciences Mercy Health Saint Mary's, Grand Rapids, MI, USA
| | - Joel N Phillips
- Department of Neurology, 24752Hauenstein Neurosciences Mercy Health Saint Mary's, Grand Rapids, MI, USA.,Department of Palliative and Supportive Care, 24752Mercy Health Saint Mary's, Grand Rapids, MI, USA
| | - Rafael Bloise
- Department of Palliative and Supportive Care, 24752Mercy Health Saint Mary's, Grand Rapids, MI, USA
| | - Tracy J Koehler
- Scholarly Activity Solutions, LLC-Grand Rapids, Grand Rapids, MI, USA
| | - Philip B Gorelick
- Department of Neurology, 24752Hauenstein Neurosciences Mercy Health Saint Mary's, Grand Rapids, MI, USA
| | - Brandon A Francis
- Department of Neurology and Ophthalmology, 3078Michigan State University, Lansing, MI, USA
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42
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Sarmet M. Neuroanatomical Subaquatic Pearl: The Beauty of Neuropalliative Care Revisited. J Palliat Med 2022; 25:838-839. [PMID: 35499377 DOI: 10.1089/jpm.2022.0029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Max Sarmet
- Graduate Department of Health Science and Technology, University of Brasília, Brasília, Brazil.,Department of Palliative Care, Hospital de Apoio de Brasília, Brasília, Brazil.,Tertiary Referral Center of Neuromuscular Diseases, Hospital de Apoio de Brasília, Brasília, Brazil
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43
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da Silveira MRM, Forte DN. Palliative care and neurology: a path to neuropalliativism. ARQUIVOS DE NEURO-PSIQUIATRIA 2022; 80:328-335. [PMID: 35976309 PMCID: PMC9491435 DOI: 10.1590/0004-282x-anp-2022-s119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 04/29/2022] [Indexed: 06/15/2023]
Abstract
This article aims to expand the understanding of how it is possible to alleviate suffering and enable a dignified life trajectory for patients with progressive neurological diseases or with severe and permanent neurological impairment. The four most common disease trajectories described for people with chronic and progressive disease used to advance care planning, Brazilian normative ethical resolutions, evidence-based benefits of palliative care (PC), as well as particularities of PC in neurology, such as neurological symptom control, caring for existential and psychological suffering, care provider's needs and particularities of pediatric neurologic PC are reviewed.
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Affiliation(s)
- Mariana Ribeiro Marcondes da Silveira
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Divisão de Neurologia, São Paulo SP, Brazil
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Instituto da Criança, Unidade de Dor e Cuidados Paliativos, São Paulo SP, Brazil
| | - Daniel Neves Forte
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Emergências Clíncias, São Paulo SP, Brazil
- Hospital Sírio-Libanês, Núcleo de Cuidados Paliativos, São Paulo SP, Brazil
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44
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Taylor LP, Besbris JM, Graf WD, Rubin MA, Cruz-Flores S, Epstein LG. Clinical Guidance in Neuropalliative Care: An AAN Position Statement. Neurology 2022; 98:409-416. [PMID: 35256519 DOI: 10.1212/wnl.0000000000200063] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 01/03/2022] [Indexed: 11/15/2022] Open
Affiliation(s)
- Lynne P Taylor
- From the Department of Neurology (L.P.T.), University of Washington, Seattle; Department of Supportive Care Medicine and Neurology (J.M.B.), Cedars-Sinai Medical Center, Los Angeles, CA; Department of Pediatrics (Division of Neurology) (W.D.G.), Connecticut Children's, University of Connecticut, Farmington; Department of Neurology (M.A.R.), University of Texas Southwestern Medical Center, Dallas; Department of Neurology (S.C.C.-F.), Texas Tech University Center, El Paso; and Department of Pediatrics and Neurology (L.G.E.), Northwestern University School of Medicine, Chicago, IL.
