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Feng TL, Stoessl AJ, Harrison RA. Integrated Care in Neurology: The Current Landscape and Future Directions. Can J Neurol Sci 2024:1-9. [PMID: 38679923 DOI: 10.1017/cjn.2024.62] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
The rising burden of neurological disorders poses significant challenges to healthcare systems worldwide. There has been an increasing momentum to apply integrated approaches to the management of several chronic illnesses in order to address systemic healthcare challenges and improve the quality of care for patients. The aim of this paper is to provide a narrative review of the current landscape of integrated care in neurology. We identified a growing body of research from countries around the world applying a variety of integrated care models to the treatment of common neurological conditions. Based on our findings, we discuss opportunities for further study in this area. Finally, we discuss the future of integrated care in Canada, including unique geographic, historical, and economic considerations, and the role that integrated care may play in addressing challenges we face in our current healthcare system.
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Affiliation(s)
- Tanya L Feng
- Division of Neurology, The University of British Columbia, Vancouver, BC, Canada
| | - A Jon Stoessl
- Division of Neurology, The University of British Columbia, Vancouver, BC, Canada
- Pacific Parkinson's Research Centre, Vancouver, BC, Canada
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
| | - Rebecca A Harrison
- Division of Neurology, The University of British Columbia, Vancouver, BC, Canada
- British Columbia Cancer Agency, Vancouver, BC, Canada
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Jang MS, Yoo SH, Kim MS, Cho B, Kim KH, Shin J, Hwang I, Choi SJ, Sung JJ, Lee SY. Healthcare Utilization and Supportive Care Timing in South Korean People Living With Amyotrophic Lateral Sclerosis: A Single-Center Retrospective Study. J Clin Neurol 2024; 20:166-174. [PMID: 38212665 PMCID: PMC10921051 DOI: 10.3988/jcn.2023.0211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 08/19/2023] [Accepted: 09/18/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND AND PURPOSE Despite the growing demands and challenges faced by patients with amyotrophic lateral sclerosis (ALS) in accessing healthcare services, our understanding of this access remains poor. This study aimed to investigate the healthcare utilization patterns and timing of nutritional and respiration support in patients with ALS in South Korea. METHODS A retrospective cohort study was conducted on patients diagnosed with ALS at a single tertiary hospital between 2016 and 2019 and followed up for 2 years. We evaluated patient characteristics, healthcare utilization (hospital admissions, outpatient visits, and emergency department [ED] visits), and the timing of nutritional and respiration support (noninvasive positive pressure ventilation [NIPPV], tracheostomy, gastrostomy, and nasogastric tube) at 6-month intervals from the first outpatient visit. RESULTS Among the 143 included patients, 73.4% were admitted at least once, 18.9% experienced unplanned admissions, and 30.1% visited the ED at least once during the study period. The most-common reason for ED visits was neurological symptoms during the first 6 months (59.1%), followed by respiratory symptoms. One fifth of patients who visited the ED underwent tracheostomy (20.9%) or NIPPV (20.9%). Two years after the first visit, 32.2% used a ventilator, and 13.3%, 26.6%, and 6.3% had undergone tracheostomy, gastrostomy, and nasogastric tube insertion, respectively. CONCLUSIONS During the 2 years following their first outpatient visit, 20% of patients with ALS experienced unplanned admissions and 30% visited the ED. An active and prompt supportive-care program should be implemented to ensure timely functional support in order to reduce these risks of unplanned admissions.
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Affiliation(s)
- Min Seol Jang
- Seoul National University Graduate School of Public Health, Seoul, Korea
| | - Shin Hye Yoo
- Center for Palliative Care and Clinical Ethics, Seoul National University Hospital, Seoul, Korea
- Department of Human Systems Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Min Sun Kim
- Public Healthcare Center, Seoul National University Hospital, Seoul, Korea
- Department of Pediatrics, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Belong Cho
- Department of Human Systems Medicine, Seoul National University College of Medicine, Seoul, Korea
- Public Healthcare Center, Seoul National University Hospital, Seoul, Korea
- Institute on Aging, Seoul National University College of Medicine, Seoul, Korea
| | - Kyae Hyung Kim
- Public Healthcare Center, Seoul National University Hospital, Seoul, Korea
| | - Jeongmi Shin
- Public Healthcare Center, Seoul National University Hospital, Seoul, Korea
| | - Inyoung Hwang
- Public Healthcare Center, Seoul National University Hospital, Seoul, Korea
| | - Seok-Jin Choi
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
| | - Jung-Joon Sung
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
| | - Sun Young Lee
- Department of Human Systems Medicine, Seoul National University College of Medicine, Seoul, Korea
- Public Healthcare Center, Seoul National University Hospital, Seoul, Korea.
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Huynh A, Adams K, Barnett-Tapia C, Kalra S, Zinman L, Yunusova Y. Accessing and Receiving Speech-Language Pathology Services at the Multidisciplinary Amyotrophic Lateral Sclerosis Clinic: An Exploratory Qualitative Study of Patient Experiences and Needs. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023:1-13. [PMID: 37678221 DOI: 10.1044/2023_jslhr-23-00087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
PURPOSE This study sought to explore how patients with amyotrophic lateral sclerosis (ALS) presenting with coexisting bulbar and cognitive impairments and their caregivers experienced the speech-language pathologist (SLP) services provided in multidisciplinary ALS clinics in Canada and identified their perceived needs for bulbar symptom management. METHOD This qualitative study was informed by interpretive description. Seven interviews were conducted with patients with severe bulbar dysfunction or severe bulbar and cognitive dysfunction due to ALS or ALS-frontotemporal dementia, respectively, and/or their caregivers. Purposive sampling was used to recruit individuals with severe bulbar or bulbar and cognitive disease. Thematic analysis was used to analyze interview data. RESULTS Patients and caregivers reported difficulties with accessing and receiving SLP services at the multidisciplinary ALS clinic. These difficulties were further exacerbated in those with severe cognitive disease. Participants expressed a need for more specific (i.e., disease and service-related) information and personalized care to address their changing needs and preferences. Engaging caregivers earlier in SLP appointments was perceived as vital to support care planning and provide in-time caregiver education. CONCLUSIONS This study highlighted the challenges experienced by patients and caregivers in accessing and receiving SLP services. There is a pressing need for a more person-centered approach to ALS care and a continuing need for education of SLPs on care provision in cases of complex multisymptom diseases within a multidisciplinary ALS clinic. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.24069222.
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Affiliation(s)
- Anna Huynh
- Department of Speech-Language Pathology, University of Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Ontario, Canada
- Sunnybrook Research Institute, Toronto, Ontario, Canada
- KITE-Toronto Rehabilitation Institute, University Health Network, Ontario, Canada
| | | | | | - Sanjay Kalra
- Department of Medicine (Neurology), University of Alberta, Edmonton, Canada
| | - Lorne Zinman
- Rehabilitation Sciences Institute, University of Toronto, Ontario, Canada
- Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Yana Yunusova
- Department of Speech-Language Pathology, University of Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Ontario, Canada
- Sunnybrook Research Institute, Toronto, Ontario, Canada
- KITE-Toronto Rehabilitation Institute, University Health Network, Ontario, Canada
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Alquati S, Ghirotto L, De Panfilis L, Autelitano C, Bertocchi E, Artioli G, Sireci F, Tanzi S, Sacchi S. Negotiating the Beginning of Care: A Grounded Theory Study of Health Services for Amyotrophic Lateral Sclerosis. Brain Sci 2022; 12:brainsci12121623. [PMID: 36552083 PMCID: PMC9775577 DOI: 10.3390/brainsci12121623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/17/2022] [Accepted: 11/24/2022] [Indexed: 11/29/2022] Open
Abstract
A range of professional figures are needed to preserve the quality of life of people with amyotrophic lateral sclerosis. This study aimed to explore the beginning of the care process as negotiated by people with amyotrophic lateral sclerosis, their caregivers, and healthcare professionals. We designed the study according to the constructivist Grounded Theory method, collecting data through open-ended, semi-structured interviews, employing theoretical sampling and constant comparison, and performing conceptual coding as data analysis. By naming the core category "off-beat interfacing", we were able to show how the demands of the professionals concerned did not correspond to the ability of people with ALS and their proxies to process information, deal with requests, and be at ease in making decisions at the beginning of the shared care pathway. Three categories were generated: (i) navigating different paths, (ii) offering and experiencing a standard, non-personalized pathway, and (iii) anticipating decisions. The network of services must be organized according to guidelines, but must also contemplate a patient-family-centered approach that permits more personalized assistance.
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Affiliation(s)
- Sara Alquati
- Palliative Care Unit, Azienda USL—IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Luca Ghirotto
- Qualitative Research Unit, Azienda USL—IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
- Correspondence:
| | | | - Cristina Autelitano
- Palliative Care Unit, Azienda USL—IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Elisabetta Bertocchi
- Palliative Care Unit, Azienda USL—IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Giovanna Artioli
- Department of Medicine and Surgery, University of Parma, 43125 Parma, Italy
| | - Francesca Sireci
- Neurology Unit, Azienda USL—IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Silvia Tanzi
- Palliative Care Unit, Azienda USL—IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Simona Sacchi
- Palliative Care Unit, Azienda USL—IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
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Brewah H, Borrett K, Tavares N, Jarrett N. Perceptions of people with motor neurone disease, families and HSCPs: a literature review. Br J Community Nurs 2022; 27:188-198. [PMID: 35353593 DOI: 10.12968/bjcn.2022.27.4.188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Motor neurone disease or amyotrophic lateral sclerosis is a rapidly progressive terminal neurodegenerative condition caused by degeneration of the upper and lower motor neurones in the central nervous system of the brain. The effects of motor neurone disease are multifaceted, leading to many adjustments in everyday life. This literature review asked what the experiences of people living with motor neurone disease was before and during the COVID-19 pandemic and during the COVID-19 pandemic, especially in terms of their condition and the support they received from health and social care services. A key theme identified was lack of knowledge among professionals when they cared for people living with motor neurone disease and their families. This lack of knowledge often resulted in delayed diagnosis and poor standards of care. COVID-19 impacted on the care of people living with motor neurone disease and their families, and there is a paucity of evidence on how services were perceived by these groups during the COVID-19 pandemic. The experiences of people living with motor neurone disease and their families are currently missing in the literature. In conclusion, further studies are required to include care of people living with motor neurone disease and their families.
