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Wilder CA. Palliative Care for Patients With Multiple Sclerosis: Recommendations Emerging From a Case Study. J Hosp Palliat Nurs 2023; 25:12-17. [PMID: 36162091 DOI: 10.1097/njh.0000000000000912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Multiple sclerosis (MS) affects more than 2.8 million people worldwide and is an incurable, heterogeneous, chronic, degenerative, demyelinating, immune-mediated neurological disease of the central nervous system. It affects the physical, mental, psychosocial, financial, and spiritual dimensions of patients and their families. Given this illness trajectory and the multiple complex symptoms associated with MS, palliative care services would improve the quality of life for MS patients. Palliative care is a human right for all patients with a life-limiting, progressive disease. The goal of palliative care is the prevention and relief of suffering by means of assessment and treatment that holistically addresses symptoms and suffering. Thus, this article argues for the early integration of palliative care for persons given a diagnosis of MS. This argument is underscored by the analysis of a case study of a typical patient with MS who would have benefited from conjunctive palliative care.
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Affiliation(s)
- Carolyn Ann Wilder
- Carolyn Ann Wilder, BSN, RN , is registered nurse, Neurosciences Division, University of California San Diego; and PhD student, Loma Linda University School of Nursing, CA
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Young CA, Mills RJ, Langdon D, Rog DJ, Sharrack B, Kalra S, Majeed T, Footit D, Harrower T, Nicholas RS, Ford HL, Woolmore J, Johnstone C, Thorpe J, Paling D, Ellis C, Hanneman CO, Tennant A. Measuring coping in multiple sclerosis: The Coping Index-MS. Mult Scler 2022; 28:2274-2284. [PMID: 36000480 DOI: 10.1177/13524585221114004] [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: 11/17/2022]
Abstract
BACKGROUND Coping in multiple sclerosis (MS) refers to cognitive and behavioural efforts to manage stresses imposed by the illness. Existing generic and disease-specific coping scales do not meet modern guidelines for scale development and cannot produce interval-level metrics to allow for change scores. OBJECTIVE The main aim of this study was to develop a brief patient-reported outcome measure for coping in MS, capable of interval-level measurement. METHODS Qualitative work in 43 people with MS leads to a draft scale which was administered to 5747 participants, with longitudinal collection in 2290. A calibration sample of 1000 subjects split into development and validation sets was used to generate three scales consistent with Rasch model expectations. RESULTS The total Coping Index-MS (CI-MS-T), CI-MS-Internal (CI-MS-I) and CI-MS-External (CI-MS-E) cover total, internal and externally focused coping. All three scales are capable of interval-level measurement. Trajectory analysis of 9000 questionnaires showed two trajectories in CI-MS-T: Group 1 showed a low level of coping with slight decline over 40 months, while Group 2 had a better and stable level of coping due to improving CI-MS-I which compensated for the deteriorating CI-MS-E over time. CI-MS-T < 30 identified group membership at baseline. CONCLUSION The CI-MS-T, CI-MS-I and CI-MS-E, comprising 20 items, provide interval-level measurement and are free-for-use in not-for-profit settings.
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Affiliation(s)
- Carolyn A Young
- The Walton Centre NHS Foundation Trust, Liverpool, UK/University of Liverpool, Liverpool, UK
| | - Roger J Mills
- The Walton Centre NHS Foundation Trust, Liverpool, UK/University of Liverpool, Liverpool, UK
| | | | - David J Rog
- Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Salford, UK
| | - Basil Sharrack
- Academic Department of Neurology, The University of Sheffield, Sheffield, UK
| | - Seema Kalra
- University Hospital of North Midlands NHS Trust, Stoke-on-Trent, UK
| | | | - David Footit
- Cumbria Partnership NHS Foundation Trust, Carlisle, UK
| | | | | | | | | | - Clare Johnstone
- York and Scarborough Teaching Hospitals NHS Foundation Trust, York, UK
| | - John Thorpe
- Peterborough City Hospital, Peterborough, UK
| | | | - Cathy Ellis
- Dartford & Gravesham NHS Trust, Dartford, UK
| | | | - Alan Tennant
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
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