| | - Jessica M Besbris
- From the Department of Neurology (L.P.T.), University of Washington, Seattle; Department of Supportive Care Medicine and Neurology (J.M.B.), Cedars-Sinai Medical Center, Los Angeles, CA; Department of Pediatrics (Division of Neurology) (W.D.G.), Connecticut Children's, University of Connecticut, Farmington; Department of Neurology (M.A.R.), University of Texas Southwestern Medical Center, Dallas; Department of Neurology (S.C.C.-F.), Texas Tech University Center, El Paso; and Department of Pediatrics and Neurology (L.G.E.), Northwestern University School of Medicine, Chicago, IL
| | - William D Graf
- From the Department of Neurology (L.P.T.), University of Washington, Seattle; Department of Supportive Care Medicine and Neurology (J.M.B.), Cedars-Sinai Medical Center, Los Angeles, CA; Department of Pediatrics (Division of Neurology) (W.D.G.), Connecticut Children's, University of Connecticut, Farmington; Department of Neurology (M.A.R.), University of Texas Southwestern Medical Center, Dallas; Department of Neurology (S.C.C.-F.), Texas Tech University Center, El Paso; and Department of Pediatrics and Neurology (L.G.E.), Northwestern University School of Medicine, Chicago, IL
| | - Michael A Rubin
- From the Department of Neurology (L.P.T.), University of Washington, Seattle; Department of Supportive Care Medicine and Neurology (J.M.B.), Cedars-Sinai Medical Center, Los Angeles, CA; Department of Pediatrics (Division of Neurology) (W.D.G.), Connecticut Children's, University of Connecticut, Farmington; Department of Neurology (M.A.R.), University of Texas Southwestern Medical Center, Dallas; Department of Neurology (S.C.C.-F.), Texas Tech University Center, El Paso; and Department of Pediatrics and Neurology (L.G.E.), Northwestern University School of Medicine, Chicago, IL
| | - Salvador Cruz-Flores
- From the Department of Neurology (L.P.T.), University of Washington, Seattle; Department of Supportive Care Medicine and Neurology (J.M.B.), Cedars-Sinai Medical Center, Los Angeles, CA; Department of Pediatrics (Division of Neurology) (W.D.G.), Connecticut Children's, University of Connecticut, Farmington; Department of Neurology (M.A.R.), University of Texas Southwestern Medical Center, Dallas; Department of Neurology (S.C.C.-F.), Texas Tech University Center, El Paso; and Department of Pediatrics and Neurology (L.G.E.), Northwestern University School of Medicine, Chicago, IL
| | - Leon G Epstein
- From the Department of Neurology (L.P.T.), University of Washington, Seattle; Department of Supportive Care Medicine and Neurology (J.M.B.), Cedars-Sinai Medical Center, Los Angeles, CA; Department of Pediatrics (Division of Neurology) (W.D.G.), Connecticut Children's, University of Connecticut, Farmington; Department of Neurology (M.A.R.), University of Texas Southwestern Medical Center, Dallas; Department of Neurology (S.C.C.-F.), Texas Tech University Center, El Paso; and Department of Pediatrics and Neurology (L.G.E.), Northwestern University School of Medicine, Chicago, IL
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45
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Harrison KL, Garrett SB, Gilissen J, Terranova MJ, Bernstein Sideman A, Ritchie CS, Geschwind MD. Developing neuropalliative care for sporadic Creutzfeldt-Jakob Disease. Prion 2022; 16:23-39. [PMID: 35239456 PMCID: PMC8896185 DOI: 10.1080/19336896.2022.2043077] [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
We aimed to identify targets for neuropalliative care interventions in sporadic Creutzfeldt-Jakob disease by examining characteristics of patients and sources of distress and support among former caregivers. We identified caregivers of decedents with sporadic Creutzfeldt-Jakob disease from the University of California San Francisco Rapidly Progressive Dementia research database. We purposively recruited 12 caregivers for in-depth interviews and extracted associated patient data. We analysed interviews using the constant comparison method and chart data using descriptive statistics. Patients had a median age of 70 (range: 60–86) years and disease duration of 14.5 months (range 4–41 months). Caregivers were interviewed a median of 22 (range 11–39) months after patient death and had a median age of 59 (range 45–73) years. Three major sources of distress included (1) the unique nature of sporadic Creutzfeldt-Jakob disease; (2) clinical care issues such as difficult diagnostic process, lack of expertise in sporadic Creutzfeldt-Jakob disease, gaps in clinical systems, and difficulties with end-of-life care; and (3) caregiving issues, including escalating responsibilities, intensifying stress, declining caregiver well-being, and care needs surpassing resources. Two sources of support were (1) clinical care, including guidance from providers about what to expect and supportive relationships; and (2) caregiving supports, including connection to persons with experience managing Creutzfeldt-Jakob disease, instrumental support, and social/emotional support. The challenges and supports described by caregivers align with neuropalliative approaches and can be used to develop interventions to address needs of persons with sporadic Creutzfeldt-Jakob disease and their caregivers.