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Affiliation(s)
- Helen Brewah
- Queen's Nurse, Florence Nightingale Scholar and PhD student, University of Portsmouth
| | - Kevin Borrett
- Mental Health Governance Lead, Solent NHS Trust, and PhD Supervisor, University of Portsmouth
| | - Nuno Tavares
- Supervisor and Senior Teaching Fellow, Faculty of Science and Health, University of Portsmouth
| | - Nikki Jarrett
- Course Lead for Professional Doctorate in Health and Social Care, University of Portsmouth
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Caregivers' View of Socio-Medical Care in the Terminal Phase of Amyotrophic Lateral Sclerosis-How Can We Improve Holistic Care in ALS? J Clin Med 2022; 11:jcm11010254. [PMID: 35011995 PMCID: PMC8745628 DOI: 10.3390/jcm11010254] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 12/28/2021] [Accepted: 12/30/2021] [Indexed: 11/18/2022] Open
Abstract
Multidimensional socio-medical care with an early integration of palliative principles is strongly recommended in amyotrophic lateral sclerosis (ALS), but provided inconsistently. We conducted telephone interviews with 49 former caregivers of deceased ALS patients to examine their experience of care in the terminal phase including caregiver burden. Patients who received specialized palliative care (45% of patients) were more likely to die at home (p = 0.004) and without burdening symptoms (p = 0.021). The majority of caregivers (86%) reported deficits in socio-medical care. Most frequently mentioned were problems receiving medical aids (45%) and a lack of caregiver support (35%). A higher level of deficits experienced by caregivers was associated with negative health outcomes on the side of the caregivers (reported by 57% of them; p = 0.002) and stronger caregiver burden (p = 0.004). To provide good quality of dying to patients and reduce the burden on caregivers, multidimensional—including palliative—care in ALS urgently needs to be strengthened in the healthcare structures.
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Palese F, Gigli GL, Manganotti P, Passadore P, Rana M, Verriello L. The diagnostic, therapeutic and assistance pathway for amyotrophic lateral sclerosis in a north-eastern Italian region: satisfaction of patients and their caregivers. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:124-132. [PMID: 34014000 DOI: 10.1111/hsc.13379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 02/06/2021] [Accepted: 03/03/2021] [Indexed: 06/12/2023]
Abstract
In order to evaluate the users' satisfaction degree for the diagnostic, therapeutic and assistance services for amyotrophic lateral sclerosis (ALS) in the Italian region Friuli-Venezia Giulia (FVG), a self-compiled anonymous multiple-choice questionnaire was administered to ALS patients and their caregivers. The questionnaire explored 41 different issues covering the following areas: (a) access to diagnostic pathway and communication among patients, families and health professionals; (b) quality of disease monitoring and effectiveness of interventions aimed at mitigating ALS symptoms; (c) easiness of access to assistive devices (e.g. wheelchair, ankle-foot-orthosis) and home assistance; (d) patient' choices sharing and health professionals empathy. The same issues were proposed both to patients and carers, appropriately adapting the questions, during the period between June and December 2019. The answers were categorised according to criticality level. Median with interquartile range of the numeric variables and percentages of the categorical variables and of the answers to questions were calculated. The mean percentage of satisfied users was 72.8%, considering all the areas. Pain treatment and easiness of access to ambulance transport were the most positive aspects (95.7% and 92.5% of satisfied respondents, respectively), while information about possible enrolment in clinical trials and about possible registration to the regional ALS association were the most critical issues (30.9% and 43.4% of satisfied users). Although the satisfaction level of ALS patients and their caregivers for the services provided resulted generally good, there were some areas that have to be improved. For this purpose, enhancement of multidisciplinary collaboration, sharing of points of view from users and different practitioners and rising awareness among healthcare professionals through clinical audits could be useful. Further research is needed to identify a wider range of users' unexplored unmet needs.
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Affiliation(s)
| | - Gian Luigi Gigli
- Clinical Neurology Unit, Department of Neurosciences, Santa Maria della Misericordia University Hospital, ASUFC, Udine, Italy
- Department of Mathematics, Informatics and Physics, University of Udine, Udine, Italy
| | - Paolo Manganotti
- Clinical Neurology Unit, Department of Medical, Surgical, and Health Sciences, University Hospital of Trieste, ASUGI, Trieste, Italy
| | - Paolo Passadore
- Neurology Unit, Santa Maria degli Angeli Hospital, ASFO, Pordenone, Italy
| | - Michele Rana
- Neurology Unit, Hospital of Gorizia, ASUGI, Gorizia, Italy
| | - Lorenzo Verriello
- Neurology Unit, Department of Neurosciences, Santa Maria della Misericordia University Hospital, ASUFC, Udine, Italy
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Kierkegaard M, Gottberg K, Johansson S, Littorin S, Sandstedt P, Ytterberg C, Holmqvist LW. Healthcare Utilisation and Satisfaction with Care in Patients with Amyotrophic Lateral Sclerosis - An Observational Study. J Neuromuscul Dis 2021; 8:1079-1088. [PMID: 34057094 PMCID: PMC8673529 DOI: 10.3233/jnd-210687] [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: 11/15/2022]
Abstract
BACKGROUND Patients with amyotrophic lateral sclerosis (ALS) need a large amount of healthcare services. Knowledge on use of and satisfaction with healthcare is, however, scarce. OBJECTIVE The objectives were to explore use and satisfaction of healthcare in patients with ALS. METHODS The sample consisted of patients with ALS, recruited from the ALS clinic at the Karolinska University Hospital, Stockholm, Sweden, participating in a three-year observational study. Data on healthcare utilisation were retrieved from the computerised register at Region Stockholm, Sweden. Information regarding disability, contextual factors and satisfaction with care was collected by home visits. RESULTS Over time, half, or less of the patients used inpatient care, whereas all used outpatient care. Half of all outpatient contacts were with providers of advanced healthcare in the home and one-fifth with allied health professionals. Nurses performing home visits composed the largest proportion of outpatient contacts. A small amount of the utilised outpatient care emerged from the ALS clinic. Patients with severe disease and longer time since diagnosis had fewer contacts with the ALS clinic. Satisfaction with care was in general stable over time with around two-thirds or more of patients being satisfied. Most patients wanted to participate in care planning, but few had. CONCLUSION Patients with ALS use hospital-based specialist care and other outpatient care in parallel with many healthcare providers involved. Our findings highlight the need for implementation of person-centred care to improve both coordination of care, care transitions and satisfaction with healthcare services.
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Affiliation(s)
- Marie Kierkegaard
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Women's Health and Allied Health Professionals Theme, Karolinska University Hospital, Stockholm, Sweden.,Academic Specialist Center, Stockholm Health Services, Stockholm, Sweden
| | - Kristina Gottberg
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Sverker Johansson
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Women's Health and Allied Health Professionals Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Susanne Littorin
- Women's Health and Allied Health Professionals Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Petter Sandstedt
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Women's Health and Allied Health Professionals Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Charlotte Ytterberg
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Women's Health and Allied Health Professionals Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Lotta Widén Holmqvist
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Women's Health and Allied Health Professionals Theme, Karolinska University Hospital, Stockholm, Sweden
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Aoun SM, Cafarella PA, Hogden A, Thomas G, Jiang L, Edis R. Why and how the work of Motor Neurone Disease Associations matters before and during bereavement: a consumer perspective. Palliat Care Soc Pract 2021; 15:26323524211009537. [PMID: 34104885 PMCID: PMC8072839 DOI: 10.1177/26323524211009537] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 03/24/2021] [Indexed: 12/14/2022] Open
Abstract
Background: Studies on the experiences of consumers with Motor Neurone Disease Associations at end of life and bereavement are lacking, and their role and capability within the broader sectors of health and disability are unknown. Objectives: To ascertain the experiences and views of bereaved motor neurone disease caregivers with Motor Neurone Disease Associations about service gaps and needed improvements before and during bereavement and to propose a model of care that fits with consumer preferences and where Motor Neurone Disease Associations are effective enablers of care. Methods: A national bereavement survey was facilitated in 2019 by all Motor Neurone Disease Associations in Australia. A total of 363 respondents completed the section on support provided by Motor Neurone Disease Associations. A mixed-method design was used. Results: Respondents were generally positive about support received before bereavement (73-76%), except for emotional support (55%). Positive experiences related to the following: information, equipment advice/provision, advocacy/linking to services, showing empathy/understanding, personal contact and peer social support. Negative experiences included lack of continuity in case management and contact, perceived lack of competence or training, lack of emotional support and a lack of access to motor neurone disease services in rural areas. Suggested improvements were as follows: more contact and compassion at end of life and postdeath; better preparation for end of life; option of discussing euthanasia; providing referrals and links for counseling; access to caregiver support groups and peer interaction; provision of a genuine continuum of care rather than postdeath abandonment; guidance regarding postdeath practicalities; and more access to bereavement support in rural areas. Conclusion: This study provides consumer perspectives on driving new or improved initiatives by Motor Neurone Disease Associations and the need for a national standardised approach to training and service delivery, based on research evidence. A public health approach to motor neurone disease end-of-life care, of international applicability, is proposed to address the needs and preferences of motor neurone disease consumers, while supporting the capability of Motor Neurone Disease Associations within a multidisciplinary workforce to deliver that care.
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Affiliation(s)
- Samar M Aoun
- Public Health Palliative Care Unit, School of Psychology and Public Health, La Trobe University, Melbourne, VIC 3086, Australia
| | - Paul A Cafarella
- Department of Respiratory Medicine, Flinders Medical Centre, Bedford Park, SA, Australia; School of Psychology, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia; College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, Australia
| | - Anne Hogden
- Australian Institute of Health Service Management, College of Business and Economics, University of Tasmania, Sydney, NSW, Australia
| | - Geoff Thomas
- Thomas MND Research Group, Adelaide, SA, Australia; Consumer Advocate and Chair; MND Association in South Australia, Mile End, SA, Australia
| | - Leanne Jiang
- Perron Institute for Neurological and Translational Science, Perth, WA, Australia; Public Health Palliative Care Unit, School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Robert Edis
- Department of Neurology, Sir Charles Gairdner Hospital, Perth, WA, Australia
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Tobin K, Maguire S, Corr B, Normand C, Hardiman O, Galvin M. Discrete choice experiment for eliciting preference for health services for patients with ALS and their informal caregivers. BMC Health Serv Res 2021; 21:213. [PMID: 33750360 PMCID: PMC7941893 DOI: 10.1186/s12913-021-06191-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 02/18/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Amyotrophic Lateral Sclerosis (ALS) is a progressive neurodegenerative condition with a mean life expectancy of 3 years from first symptom. Understanding the factors that are important to both patients and their caregivers has the potential to enhance service delivery and engagement, and improve efficiency. The Discrete Choice Experiment (DCE) is a stated preferences method which asks service users to make trade-offs for various attributes of health services. This method is used to quantify preferences and shows the relative importance of the attributes in the experiment, to the service user. METHODS A DCE with nine choice sets was developed to measure the preferences for health services of ALS patients and their caregivers and the relative importance of various aspects of care, such as timing of care, availability of services, and decision making. The DCE was presented to patients with ALS, and their caregivers, recruited from a national multidisciplinary clinic. A random effects probit model was applied to estimate the impact of each attribute on a participant's choice. RESULTS Patients demonstrated the strongest preferences about timing of receiving information about ALS. A strong preference was also placed on seeing the hospice care team later rather than early on in the illness. Patients also indicated their willingness to consider the use of communication devices. Grouping by stage of disease, patients who were in earlier stages of disease showed a strong preference for receipt of extensive information about ALS at the time of diagnosis. Caregivers showed a strong preference for engagement with healthcare professionals, an attribute that was not prioritised by patients. CONCLUSIONS The DCE method can be useful in uncovering priorities of patients and caregivers with ALS. Patients and caregivers have different priorities relating to health services and the provision of care in ALS, and patient preferences differ based on the stage and duration of their illness. Multidisciplinary teams must calibrate the delivery of care in the context of the differing expectations, needs and priorities of the patient/caregiver dyad.
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Affiliation(s)
- Katy Tobin
- Global Brain Health Institute, School of Medicine, Trinity College Dublin, Dublin, Ireland.
| | - Sinead Maguire
- Department of Neurology, National Neuroscience Centre, Beaumont Hospital, Dublin, Ireland
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Bernie Corr
- Department of Neurology, National Neuroscience Centre, Beaumont Hospital, Dublin, Ireland
| | - Charles Normand
- Centre for Health Policy and Management, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Orla Hardiman
- Department of Neurology, National Neuroscience Centre, Beaumont Hospital, Dublin, Ireland
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
- FutureNeuro SFI Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Miriam Galvin
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
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Aoun SM, Cafarella PA, Rumbold B, Thomas G, Hogden A, Jiang L, Gregory S, Kissane DW. Who cares for the bereaved? A national survey of family caregivers of people with motor neurone disease. Amyotroph Lateral Scler Frontotemporal Degener 2020; 22:12-22. [PMID: 32909457 DOI: 10.1080/21678421.2020.1813780] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Although Motor Neurone Disease (MND) caregivers are most challenged physically and psychologically, there is a paucity of population-based research to investigate the impact of bereavement, unmet needs, range of supports, and their helpfulness as perceived by bereaved MND caregivers. Methods: An anonymous national population-based cross-sectional postal and online survey of bereavement experiences of family caregivers who lost a relative/friend to MND in 2016, 2017, and 2018. Recruitment was through all MND Associations in Australia. Results: 393 valid responses were received (31% response rate). Bereaved caregiver deterioration in physical (31%) and mental health (42%) were common. Approximately 40% did not feel their support needs were met. Perceived insufficiency of support was higher for caregivers at high bereavement risk (63%) and was associated with a significant worsening of their mental and physical health. The majority accessed support from family and friends followed by MND Associations, GPs, and funeral providers. Informal supports were reported to be the most helpful. Sources of professional help were the least used and they were perceived to be the least helpful. Conclusions: This study highlights the need for a new and enhanced approach to MND bereavement care involving a caregiver risk and needs assessment as a basis for a tailored "goodness of fit" support plan. This approach requires continuity of care, more resources, formal plans, and enhanced training for professionals, as well as optimizing community capacity. MND Associations are well-positioned to support affected families before and after bereavement but may require additional training and resources to fulfill this role.
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Affiliation(s)
- Samar M Aoun
- Public Health Palliative Care Unit, School of Psychology and Public Health, La Trobe University, Melbourne, Australia.,Perron Institute for Neurological and Translational Science, Perth, Australia
| | - Paul A Cafarella
- Department of Respiratory Medicine, Flinders Medical Centre, Adelaide, Australia.,School of Psychology, Faculty of Health and Medical Sciences, University of Adelaide, Australia
| | - Bruce Rumbold
- Public Health Palliative Care Unit, Department of Public Health, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Geoff Thomas
- Consumer Advocate Thomas MND Research Group, Adelaide, Australia
| | - Anne Hogden
- Australian Institute of Health Service Management, College of Business and Economics, University of Tasmania, Australia
| | - Leanne Jiang
- Public Health Palliative Care Unit, School of Psychology and Public Health, La Trobe University, Melbourne, Australia.,Perron Institute for Neurological and Translational Science, Perth, Australia
| | | | - David W Kissane
- Palliative Medicine Research, The University of Notre Dame Australia, Sydney, Australia.,The Cunningham Centre for Palliative Care Research, St Vincent's Hospital, Sydney, Australia and.,Cabrini Psycho-Oncology and Supportive Care Research Unit, Monash University, Melbourne, Australia
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Steinbach R, Prell T, Gaur N, Stubendorff B, Roediger A, Ilse B, Witte OW, Grosskreutz J. Triage of Amyotrophic Lateral Sclerosis Patients during the COVID-19 Pandemic: An Application of the D50 Model. J Clin Med 2020; 9:jcm9092873. [PMID: 32899481 PMCID: PMC7565659 DOI: 10.3390/jcm9092873] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 08/30/2020] [Accepted: 09/02/2020] [Indexed: 12/11/2022] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is a progressive neuromuscular disease, the management of which requires the continuous provision of multidisciplinary therapies. Owing to the novel coronavirus disease (COVID-19) pandemic, regular contact with ALS patients at our center was severely restricted and patient care was at risk by delay of supportive therapies. We established a triage system based on the D50 disease progression model and were thus able to identify a prospective cohort with high disease aggressiveness (D50 < 30). Thirty-seven patients with highly aggressive disease were actively offered follow-up, either via telephone or on-site, depending on their disease-specific needs and abilities. We describe here the procedures, obstacles, and results of these prescient efforts during the restrictions caused by COVID-19 in the period between March and June 2020. In conclusion, four patients with highly aggressive disease were initiated with non-invasive ventilation and two received a gastrostomy. We could show that a comparable amount of advanced care was induced in a retrospective cohort within a similar time period one year prior to the COVID-19 outbreak. Our workflow to identify high-risk patients via D50 model metrics can be easily implemented and integrated within existing centers. It helped to maintain a high quality of advanced care planning for our ALS patients.
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Affiliation(s)
- Robert Steinbach
- Hans Berger Department of Neurology, Jena University Hospital, 07747 Jena, Germany; (T.P.); (N.G.); (B.S.); (A.R.); (B.I.); (O.W.W.); (J.G.)
- Correspondence: ; Tel.: +49-3641-9323-587
| | - Tino Prell
- Hans Berger Department of Neurology, Jena University Hospital, 07747 Jena, Germany; (T.P.); (N.G.); (B.S.); (A.R.); (B.I.); (O.W.W.); (J.G.)
- Center for Healthy Ageing, Jena University Hospital, 07747 Jena, Germany
| | - Nayana Gaur
- Hans Berger Department of Neurology, Jena University Hospital, 07747 Jena, Germany; (T.P.); (N.G.); (B.S.); (A.R.); (B.I.); (O.W.W.); (J.G.)
| | - Beatrice Stubendorff
- Hans Berger Department of Neurology, Jena University Hospital, 07747 Jena, Germany; (T.P.); (N.G.); (B.S.); (A.R.); (B.I.); (O.W.W.); (J.G.)
| | - Annekathrin Roediger
- Hans Berger Department of Neurology, Jena University Hospital, 07747 Jena, Germany; (T.P.); (N.G.); (B.S.); (A.R.); (B.I.); (O.W.W.); (J.G.)
| | - Benjamin Ilse
- Hans Berger Department of Neurology, Jena University Hospital, 07747 Jena, Germany; (T.P.); (N.G.); (B.S.); (A.R.); (B.I.); (O.W.W.); (J.G.)
| | - Otto W. Witte
- Hans Berger Department of Neurology, Jena University Hospital, 07747 Jena, Germany; (T.P.); (N.G.); (B.S.); (A.R.); (B.I.); (O.W.W.); (J.G.)
- Center for Healthy Ageing, Jena University Hospital, 07747 Jena, Germany
| | - Julian Grosskreutz
- Hans Berger Department of Neurology, Jena University Hospital, 07747 Jena, Germany; (T.P.); (N.G.); (B.S.); (A.R.); (B.I.); (O.W.W.); (J.G.)
- Center for Healthy Ageing, Jena University Hospital, 07747 Jena, Germany
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Anestis E, Eccles F, Fletcher I, French M, Simpson J. Giving and receiving a diagnosis of a progressive neurological condition: A scoping review of doctors' and patients' perspectives. PATIENT EDUCATION AND COUNSELING 2020; 103:1709-1723. [PMID: 32299642 DOI: 10.1016/j.pec.2020.03.023] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 03/04/2020] [Accepted: 03/26/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Delivering a life changing diagnosis can be a distressing experience for patients and a challenging task for professionals. Diagnosis delivery can be especially difficult for individuals with neurodegenerative diseases such as motor neurone disease (MND), multiple sclerosis (MS) and Parkinson's disease (PD). This review aims to scope the literature on doctors' and patients' perspectives on diagnosis delivery for these conditions in order to enhance our understanding in this area and identify potential research gaps. METHODS A scoping review methodology was used, and data were summarised using content analysis. RESULTS 47 studies fulfilled the inclusion criteria. Studies showed that although patients were generally satisfied with diagnosis delivery, a considerable proportion was still dissatisfied with aspects of the consultation, especially the information and time provided and the doctor's approach. Only six studies addressed doctors' perspectives, which focused more on doctors' practice. CONCLUSION There was a significant research gap in professionals' perspectives. The review also found that although basic standards of good practice were being met, a significant proportion of patients were dissatisfied with diagnosis communication. PRACTICE IMPLICATIONS Professionals delivering such diagnoses need to assess and respond to patients' information needs, provide time for questions and maintain an empathic attitude.