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Affiliation(s)
- Krista L Harrison
- Division of Geriatrics, University of California, San Francisco, USA.,Philip R. University of California, San Francisco, USA.,Global Brain Health Institute, University of California, San Francisco, California, USA
| | | | - Joni Gilissen
- Global Brain Health Institute, University of California, San Francisco, California, USA.,End-of-Life Care Research Group, Department of Family Medicine & Chronic Care, Vrije Universiteit Brussel (Vub), Belgium
| | - Michael J Terranova
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA
| | - Alissa Bernstein Sideman
- Philip R. University of California, San Francisco, USA.,Global Brain Health Institute, University of California, San Francisco, California, USA.,Department of Humanities and Social Sciences, University of California San Francisco, San Francisco, California, USA
| | - Christine S Ritchie
- Division of Geriatrics, University of California, San Francisco, USA.,Global Brain Health Institute, University of California, San Francisco, California, USA.,The Mongan Institute and the Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Boston, USA
| | - Michael D Geschwind
- Global Brain Health Institute, University of California, San Francisco, California, USA.,Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA
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46
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Sarmet M, Cavalcanti de Oliveira ERN, Cirne Franco H, Zeredo JL, Mehta AK. The Current State of Neuropalliative Care in Brazil: Trends in Representation and Advocacy. J Palliat Med 2022; 25:343-344. [PMID: 35230899 DOI: 10.1089/jpm.2021.0614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Max Sarmet
- Department of Palliative Care, Hospital de Apoio de Brasília, Brasília, Brazil.,Department of Neurology, Tertiary Referral Center of Neuromuscular Diseases, Hospital de Apoio de Brasília, Brasília, Brazil.,Graduate Department of Health Sciences and Technologies, University of Brasília, Brasília, Brazil
| | | | - Hamilton Cirne Franco
- Department of Neurology, Tertiary Referral Center of Neuromuscular Diseases, Hospital de Apoio de Brasília, Brasília, Brazil
| | - Jorge L Zeredo
- Graduate Department of Health Sciences and Technologies, University of Brasília, Brasília, Brazil
| | - Ambereen K Mehta
- Palliative Care Program, Division of General Internal Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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47
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Neuro-oncology and supportive care: the role of the neurologist. Neurol Sci 2022; 43:939-950. [DOI: 10.1007/s10072-021-05862-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 12/28/2021] [Indexed: 11/29/2022]
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48
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Kluger BM, Kramer NM, Katz M, Galifianakis NB, Pantilat S, Long J, Vaughan CL, Foster LA, Creutzfeldt CJ, Holloway RG, Sillau S, Hauser J. Development and Dissemination of a Neurology Palliative Care Curriculum: Education in Palliative and End-of-Life Care Neurology. Neurol Clin Pract 2022; 12:176-182. [PMID: 35747891 PMCID: PMC9208408 DOI: 10.1212/cpj.0000000000001146] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 08/09/2021] [Indexed: 11/15/2022]
Abstract
ABSTRACTDespite increasing awareness of the importance of a palliative care approach to meet the needs of persons living with neurologic illness, residency and fellowship programs report meeting this educational need due to a limited pool of neuropalliative care educators and a lack of adequate educational resources. To meet this need, a group of experts in neuropalliative care and palliative medicine leveraged resources from the Education in Palliative and End-of-life Care (EPEC) program and the National Institutes of Nursing Research (NINR) to create a library of modules addressing topics relevant for neurology trainees, palliative medicine fellows and clinicians in practice. In this manuscript, we describe the development and dissemination plan of the Education in Palliative and End-of-life Care Neurology (EPEC-N) program, initial evidence of efficacy, and opportunities for neurology educators and health services researchers to utilize these resources.