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Affiliation(s)
| | - Fiona Eccles
- Division of Health Research, Lancaster University, Lancaster, LA1, UK
| | - Ian Fletcher
- Division of Health Research, Lancaster University, Lancaster, LA1, UK
| | - Maddy French
- Division of Health Research, Lancaster University, Lancaster, LA1, UK
| | - Jane Simpson
- Division of Health Research, Lancaster University, Lancaster, LA1, UK
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“Truly holistic?” Differences in documenting physical and psychosocial needs and hope in Portuguese palliative patients. Palliat Support Care 2020; 19:69-74. [DOI: 10.1017/s1478951520000413] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjectivePalliative care (PC) aims to improve patients' and families' quality of life through an approach that relieves physical, psychosocial, and spiritual suffering, although the latter continues to be under-assessed and under-treated. This study aimed to describe the prevalence of physical, psychosocial, and hope assessments documented by a PC team in the first PC consultation.MethodThe retrospective descriptive analysis of all first PC consultations registered in our anonymized database (December 2018–January 2020), searching for written documentation regarding (1) Edmonton Symptom Assessment Scale (ESAS) physical subscale (pain, tiredness, nausea, drowsiness, appetite, shortness of breath, constipation, insomnia, and well-being), (2) the single question “Are you depressed?” (SQD), (3) the question “Do you feel anxious?” (SQA), (4) feeling a burden, (5) hope-related concerns, (6) the dignity question (DQ), and (7) will to live (WtL).ResultsOf the 174 total of patients anonymously registered in our database, 141 PC home patients were considered for analysis; 63% were male, average age was 70 years, the majority had malignancies (82%), with a mean performance status of 52%. Evidence of written documentation was (1) ESAS pain (96%), tiredness (89%), nausea (89%), drowsiness (79%), appetite (89%), shortness of breath (82%), constipation (74%), insomnia (72%), and well-being (52%); (2) the SQD (39%); (3) the SQA (11%); (4) burden (26%); (5) hope (11%); (6) the DQ (33%); and (7) WtL (33%).Significant differences were found between the frequencies of all documented items of the ESAS physical subscale (29%), and all documented psychosocial items (SQD + SQA + burden + DQ) (1%), hope (11%), and WtL (33%) (p = 0.0000; p = 0.0005; p = 0.0181, respectively).Significance of resultsThere were differences between documentation of psychosocial, hope, and physical assessments after the first PC consultation, with the latter being much more frequent. Further research using multicenter data is now required to help identify barriers in assessing and documenting non-physical domains of end-of-life experience.
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Lulé D, Kübler A, Ludolph AC. Ethical Principles in Patient-Centered Medical Care to Support Quality of Life in Amyotrophic Lateral Sclerosis. Front Neurol 2019; 10:259. [PMID: 30967833 PMCID: PMC6439311 DOI: 10.3389/fneur.2019.00259] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 02/26/2019] [Indexed: 12/12/2022] Open
Abstract
It is one of the primary goals of medical care to secure good quality of life (QoL) while prolonging survival. This is a major challenge in severe medical conditions with a prognosis such as amyotrophic lateral sclerosis (ALS). Further, the definition of QoL and the question whether survival in this severe condition is compatible with a good QoL is a matter of subjective and culture-specific debate. Some people without neurodegenerative conditions believe that physical decline is incompatible with satisfactory QoL. Current data provide extensive evidence that psychosocial adaptation in ALS is possible, indicated by a satisfactory QoL. Thus, there is no fatalistic link of loss of QoL when physical health declines. There are intrinsic and extrinsic factors that have been shown to successfully facilitate and secure QoL in ALS which will be reviewed in the following article following the four ethical principles (1) Beneficence, (2) Non-maleficence, (3) Autonomy and (4) Justice, which are regarded as key elements of patient centered medical care according to Beauchamp and Childress. This is a JPND-funded work to summarize findings of the project NEEDSinALS (www.NEEDSinALS.com) which highlights subjective perspectives and preferences in medical decision making in ALS.
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Affiliation(s)
- Dorothée Lulé
- Department of Neurology, University of Ulm, Ulm, Germany
| | - Andrea Kübler
- Interventional Psychology, Psychology III, University of Würzburg, Würzburg, Germany
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James N, Power E, Hogden A, Vucic S. Patients' perspectives of multidisciplinary home-based e-Health service delivery for motor neurone disease. Disabil Rehabil Assist Technol 2018; 14:737-743. [PMID: 30182780 DOI: 10.1080/17483107.2018.1499139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Purpose: To explore the views of people with motor neurone disease (MND) on the barriers, facilitators and potential benefits of using home-based e-Health service delivery (telehealth) to access MND multidisciplinary clinic care. Methods: Twelve patients from three MND multidisciplinary clinics and an MND support association group completed a survey of information technology (IT) use and participated in interviews, to gather participants' experiences and perceptions of home-based telehealth for MND clinic care. Survey data were analyzed descriptively, with interview data analyzed using a stepwise inductive approach. Results: Surveys revealed that participants used IT to communicate with family and friends, but were less likely to use the phone, email or videoconferencing with health professionals. Two themes of participants' use of IT in MND care reflected their experiences of MND care; and personal preferences for modes of healthcare delivery. Participants were willing to use telehealth for MND care, with family members acting as patients' main support for telehealth participation. Nevertheless, participants preferred face-to-face contact with the MND clinic team in the initial and early stages of the disease. Conclusions: People living with MND may wish to participate in individual care planning to facilitate their access to a variety of e-Health service modalities. Additionally, individual care planning may allow healthcare professionals to deliver e-Health-based care, such as telehealth, to increase the scope of care provided. Research to ascertain the views of health professionals and family members as co-participants in service delivery via telehealth is needed to fully assess the potential contribution of e-Health. Implications for Rehabilitation People living with MND face a range of barriers to attending specialized multidisciplinary care, including fatigue, caregiver availability and logistical challenges to travel. Patients have indicated willingness to use e-Health applications to improve their access to care. Use of telehealth could expand service delivery to people with MND living long distances from multidisciplinary clinics, and increase the patient-centred focus of care by tailoring care planning. By offering telehealth services routinely, MND multidisciplinary clinics could also improve the quality and timelines of services offered.
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Affiliation(s)
| | - Emma Power
- b University of Sydney, Speech Pathology, Faculty of Health Sciences , Sydney , Australia
| | - Anne Hogden
- c Australian Institute of Health Innovation, Macquarie University , Sydney , Australia
| | - Steve Vucic
- d Western Clinical School, University of Sydney , Sydney , Australia
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Harris DA, Jack K, Wibberley C. The meaning of living with uncertainty for people with motor neurone disease. J Clin Nurs 2018. [DOI: 10.1111/jocn.14350] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Denise Andrea Harris
- Faculty of Health, Psychology and Social Care; Manchester Metropolitan University; Manchester UK
| | - Kirsten Jack
- Faculty of Health, Psychology and Social Care; Manchester Metropolitan University; Manchester UK
| | - Christopher Wibberley
- Faculty of Health, Psychology and Social Care; Manchester Metropolitan University; Manchester UK
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Support needs of caregivers of patients with amyotrophic lateral sclerosis: A qualitative study. Palliat Support Care 2018; 17:195-201. [DOI: 10.1017/s1478951517001213] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
AbstractObjectiveThe aim of this study was to explore the support needs of Dutch informal caregivers of patients with amyotrophic lateral sclerosis (ALS).MethodIndividual semi-structured interviews were conducted with 21 caregivers of ALS patients. Audio-taped interviews were transcribed and data were analyzed thematically.ResultA total of four global support needs emerged: “more personal time”, “assistance in applying for resources”, “counseling”, and “peer contact”. Despite their needs, caregivers are reluctant to apply for and accept support. They saw their own needs as secondary to the needs of the patients.Significance of resultsALS seems to lead to an intensive caregiving situation with multiple needs emerging in a short period. This study offers targets for the development of supportive interventions. A proactive approach seems essential, acknowledging the importance of the role of the caregivers in the care process at an early stage, informing them about the risk of burden, monitoring their wellbeing, and repeatedly offering support opportunities. Using e-health may help tailor interventions to the caregivers’ support needs.