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Affiliation(s)
- Benzi M Kluger
- Departments of Neurology and Medicine (BMK, RGH), University of Rochester Medical Center, NY; Department of Internal Medicine (NMK), Rush University Medical College, Chicago, IL; Division of Palliative Medicine and Department of Medicine (MK, NBG, SP, JL), University of California, San Francisco; Department of Neurology (CLV, LAF, SS), University of Colorado Anschutz Medical Campus, Aurora; Department of Neurology (CJC), University of Washington, Seattle; and Departments of Palliative and Internal Medicine (JH), Northwestern University, Chicago, IL
| | - Neha M Kramer
- Departments of Neurology and Medicine (BMK, RGH), University of Rochester Medical Center, NY; Department of Internal Medicine (NMK), Rush University Medical College, Chicago, IL; Division of Palliative Medicine and Department of Medicine (MK, NBG, SP, JL), University of California, San Francisco; Department of Neurology (CLV, LAF, SS), University of Colorado Anschutz Medical Campus, Aurora; Department of Neurology (CJC), University of Washington, Seattle; and Departments of Palliative and Internal Medicine (JH), Northwestern University, Chicago, IL
| | - Maya Katz
- Departments of Neurology and Medicine (BMK, RGH), University of Rochester Medical Center, NY; Department of Internal Medicine (NMK), Rush University Medical College, Chicago, IL; Division of Palliative Medicine and Department of Medicine (MK, NBG, SP, JL), University of California, San Francisco; Department of Neurology (CLV, LAF, SS), University of Colorado Anschutz Medical Campus, Aurora; Department of Neurology (CJC), University of Washington, Seattle; and Departments of Palliative and Internal Medicine (JH), Northwestern University, Chicago, IL
| | - Nicholas B Galifianakis
- Departments of Neurology and Medicine (BMK, RGH), University of Rochester Medical Center, NY; Department of Internal Medicine (NMK), Rush University Medical College, Chicago, IL; Division of Palliative Medicine and Department of Medicine (MK, NBG, SP, JL), University of California, San Francisco; Department of Neurology (CLV, LAF, SS), University of Colorado Anschutz Medical Campus, Aurora; Department of Neurology (CJC), University of Washington, Seattle; and Departments of Palliative and Internal Medicine (JH), Northwestern University, Chicago, IL
| | - Steven Pantilat
- Departments of Neurology and Medicine (BMK, RGH), University of Rochester Medical Center, NY; Department of Internal Medicine (NMK), Rush University Medical College, Chicago, IL; Division of Palliative Medicine and Department of Medicine (MK, NBG, SP, JL), University of California, San Francisco; Department of Neurology (CLV, LAF, SS), University of Colorado Anschutz Medical Campus, Aurora; Department of Neurology (CJC), University of Washington, Seattle; and Departments of Palliative and Internal Medicine (JH), Northwestern University, Chicago, IL
| | - Judith Long
- Departments of Neurology and Medicine (BMK, RGH), University of Rochester Medical Center, NY; Department of Internal Medicine (NMK), Rush University Medical College, Chicago, IL; Division of Palliative Medicine and Department of Medicine (MK, NBG, SP, JL), University of California, San Francisco; Department of Neurology (CLV, LAF, SS), University of Colorado Anschutz Medical Campus, Aurora; Department of Neurology (CJC), University of Washington, Seattle; and Departments of Palliative and Internal Medicine (JH), Northwestern University, Chicago, IL
| | - Christina L Vaughan
- Departments of Neurology and Medicine (BMK, RGH), University of Rochester Medical Center, NY; Department of Internal Medicine (NMK), Rush University Medical College, Chicago, IL; Division of Palliative Medicine and Department of Medicine (MK, NBG, SP, JL), University of California, San Francisco; Department of Neurology (CLV, LAF, SS), University of Colorado Anschutz Medical Campus, Aurora; Department of Neurology (CJC), University of Washington, Seattle; and Departments of Palliative and Internal Medicine (JH), Northwestern University, Chicago, IL
| | - Laura A Foster
- Departments of Neurology and Medicine (BMK, RGH), University of Rochester Medical Center, NY; Department of Internal Medicine (NMK), Rush University Medical College, Chicago, IL; Division of Palliative Medicine and Department of Medicine (MK, NBG, SP, JL), University of California, San Francisco; Department of Neurology (CLV, LAF, SS), University of Colorado Anschutz Medical Campus, Aurora; Department of Neurology (CJC), University of Washington, Seattle; and Departments of Palliative and Internal Medicine (JH), Northwestern University, Chicago, IL
| | - Claire J Creutzfeldt
- Departments of Neurology and Medicine (BMK, RGH), University of Rochester Medical Center, NY; Department of Internal Medicine (NMK), Rush University Medical College, Chicago, IL; Division of Palliative Medicine and Department of Medicine (MK, NBG, SP, JL), University of California, San Francisco; Department of Neurology (CLV, LAF, SS), University of Colorado Anschutz Medical Campus, Aurora; Department of Neurology (CJC), University of Washington, Seattle; and Departments of Palliative and Internal Medicine (JH), Northwestern University, Chicago, IL