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Funke A, Spittel S, Grehl T, Grosskreutz J, Kettemann D, Petri S, Weyen U, Weydt P, Dorst J, Ludolph AC, Baum P, Oberstadt M, Jordan B, Hermann A, Wolf J, Boentert M, Walter B, Gajewski N, Maier A, Münch C, Meyer T. Provision of assistive technology devices among people with ALS in Germany: a platform-case management approach. Amyotroph Lateral Scler Frontotemporal Degener 2018; 19:342-350. [DOI: 10.1080/21678421.2018.1431786] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Andreas Funke
- Outpatient Center for ALS and other Motor Neuron Disorders, Charité – Universitätsmedizin Berlin, Berlin, Germany,
| | - Susanne Spittel
- Outpatient Center for ALS and other Motor Neuron Disorders, Charité – Universitätsmedizin Berlin, Berlin, Germany,
| | - Torsten Grehl
- Department of Neurology, Outpatient Center for ALS and other Motor Neuron Disorders, Alfried Krupp Krankenhaus, Essen, Germany,
| | - Julian Grosskreutz
- Hans Berger Department of Neurology, University Hospital Jena, Jena, Germany,
| | - Dagmar Kettemann
- Outpatient Center for ALS and other Motor Neuron Disorders, Charité – Universitätsmedizin Berlin, Berlin, Germany,
| | - Susanne Petri
- Department of Neurology, Medizinische Hochschule Hannover, Hannover, Germany,
| | - Ute Weyen
- Department of Neurology, Outpatient Center for ALS and other Motor Neuron Disorders, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bochum, Germany,
| | - Patrick Weydt
- Department of Neurodegenerative Diseases and Gerontopsychiatry, University of Bonn, Bonn, Germany,
| | - Johannes Dorst
- Department of Neurology, University of Ulm, Ulm, Germany,
| | | | - Petra Baum
- Department of Neurology, Universitätsklinikum Leipzig, Leipzig, Germany,
| | - Moritz Oberstadt
- Department of Neurology, Universitätsklinikum Leipzig, Leipzig, Germany,
| | - Berit Jordan
- Department of Neurology, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany,
| | - Andreas Hermann
- Department of Neurology, Technische Universität Dresden, Dresden, Germany,
- Research Site Dresden, German Center for Neurodegenerative Diseases (DZNE), Dresden, Germany,
| | - Joachim Wolf
- Department of Neurology, Diakonissenkrankenhaus Mannheim, Mannheim, Germany,
| | - Matthias Boentert
- Department for Sleep Medicine and Neuromuscular Disorders, Universitätsklinikum Münster, Münster, Germany, and
| | - Bertram Walter
- Ambulanzpartner Soziotechnologie APST GmbH, Berlin, Germany
| | | | - André Maier
- Outpatient Center for ALS and other Motor Neuron Disorders, Charité – Universitätsmedizin Berlin, Berlin, Germany,
| | - Christoph Münch
- Outpatient Center for ALS and other Motor Neuron Disorders, Charité – Universitätsmedizin Berlin, Berlin, Germany,
- Ambulanzpartner Soziotechnologie APST GmbH, Berlin, Germany
| | - Thomas Meyer
- Outpatient Center for ALS and other Motor Neuron Disorders, Charité – Universitätsmedizin Berlin, Berlin, Germany,
- Ambulanzpartner Soziotechnologie APST GmbH, Berlin, Germany
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Madsen LS, Jeppesen J, Handberg C. “Understanding my ALS”. Experiences and reflections of persons with amyotrophic lateral sclerosis and relatives on participation in peer group rehabilitation. Disabil Rehabil 2018; 41:1410-1418. [DOI: 10.1080/09638288.2018.1429499] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Louise Sofia Madsen
- Department of Public Health, Faculty of Health, Section for Clinical Social Medicine and Rehabilitation, Aarhus University, Aarhus, Denmark
- DEFACTUM, Central Denmark Region, Denmark
| | - Jørgen Jeppesen
- The National Rehabilitation Centre for Neuromuscular Diseases, Aarhus, Denmark
| | - Charlotte Handberg
- Department of Public Health, Faculty of Health, Section for Clinical Social Medicine and Rehabilitation, Aarhus University, Aarhus, Denmark
- DEFACTUM, Central Denmark Region, Denmark
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Jerath NU, Simoens K, Mann D, Kollasch S, Grosland N, Malik KA, Reddy CG. Survey of the functional priorities in patients with disability due to neuromuscular disorders. Disabil Rehabil Assist Technol 2017; 14:133-137. [PMID: 29216771 DOI: 10.1080/17483107.2017.1413143] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
TITLE Survey of the functional priorities in patients with disability due to neuromuscular disorders. OBJECTIVE This study attempts to determine the functional priorities for patients with neuromuscular disorders. METHODS A survey asking about functional priorities with respect to activities of daily living, ankle foot orthotic design, and assistive device design, was distributed to patients with neuromuscular disorders to assess the needs of patients from their perspectives. Descriptive statistics were used to analyse answers. RESULTS A total of 171 subjects with neuromuscular disorders responded to the questionnaire. Of the respondents with weakness in both the upper and lower extremities, 45% stated that if they had to choose between correction of one or the other, they would prefer that of their lower extremities. Activities that patients most frequently wanted to gain independence with were mobility and transfers (46%), followed by toilet use and hygiene (32%). The most popular control mechanism of an assistive device was voice activation (35%). CONCLUSION This study assessed the functional priorities of those with neuromuscular disorders. Although such individuals can experience a range of weakness in the upper and/or lower extremities, common functional priorities were reported: independence with mobility, transfers, toilet use and hygiene. Knowledge of these priorities will help guide development of assistive devices that will restore function in the future. Implications for Rehabilitation Neuromuscular Disorders • Neuromuscular disorders result in disabling weakness; there are few cures and many are unable to carry out activities of daily living. • Information that would be helpful in determining functional priorities is limited. • In a survey of 171 patients with neuromuscular disorders, functional priorities included mobility and transfers (46%), followed by toilet use and hygiene (32%). • Of the respondents with weakness in both the upper and lower extremities, 45% stated that if they had to choose between correction of one or the other, they would prefer that of their lower extremities. • If an assistive device were to be created to help those with neuromuscular disorders, the most popular control mechanism would be voice activation (35%).
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Affiliation(s)
- Nivedita U Jerath
- a Carver College of Medicine, Department of Neurology , The University of Iowa , Iowa City , IA , USA.,b Department of Neurology , The University of Florida , Gainesville , FL , USA
| | - Kevin Simoens
- c Department of Biomedical Engineering , The University of Iowa , Iowa City , IA , USA
| | - Dylan Mann
- c Department of Biomedical Engineering , The University of Iowa , Iowa City , IA , USA
| | - Steph Kollasch
- d Muscular Dystrophy Association , Cedar Rapids , IA , USA
| | - Nicole Grosland
- c Department of Biomedical Engineering , The University of Iowa , Iowa City , IA , USA
| | - Karim A Malik
- c Department of Biomedical Engineering , The University of Iowa , Iowa City , IA , USA
| | - Chandan G Reddy
- e Department of Neurosurgery , The University of Florida , Gainesville , FL , USA
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Cipolletta S, Gammino GR, Palmieri A. Illness trajectories in patients with amyotrophic lateral sclerosis: How illness progression is related to life narratives and interpersonal relationships. J Clin Nurs 2017; 26:5033-5043. [PMID: 28793379 DOI: 10.1111/jocn.14003] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2017] [Indexed: 12/12/2022]
Abstract
AIMS AND OBJECTIVES To identify illness trajectories in amyotrophic lateral sclerosis by analysing personal, social and functional dimensions related to amyotrophic lateral sclerosis progression. BACKGROUND Previous studies have considered some psychological distinct variables that may moderate illness progression, but no research has combined an extensive qualitative understanding of amyotrophic lateral sclerosis patients' psychological characteristics and illness progression. DESIGN A mixed-methods approach was used to combine quantitative and qualitative measures. Illness progression was assessed through a longitudinal design. METHODS Eighteen patients with amyotrophic lateral sclerosis attending a Neurology Department in northern Italy participated in the study. Semi-structured interviews to explore personal experience, and dependency grids to assess the distribution of dependency; ALSFRS-R and neuropsychological screening were, respectively, used to measure physical and cognitive impairment. To assess the progression of the disease, ALSFRS-R was re-administered after 8 months and mortality rate was considered. Data were analysed using the grounded theory approach. RESULTS Illness progression changed according to the perception of the disease, the trust placed in medical care, self-construction and the distribution of dependency. Based on these categories, cases that had similar experiences were grouped, and four illness trajectories were identified: aggressiveness, threat, constriction and guilt. CONCLUSION The findings suggest that it is possible to identify different illness trajectories in amyotrophic lateral sclerosis. RELEVANCE TO CLINICAL PRACTICE Personalised intervention strategies may be construed based on the different trajectories identified.
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Affiliation(s)
| | | | - Arianna Palmieri
- Department of Philosophy, Sociology, Pedagogy and Applied Psychology, University of Padua, Padua, Italy
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Oh J, Kim JA. Supportive care needs of patients with amyotrophic lateral sclerosis/motor neuron disease and their caregivers: A scoping review. J Clin Nurs 2017; 26:4129-4152. [PMID: 28681543 DOI: 10.1111/jocn.13945] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2017] [Indexed: 12/11/2022]
Abstract
AIMS AND OBJECTIVES To identify the supportive care needs of amyotrophic lateral sclerosis/motor neuron disease patients and their caregivers, categorise and summarise them into a Supportive Care Needs Framework and identify gaps in literature. BACKGROUND Little is known about the supportive care needs of amyotrophic lateral sclerosis/motor neuron disease patients and their caregivers, and this subject has not previously been systemically reviewed. DESIGN Scoping review. METHODS We conducted a scoping review from the MEDLINE, EMBASE, CINAHL and Cochrane databases for the period January 2000-July 2016, using the following inclusion criteria: (i) written in English only, (ii) published in peer-reviewed journals, (iii) at least part of the research considered the supportive care needs perspective of amyotrophic lateral sclerosis/motor neuron disease patients or their caregivers and (iv) the population sample included patients of amyotrophic lateral sclerosis/motor neuron disease or their caregivers. RESULTS Thirty-seven articles were included. Our review shows that amyotrophic lateral sclerosis/motor neuron disease patients and their caregivers' supportive care needs were mentioned across all seven domains of the Supportive Care Needs Framework. Most common were practical needs (n = 24), followed by Informational needs (n = 19), Social needs (n = 18), Psychological needs (n = 16), Physical needs (n = 15), Emotional needs (n = 13) and Spiritual needs (n = 8). CONCLUSION From the perspectives of amyotrophic lateral sclerosis/motor neuron disease patients and their caregivers, there is a significant need for more practical, social, informational, psychological, physical, emotional and spiritual support. RELEVANCE TO CLINICAL PRACTICE The Supportive Care Needs Framework has potential utility in the development of patient-centred support services or healthcare policies and serves as an important base for further studies; especially, specific examples of each supportive care needs domain can guide in clinical settings when healthcare professionals provide multidisciplinary care to amyotrophic lateral sclerosis/motor neuron disease patients and individualised care.