| | - Robert G Holloway
- Departments of Neurology and Medicine (BMK, RGH), University of Rochester Medical Center, NY; Department of Internal Medicine (NMK), Rush University Medical College, Chicago, IL; Division of Palliative Medicine and Department of Medicine (MK, NBG, SP, JL), University of California, San Francisco; Department of Neurology (CLV, LAF, SS), University of Colorado Anschutz Medical Campus, Aurora; Department of Neurology (CJC), University of Washington, Seattle; and Departments of Palliative and Internal Medicine (JH), Northwestern University, Chicago, IL
| | - Stefan Sillau
- Departments of Neurology and Medicine (BMK, RGH), University of Rochester Medical Center, NY; Department of Internal Medicine (NMK), Rush University Medical College, Chicago, IL; Division of Palliative Medicine and Department of Medicine (MK, NBG, SP, JL), University of California, San Francisco; Department of Neurology (CLV, LAF, SS), University of Colorado Anschutz Medical Campus, Aurora; Department of Neurology (CJC), University of Washington, Seattle; and Departments of Palliative and Internal Medicine (JH), Northwestern University, Chicago, IL
| | - Joshua Hauser
- Departments of Neurology and Medicine (BMK, RGH), University of Rochester Medical Center, NY; Department of Internal Medicine (NMK), Rush University Medical College, Chicago, IL; Division of Palliative Medicine and Department of Medicine (MK, NBG, SP, JL), University of California, San Francisco; Department of Neurology (CLV, LAF, SS), University of Colorado Anschutz Medical Campus, Aurora; Department of Neurology (CJC), University of Washington, Seattle; and Departments of Palliative and Internal Medicine (JH), Northwestern University, Chicago, IL
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Oliver D. Neuropalliative care: Defining an emerging field. HANDBOOK OF CLINICAL NEUROLOGY 2022; 190:17-31. [PMID: 36055714 DOI: 10.1016/b978-0-323-85029-2.00008-7] [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: 06/15/2023]
Abstract
Palliative care is increasingly becoming an established part of medical care, providing the holistic assessment and management of the person at the center of care-physical, psychological, social, and spiritual. This had originally been primarily provided for people with terminal cancers but in the last 50 years, this care has extended to caring for people with issues throughout disease progression and for all diagnoses, including neurologic diseases. Palliative care in fact is now included within guidelines and standards for many neurologic diseases. Palliative care may be delivered as an approach provided by all health and social care professionals; by focused care provided within neurology; and through the involvement of specialist palliative care and neuropalliative care for more complex issues. The education of neurologists and palliative care specialists is essential to enable all to be aware of the issues faced by patients and their families and provide adequate support for patients, families, and healthcare professionals. In this way, the quality of life can be maintained as much as possible and patients are able to die with as little distress as possible, with their families and carers supported.
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Affiliation(s)
- David Oliver
- Tizard Centre, University of Kent, Canterbury, United Kingdom.
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50
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Kluger BM, Miyasaki JM. Key concepts and opportunities. HANDBOOK OF CLINICAL NEUROLOGY 2022; 190:3-15. [PMID: 36055718 DOI: 10.1016/b978-0-323-85029-2.00014-2] [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: 06/15/2023]
Abstract
Neuropalliative care is an emerging field dedicated to applying palliative care approaches to meet the needs of persons living with neurologic illness and their families. The development of this field acknowledges the unique needs of this population, including in terms of neuropsychiatric symptoms, the impact of neurologic illness on personhood, and the logistics of managing neurologic disability. In defining the goals of this field, it is important to distinguish between neuropalliative care as an approach to care, as a skillset, as a medical subspecialty, and as a public health goal as each of these constructs offers their own contributions and opportunities. As a newly emerging field, there are nearly unlimited opportunities to improve care through research, clinical care, education, and advocacy.
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Affiliation(s)
- Benzi M Kluger
- Department of Neurology, University of Rochester, Rochester, NY, United States
| | - Janis M Miyasaki
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada.
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