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Affiliation(s)
- Juyeon Oh
- Division of Nursing, Hanyang University, Seoul, Korea.,Cell therapy Center for Intractable Disorders, Hanyang University Hospital, Seoul, Korea
| | - Jung A Kim
- Division of Nursing, Hanyang University, Seoul, Korea
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Supporting wellbeing in motor neurone disease for patients, carers, social networks, and health professionals: A scoping review and synthesis. Palliat Support Care 2017; 16:228-237. [DOI: 10.1017/s1478951517000700] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
ABSTRACTObjective:Disease management in motor neurone disease (MND) is focused on preserving quality of life. However, the emphasis has so far been on physical symptoms and functioning and not psychosocial wellbeing. MND affects the wellbeing of carers, of family and social network members, and of healthcare providers, as well as of the patients. We therefore aimed to assess and synthesize the knowledge about maximizing MND-related psychosocial wellbeing across all these groups.Method:We used a systematic search and selection process to assess the scope of the literature along with a narrative synthesis of recent high-quality reviews.Results:The original studies were mainly observational studies of patients and, to a lesser extent, of carers. There were few interventional studies, mainly of patients. There were very few studies of any type on wellbeing in their wider social network or in healthcare professionals. All the review literature looked at MND patient or carer wellbeing, with some covering both. No reviews were found of wellbeing in other family members, patients' social networks, or their healthcare professionals. The reviews demonstrated wellbeing problems for patients linked to psychosocial issues. Carer wellbeing is also compromised. Psychotherapies, social supports, improved decision supports, and changes to healthcare delivery are among the suggested strategies for improved patient and carer wellbeing, but no proven interventions were identified for either. Early access to palliative care, also not well-tested but recommended, is poorly implemented.Significance of results:Work on interventions to deal with well-established wellbeing problems for patients and carers is now a research priority. Explicit use of current methods for patient and public involvement and for design and testing of interventions provide a toolkit for this research. Observational research is needed in other groups. There is a potential in considering needs across patients' social networks rather than looking individually at particular groups.
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Hogden A, Foley G, Henderson RD, James N, Aoun SM. Amyotrophic lateral sclerosis: improving care with a multidisciplinary approach. J Multidiscip Healthc 2017; 10:205-215. [PMID: 28579792 PMCID: PMC5446964 DOI: 10.2147/jmdh.s134992] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease, leading to death within an average of 2–3 years. A cure is yet to be found, and a single disease-modifying treatment has had a modest effect in slowing disease progression. Specialized multidisciplinary ALS care has been shown to extend survival and improve patients’ quality of life, by providing coordinated interprofessional care that seeks to address the complex needs of this patient group. This review examines the nature of specialized multidisciplinary care in ALS and draws on a broad range of evidence that has shaped current practice. The authors explain how multidisciplinary ALS care is delivered. The existing models of care, the role of palliative care within multidisciplinary ALS care, and the costs of formal and informal care are examined. Critical issues of ALS care are then discussed in the context of the support rendered by multidisciplinary-based care. The authors situate the patient and family as key stakeholders and decision makers in the multidisciplinary care network. Finally, the current challenges to the delivery of coordinated interprofessional care in ALS are explored, and the future of coordinated interprofessional care for people with ALS and their family caregivers is considered.
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Affiliation(s)
- Anne Hogden
- Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Geraldine Foley
- Discipline of Occupational Therapy, School of Medicine, Trinity College Dublin, the University of Dublin, Republic of Ireland
| | | | - Natalie James
- Motor Neurone Disease (MND) Service, Communication and Assistive Technology (CAT) Clinic, St Joseph's Hospital, St Vincent's Health Network, Sydney, NSW
| | - Samar M Aoun
- School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
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Shippee ND, Shippee TP, Mobley PD, Fernstrom KM, Britt HR. Effect of a Whole-Person Model of Care on Patient Experience in Patients With Complex Chronic Illness in Late Life. Am J Hosp Palliat Care 2017; 35:104-109. [PMID: 28133973 PMCID: PMC5704566 DOI: 10.1177/1049909117690710] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Background: Patients with serious chronic illness are at a greater risk of depersonalized, overmedicalized care as they move into later life. Existing intervention research on person-focused care for persons in this transitional period is limited. Objective: To test the effects of LifeCourse, a team-based, whole-person intervention emphasizing listening to and knowing patients, on patient experience at 6 months. Design: This is a quasi-experimental study with patients allocated to LifeCourse and comparison groups based on 2 geographic locations. Robust change-score regression models adjusted for baseline differences and confounding. Setting/Participants: Patients (113 intervention, 99 comparison in analyses) were individuals with heart failure or other serious chronic illness, cancer, or dementia who had visits to hospitals at a large multipractice health system in the United States Midwest. Measurements: Primary outcome was 6-month change in patient experience measured via a novel, validated 21-item patient experience tool developed specifically for this intervention. Covariates included demographics, comorbidity score, and primary diagnosis. Results: At 6 months, LifeCourse was associated with a moderate improvement in overall patient experience versus usual care. Individual domain subscales for care team, communication, and patient goals were not individually significant but trended positively in the direction of effect. Conclusion: Person-focused, team-based interventions can improve patient experience with care at a stage fraught with overmedicalization and many care needs. Improvement in patient experience in LifeCourse represents the sum effect of small improvements across different domains/aspects of care such as relationships with and work by the care team.
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Affiliation(s)
- Nathan D Shippee
- 1 Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Tetyana P Shippee
- 1 Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Patrick D Mobley
- 2 Division of Applied Research, Allina Health, Minneapolis, MN, USA
| | - Karl M Fernstrom
- 2 Division of Applied Research, Allina Health, Minneapolis, MN, USA
| | - Heather R Britt
- 2 Division of Applied Research, Allina Health, Minneapolis, MN, USA
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Bentley B, O'Connor M. The End-of-Life Experiences of People with Motor Neuron Disease: Family Carers' Perspectives. J Palliat Med 2016; 19:857-62. [DOI: 10.1089/jpm.2015.0538] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Brenda Bentley
- School of Health Professions, Murdoch University, Murdoch, Australia
| | - Moira O'Connor
- School of Psychology and Speech Pathology, Curtin University, Perth, Australia
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Anderson NH, Gluyas C, Mathers S, Hudson P, Ugalde A. "A monster that lives in our lives": experiences of caregivers of people with motor neuron disease and identifying avenues for support. BMJ Support Palliat Care 2016; 9:e27. [PMID: 27125270 DOI: 10.1136/bmjspcare-2015-001057] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 01/15/2016] [Accepted: 04/04/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND A developing body of evidence has provided valuable insight into the experiences of caregivers of people with motor neuron disease; however, understandings of how best to support caregivers remain limited. AIM This study sought to understand concepts related to the motor neuron disease caregiver experience which could inform the development of supportive interventions. DESIGN A qualitative thematic analysis of a one-off semistructured interview with caregivers was undertaken. SETTING/PARTICIPANTS Caregivers of people with motor neuron disease were recruited from a progressive neurological diseases clinic in Melbourne, Australia. RESULTS 15 caregivers participated. Three key themes were identified: (1) The Thief: the experience of loss and grief across varied facets of life; (2) The Labyrinth: finding ways to address ever changing challenges as the disease progressed; (3) Defying fate: being resilient and hopeful as caregivers tried to make the most of the time remaining. CONCLUSIONS Caregivers are in need of more guidance and support to cope with experiences of loss and to adapt to changeable care giving duties associated with disease progression. Therapeutic interventions which target these experiences of loss and change are worth investigation. TRIAL REGISTRATION NUMBER ACTRN12615000120572, pre-results.
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Affiliation(s)
- Nicole Hennessy Anderson
- School of Nursing & Midwifery, Deakin University, Geelong, Victoria, Australia.,Centre for Palliative Care, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Cathy Gluyas
- Psychology Department, Calvary Health Care Bethlehem, Melbourne, Victoria, Australia
| | - Susan Mathers
- Neurology Department, Calvary Health Care Bethlehem, Melbourne, Victoria, Australia
| | - Peter Hudson
- Centre for Palliative Care, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.,Department of Palliative Care, Queen's University, Belfast, Ireland
| | - Anna Ugalde
- School of Nursing & Midwifery, Deakin University, Geelong, Victoria, Australia.,Cancer Information and Support Service, Cancer Council Victoria, Melbourne, Victoria, Australia
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Foley G, Timonen V, Hardiman O. "I hate being a burden": The patient perspective on carer burden in amyotrophic lateral sclerosis. Amyotroph Lateral Scler Frontotemporal Degener 2016; 17:351-7. [PMID: 26857752 DOI: 10.3109/21678421.2016.1143512] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Research has shown that family caregivers of ALS patients encounter carer burden. Studies that have investigated the impact of caring on family in ALS have reported predominantly from the family caregiver perspective. We undertook in-depth qualitative interviews with a diverse group of ALS patients (n = 34) sampled from the Irish ALS population-based register and explored their experiences of receiving care from family members and from formal service providers. Interviews were audio recorded and transcribed and data were coded to identify psychosocial processes. Findings showed that patients perceived their care as a burden on family and had concerns about the adverse effects that caring had on family caregivers. However, participants also resisted being a burden on family and they provided emotional support to their family. Participants felt a strong sense of obligation towards family and their concern about family members shaped their expressed preferences for care. We identified that the caring process between ALS patients and their family is often bi-directional, leading in some cases to the patient experiencing carer burden. In conclusion, greater attention in ALS research and practice to patients' supportive roles in family is required to counterbalance the already strong focus on family caregiver burden.
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Affiliation(s)
| | | | - Orla Hardiman
- b Trinity College Dublin and Beaumont Hospital Dublin , Ireland
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Seeber AA, Pols AJ, Hijdra A, Grupstra HF, Willems DL, de Visser M. Experiences and reflections of patients with motor neuron disease on breaking the news in a two-tiered appointment: a qualitative study. BMJ Support Palliat Care 2016; 9:e8. [PMID: 26839121 DOI: 10.1136/bmjspcare-2015-000977] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Revised: 12/04/2015] [Accepted: 01/10/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND Breaking bad news should be fine-tuned to the individual patient, contain intelligible information, include emotional support and offer a tailor-made treatment plan. To achieve this goal in motor neuron disease (MND), neurologists of the amyotrophic lateral sclerosis (ALS) centre Amsterdam deliver the message on 2 separate visits within 14 days. AIM To evaluate how patients with MND react to and view disclosure of the diagnosis, in this 2-tiered approach. METHODS Non-participating observations and in-depth interviews with patients were conducted in 1 tertiary ALS referral centre. Qualitative analysis consisted of inductive analysis of observation reports and verbatim typed out interviews. RESULTS 10 2-tiered appointments were observed and 21 Dutch patients with MND interviewed. They experienced the straightforward message to be suffering from a fatal disease as devastating, yet unavoidable. The prospect of a short-term second appointment offered structure for the period immediately following the diagnosis. The time between appointments provided the opportunity for a first reorientation on their changed perspective on their life. The second appointment allowed for detailed discussions about various aspects of MND and a tailor-made treatment plan. CONCLUSIONS The 2-tiered approach fits well with the way in which Dutch patients with MND process the disclosure of their diagnosis, gather information and handle the changed perspective on their life. It may serve as a model for other life-limiting diseases.
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Affiliation(s)
- Antje A Seeber
- Department of Neurology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.,Section of Medical Ethics, Department of General Practice, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - A Jeannette Pols
- Section of Medical Ethics, Department of General Practice, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Albert Hijdra
- Department of Neurology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Hepke F Grupstra
- Department of Rehabilitation, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Dick L Willems
- Section of Medical Ethics, Department of General Practice, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Marianne de Visser
- Department of Neurology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
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Aoun SM, Breen LJ, Howting D, Edis R, Oliver D, Henderson R, O’Connor M, Harris R, Birks C. Receiving the news of a diagnosis of motor neuron disease: What does it take to make it better? Amyotroph Lateral Scler Frontotemporal Degener 2015; 17:168-78. [DOI: 10.3109/21678421.2015.1111907] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
| | - Lauren J Breen
- School of Psychology and Speech Pathology Faculty of Health Sciences, Curtin University, Perth, Western Australia,
| | | | - Robert Edis
- Royal Perth Hospital, Shenton Park Campus, Shenton Park, Australia,
| | - David Oliver
- Wisdom Hospice and University of Kent, Rochester, UK,
| | | | - Margaret O’Connor
- Faculty of Health, Arts & Design, Swinburne University Melbourne, Victoria,
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Foley G, Timonen V. Using Grounded Theory Method to Capture and Analyze Health Care Experiences. Health Serv Res 2015; 50:1195-210. [PMID: 25523315 PMCID: PMC4545354 DOI: 10.1111/1475-6773.12275] [Citation(s) in RCA: 201] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE Grounded theory (GT) is an established qualitative research method, but few papers have encapsulated the benefits, limits, and basic tenets of doing GT research on user and provider experiences of health care services. GT can be used to guide the entire study method, or it can be applied at the data analysis stage only. METHODS We summarize key components of GT and common GT procedures used by qualitative researchers in health care research. We draw on our experience of conducting a GT study on amyotrophic lateral sclerosis patients' experiences of health care services. FINDINGS We discuss why some approaches in GT research may work better than others, particularly when the focus of study is hard-to-reach population groups. We highlight the flexibility of procedures in GT to build theory about how people engage with health care services. CONCLUSION GT enables researchers to capture and understand health care experiences. GT methods are particularly valuable when the topic of interest has not previously been studied. GT can be applied to bring structure and rigor to the analysis of qualitative data.
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Affiliation(s)
- Geraldine Foley
- Virpi Timonen, B.A., M.Phil., D.Phil., is with the School of Social Work and Social Policy, Trinity College Dublin, Dublin, Ireland
| | - Virpi Timonen
- Virpi Timonen, B.A., M.Phil., D.Phil., is with the School of Social Work and Social Policy, Trinity College Dublin, Dublin, Ireland
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Rabbitte M, Bates U, Keane M. Psychological and psychotherapeutic approaches for people with motor neuron disease: A qualitative study. Amyotroph Lateral Scler Frontotemporal Degener 2015; 16:303-8. [PMID: 25734219 DOI: 10.3109/21678421.2015.1009117] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The aim of the study was to review current psychological and psychotherapeutic approaches for people with MND used by therapists in Ireland and to gain an insight into approaches used elsewhere. We used a qualitative study collecting data from eight therapists in Ireland and two therapists in the UK and Italy using semi-structured interviews and analysed the results using principles of grounded theory. Therapists' approaches included supporting the person in the 'here and now' by providing a 'fine focus' on what they can still do, re-affirming the person in their ability to have an active role in their life and supporting the person in exploring their emotions. The desired outcome was to provide the person with space to talk, express feelings and be able to self-direct. In conclusion, there is no consensus about a specific approach, due to the complexity of the disease and the variety of presentations. Different approaches may be required during disease progression. The findings indicate that therapists would benefit from having experience of MND, the limitations in mobility, communication and cognitive processing.
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Affiliation(s)
- Mary Rabbitte
- a Dublin City University , Dublin , Ireland.,b Our Lady's Hospice & Care Services Dublin , Ireland
| | - Ursula Bates
- b Our Lady's Hospice & Care Services Dublin , Ireland
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34
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Bakker M, Creemers H, Schipper K, Beelen A, Grupstra H, Nollet F, Abma T. Need and value of case management in multidisciplinary ALS care: A qualitative study on the perspectives of patients, spousal caregivers and professionals. Amyotroph Lateral Scler Frontotemporal Degener 2015; 16:180-6. [DOI: 10.3109/21678421.2014.971811] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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35
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Arbesman M, Sheard K. Systematic review of the effectiveness of occupational therapy-related interventions for people with amyotrophic lateral sclerosis. Am J Occup Ther 2014; 68:20-6. [PMID: 24367951 DOI: 10.5014/ajot.2014.008649] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We describe the results of a systematic review of the literature on occupational therapy-related interventions for people with amyotrophic lateral sclerosis (ALS). The review included 14 studies. We found limited to moderate evidence that people involved in multidisciplinary programs have longer survival than those in general care and limited evidence that those in multidisciplinary programs have a higher percentage of appropriate assistive devices and higher quality of life in social functioning and mental health. Limited evidence indicates that people with ALS are satisfied with the comfort and ease of use of their power wheelchairs (PWCs). In addition, limited evidence is available that PWCs allow people to have increased interaction in the community. Evidence also is limited that some assistive devices are more helpful than others. Moderate evidence indicates that a home exercise program of daily stretching and resistance exercise results in improved function. The implications for practice, education, and research are discussed.
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Affiliation(s)
- Marian Arbesman
- Marian Arbesman, PhD, OTR/L, is Consultant, Evidence-Based Practice Project, American Occupational Therapy Association, Bethesda, MD; President, ArbesIdeas, Inc., 19 Hopkins Road, Williamsville, NY 14221; and Adjunct Assistant Professor, Department of Rehabilitation Science, University at Buffalo, State University of New York;
| | - Kendra Sheard
- Kendra Sheard, OTR/L, is Occupational Therapist, University of Virginia Transitional Care Hospital and Richard R. Dart ALS Clinic, Charlottesville, VA
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Foley G, Timonen V, Hardiman O. Understanding psycho-social processes underpinning engagement with services in motor neurone disease: a qualitative study. Palliat Med 2014; 28:318-25. [PMID: 24637571 DOI: 10.1177/0269216313512013] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND People with motor neurone disease access healthcare services from disease onset to end-of-life care, but there has been paucity of research on how people with motor neurone disease understand and use healthcare services. AIM To identify key psycho-social processes that underpin how people with motor neurone disease engage with healthcare services. DESIGN Grounded theory approach comprising in-depth qualitative interviews was used in this study. Data were collected and analysed using open, axial and selective coding procedures. SETTING/PARTICIPANTS A total of 34 people with motor neurone disease were recruited from the Irish motor neurone disease population-based register. RESULTS We identified that control, reassurance, resignation and trust are key variables that shape how people with motor neurone disease engage with healthcare services. Participants exerted control in care to cope with loss. Most participants were resigned to death and sought reassurances from healthcare professionals about end-of-life care. Participants questioned the benefit of life-sustaining interventions in motor neurone disease and few of them associated life-sustaining interventions with palliative care. Participants trusted healthcare professionals who reassured them about their care and who were attuned to how they were coming to terms with loss. CONCLUSION This study identified new and important aspects of control, trust and reassurance which shed light on how people with motor neurone disease engage with healthcare professionals and approach end-of-life care. People with motor neurone disease exert control in care and meaningful relationships with healthcare professionals are important to them. Some people with motor neurone disease prefer to die without life-sustaining interventions.
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Affiliation(s)
- Geraldine Foley
- 1School of Social Work and Social Policy, Trinity College Dublin, Dublin, Ireland
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37
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O'Brien MR, Preston H. Family carer perspectives of acute hospital care following a diagnosis of motor neuron disease: a qualitative secondary analysis. BMJ Support Palliat Care 2014; 5:503-9. [PMID: 24681558 DOI: 10.1136/bmjspcare-2013-000627] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Accepted: 02/28/2014] [Indexed: 11/04/2022]
Abstract
OBJECTIVES The multifaceted nature of the problems faced by someone with motor neuron disease requires a knowledgeable multidisciplinary team approach. Where available, generally, such services are only provided on an outpatient basis, meaning that hospitalised patients are frequently admitted to non-specialist wards where understanding of their needs is limited. Little is known regarding the inpatient care received by patients. Our objective was to address this by exploring the experience of hospitalisation following a diagnosis of motor neuron disease from the perspective of family carers of those diagnosed with the illness. METHOD This was a qualitative secondary analysis of pre-existing data from two previously published, separately conducted, qualitative studies. The study involved interview data from 18 bereaved carers and 3 current carers of family members diagnosed with motor neuron disease in Northwest England. RESULTS The findings reveal dissatisfaction with the inpatient care received, which impacted negatively not only on patient and carer enthusiasm for future hospital admissions but also on carer bereavement. CONCLUSIONS Patients with motor neuron disease have specialist needs that are not always met during hospital admission, particularly to non-specialist units. The inpatient care provided for these patients must be improved as must the knowledge and understanding of the illness among healthcare professionals who treat them.
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Affiliation(s)
- Mary R O'Brien
- Faculty of Health & Social Care, Evidence-based Practice Research Centre (EPRC), Edge Hill University, Ormskirk, Lancashire, UK
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Ushikubo M. Comparison between home and hospital as the place of death for individuals with amyotrophic lateral sclerosis in the last stages of illness. Am J Hosp Palliat Care 2014; 32:417-26. [PMID: 24622867 DOI: 10.1177/1049909114525259] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Healthcare providers need to better understand the end-of-life situations of in-home amyotrophic lateral sclerosis (ALS) patients to support their desires about where to die and to allow peaceful death. PURPOSE To clarify the situations of individuals with ALS in the last stages of illness according to the place of death as reported by home care nurses. METHODS Minimum structured interviews were conducted with 14 home care nurses, and data regarding 14 ALS patients who died were collected. RESULTS Six patients died at home, and eight died at the hospital. Many sudden deaths were observed among the patients who died at home, whereas pneumonia was often the cause of death in the hospital. CONCLUSION Providing family education and ensuring the availability of local family physicians are vital to meeting a patient's desire to die at home. Home care nursing should be introduced in the early stage after diagnosis to provide support to patients for timely decision-making.
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Affiliation(s)
- Mitsuko Ushikubo
- Gunma University Graduate School of Health Sciences, Maebashi-shi, Gunma, Japan
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39
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Foley G, Timonen V, Hardiman O. Acceptance and decision making in amyotrophic lateral sclerosis from a life-course perspective. QUALITATIVE HEALTH RESEARCH 2014; 24:67-77. [PMID: 24336481 DOI: 10.1177/1049732313516545] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Researchers have explored perceptions of health care services among people with amyotrophic lateral sclerosis (ALS), but little is known about how and why people with ALS engage with services. We undertook a grounded theory study to identify key psychosocial processes that underpin how and why people with ALS engage with health care services. We conducted in-depth interviews with 34 participants sampled from the Irish ALS population-based register. We found that age and life stage shaped participants' decision making about care. Participants in later life were more accepting of ALS and of death than young and middle-aged participants. Family was the primary context to how participants engaged with services, and their decisions about care were shaped by parenthood at different life stages. Health care professionals need to be attuned to the impact of life-course trajectories and family relations on the decisions people with ALS make about their care.
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Hogden A, Greenfield D, Nugus P, Kiernan MC. Development of a model to guide decision making in amyotrophic lateral sclerosis multidisciplinary care. Health Expect 2013; 18:1769-82. [PMID: 24372800 DOI: 10.1111/hex.12169] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2013] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Patients with amyotrophic lateral sclerosis (ALS) face numerous decisions for symptom management and quality of life. Models of decision making in chronic disease and cancer care are insufficient for the complex and changing needs of patients with ALS . OBJECTIVE The aim was to examine the question: how can decision making that is both effective and patient-centred be enacted in ALS multidisciplinary care? SETTING AND PARTICIPANTS Fifty-four respondents (32 health professionals, 14 patients and eight carers) from two specialized ALS multidisciplinary clinics participated in semi-structured interviews. Interviews were transcribed, coded and analysed thematically. RESULTS Comparison of stakeholder perspectives revealed six key themes of ALS decision making. These were the decision-making process; patient-centred focus; timing and planning; information sources; engagement with specialized ALS services; and access to non-specialized services. A model, embedded in the specialized ALS multidisciplinary clinic, was derived to guide patient decision making. The model is cyclic, with four stages: 'Participant Engagement'; 'Option Information'; 'Option Deliberation'; and 'Decision Implementation'. DISCUSSION Effective and patient-centred decision making is enhanced by the structure of the specialized ALS clinic, which promotes patients' symptom management and quality of life goals. However, patient and carer engagement in ALS decision making is tested by the dynamic nature of ALS, and patient and family distress. Our model optimizes patient-centred decision making, by incorporating patients' cyclic decision-making patterns and facilitating carer inclusion in decision processes. CONCLUSIONS The model captures the complexities of patient-centred decision making in ALS. The framework can assist patients and carers, health professionals, researchers and policymakers in this challenging disease environment.
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Affiliation(s)
- Anne Hogden
- Centre for Clinical Governance Research, Australian Institute of Health Innovation, University of New South Wales Sydney, Sydney, NSW, Australia
| | - David Greenfield
- Centre for Clinical Governance Research, Australian Institute of Health Innovation, University of New South Wales Sydney, Sydney, NSW, Australia
| | - Peter Nugus
- Centre for Clinical Governance Research, Australian Institute of Health Innovation, University of New South Wales Sydney, Sydney, NSW, Australia.,Centre for Medical Education and Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Matthew C Kiernan
- Royal Prince Alfred Hospital, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
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Siewers V, Holmøy T, Frich JC. Experiences with using mechanical in–exsufflation in amyotrophic lateral sclerosis. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2013. [DOI: 10.3109/21679169.2013.834513] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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42
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Current World Literature. Curr Opin Support Palliat Care 2012; 6:402-16. [DOI: 10.1097/spc.0b013e3283573126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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43
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Hogden A, Greenfield D, Nugus P, Kiernan MC. What influences patient decision-making in amyotrophic lateral sclerosis multidisciplinary care? A study of patient perspectives. Patient Prefer Adherence 2012; 6:829-38. [PMID: 23226006 PMCID: PMC3514070 DOI: 10.2147/ppa.s37851] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Patients with amyotrophic lateral sclerosis (ALS) are required to make decisions concerning quality of life and symptom management over the course of their disease. Clinicians perceive that patients' ability to engage in timely decision-making is extremely challenging. However, we lack patient perspectives on this issue. This study aimed to explore patient experiences of ALS, and to identify factors influencing their decision-making in the specialized multidisciplinary care of ALS. METHODS An exploratory study was conducted. Fourteen patients from two specialized ALS multidisciplinary clinics participated in semistructured interviews that were audio recorded and transcribed. Data were analyzed for emergent themes. RESULTS Decision-making was influenced by three levels of factors, ie, structural, interactional, and personal. The structural factor was the decision-making environment of specialized multidisciplinary ALS clinics, which supported decision-making by providing patients with disease-specific information and specialized care planning. Interactional factors were the patient experiences of ALS, including patients' reaction to the diagnosis, response to deterioration, and engagement with the multidisciplinary ALS team. Personal factors were patients' personal philosophies, including their outlook on life, perceptions of control, and planning for the future. Patient approaches to decision-making reflected a focus on the present, rather than anticipating future progression of the disease and potential care needs. CONCLUSION Decision-making for symptom management and quality of life in ALS care is enhanced when the patient's personal philosophy is supported by collaborative relationships between the patient and the multidisciplinary ALS team. Patients valued the support provided by the multidisciplinary team; however, their focus on living in the present diverged from the efforts of health professionals to prepare patients and their carers for the future. The challenge facing health professionals is how best to engage each patient in decision-making for their future needs, to bridge this gap.
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Affiliation(s)
- Anne Hogden
- Centre for Clinical Governance Research, Australian Institute of Health Innovation, University of New South Wales, New South Wales, Australia
- Correspondence: Anne Vaughan Hogden, Centre for Clinical Governance Research, Australian Institute of Health Innovation, Faculty of Medicine, Level 1, AGSM Building, University of New South Wales, Sydney NSW 2052, Australia, Tel +612 9385 3071, Fax +612 9663 4926, Email
| | - David Greenfield
- Centre for Clinical Governance Research, Australian Institute of Health Innovation, University of New South Wales, New South Wales, Australia
| | - Peter Nugus
- Centre for Clinical Governance Research, Australian Institute of Health Innovation, University of New South Wales, New South Wales, Australia
| | - Matthew C Kiernan
- Prince of Wales Clinical School, University of New South Wales, and Neuroscience Research Australia, Sydney, New South Wales, Australia
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Hogden A, Greenfield D, Nugus P, Kiernan MC. Engaging in patient decision-making in multidisciplinary care for amyotrophic lateral sclerosis: the views of health professionals. Patient Prefer Adherence 2012; 6:691-701. [PMID: 23055703 PMCID: PMC3468167 DOI: 10.2147/ppa.s36759] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The aim of this study was to explore clinician perspectives on patient decision-making in multidisciplinary care for amyotrophic lateral sclerosis (ALS), in an attempt to identify factors influencing decision-making. METHODS Thirty-two health professionals from two specialized multidisciplinary ALS clinics participated in individual and group interviews. Participants came from allied health, medical, and nursing backgrounds. Interviews were audio recorded, and the transcripts were analyzed thematically. RESULTS Respondents identified barriers and facilitators to optimal timing and quality of decision-making. Barriers related to the patient and the health system. Patient barriers included difficulties accepting the diagnosis, information sources, and the patient-carer relationship. System barriers were timing of diagnosis and symptom management services, access to ALS-specific resources, and interprofessional communication. Facilitators were teamwork approaches, supported by effective communication and evidence-based information. CONCLUSION Patient-centered and collaborative decision-making is influenced by a range of factors that inhibit the delivery of optimal care. Decision-making relies on a fine balance between timing of information and service provision, and the readiness of patients to receive them. Health system restrictions impacted on optimal timing, and patients coming to terms with their condition. Clinicians valued proactive decision-making to prepare patients and families for inevitable change. The findings indicate disparity between patient choices and clinician perceptions of evidence, knowledge, and experience. To improve multidisciplinary ALS practice, and ultimately patient care, further work is required to bridge this gap in perspectives.
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Affiliation(s)
- Anne Hogden
- Centre for Clinical Governance Research, Australian Institute of Health Innovation, University of New South Wales, New South Wales, Australia
- Correspondence: Anne Vaughan Hogden, Centre for Clinical Governance Research, Australian Institute of Health Innovation, Faculty of Medicine, Level 1, AGSM, Building, University of New South Wales, Sydney, NSW 2052, Australia, Tel +612 9385 3071, Fax +612 9663 4926, Email
| | - David Greenfield
- Centre for Clinical Governance Research, Australian Institute of Health Innovation, University of New South Wales, New South Wales, Australia
| | - Peter Nugus
- Centre for Clinical Governance Research, Australian Institute of Health Innovation, University of New South Wales, New South Wales, Australia
| | - Matthew C Kiernan
- Prince of Wales Clinical School, University of New South Wales, and Neuroscience Research Australia, Sydney, New South Wales, Australia
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