Integration of palliative care in Parkinson's disease management

Palliative Care in Parkinson's Disease

Palliative care aims to alleviate suffering from symptoms not often addressed in typical clinic visits, including nonmotor symptoms, psychosocial and caregiver burden, and advanced care planning. Palliative care is appropriate at any point in Parkinson's disease, but hospice care is an important potential therapy for end-of-life care. Palliative care remains underutilized, and work is underway on developing palliative care delivery models.

Voices of care: navigating difficult conversations among caregivers and individuals with Parkinson's disease

PURPOSE

This study explores the experiences of informal caregivers in navigating difficult conversations with individuals living with Parkinson's disease, and other key figures such as family members and health professionals.

METHODS

Utilizing a post-positive paradigm and inductive approach, we conducted semi-structured interviews with seven caregivers to gain in-depth insights into their experiences.

RESULTS

Findings reveal that Parkinson's disease introduces layers of complexity to navigating difficult conversations, which evolve over the disease's progression. Conversations were categorized across three dimensions: degree of interaction, response orientation, and emotional valence, resulting in a biaxial framework of difficult disclosures, frank conversations, relational conversations, and planful conversations. Key mediating factors shaping these conversations included relationship strength, individual skills, personality traits, faith, and preparation efforts.

CONCLUSION

Our findings offer valuable insights for clinicians, highlighting the importance of supporting caregivers in these difficult conversations. By understanding the dimensions and mediating factors involved, clinicians can provide tailored guidance and resources, fostering more effective communication strategies. This knowledge can enhance clinical practice by promoting a collaborative approach where both caregivers and individuals with Parkinson's disease feel supported and understood throughout their interactions.

Anticholinergic use is associated with lower mortality but not increased hip fracture risk in Parkinson's disease patients: a retrospective cohort study

BACKGROUND

It is unclear whether antiparkinsonism anticholinergics (AAs) increase hip fracture (HFx) risk in Parkinson's disease (PD) patients. This study examined associations between AAs, HFx and mortality in PD using Taiwan's National Health Insurance Database.

METHODS

Newly diagnosed PD patients ≥ 50yrs were categorized by AAs exposure: PD with AAs (≥ 90 days, n = 16,921), PD without AAs (never-exposed, n = 55,940), and demographically matched non-PD controls (n = 291,444). Competing risk of death was considered in Fine & Gray models analyzing HFx. Mortality was compared using Cox regression models.

RESULTS

Both PD groups were associated with higher HFx risk compared to non-PD controls (adjusted hazard ratio [HR] = 1.51 for PD with AAs; 1.53 without). No significant difference in HFx risk was observed between PD groups with and without AAs exposure. Both groups were associated with increased mortality compared to non-PD (adjusted HR = 2.24 with AAs; 2.44 without AAs). Among PD patients, those with AAs exposure were associated with lower mortality compared to those without AAs (adjusted HR = 0.93).

CONCLUSIONS

PD was associated with increased HFx and mortality compared to non-PD, regardless of AAs exposure. AAs use was not associated with increased HFx risk and was associated with lower mortality. AAs use was not associated with increased fracture risk and was associated with lower mortality in PD, however further studies are needed to clarify these associations.

The palliative care needs and experiences of patients with advanced Parkinson's disease: a qualitative scoping review

Aim

To determine the experiences and needs of palliative care in patients with advanced Parkinson's disease (PD).

Methods

A scoping literature review methodology, as described by the Joanna Briggs Institute, was employed to search for relevant literature. An electronic search of studies published in English was conducted across five databases from inception to 10 September 2023.

Results

The search yielded a total of 1,205 articles, with 20 meeting the inclusion criteria. The findings were organized into four themes: (1) unmet emotional and informational needs; (2) needs for effective coordination of care; (3) planning for the future; and (4) symptom management. This scoping review highlights the intricate nature of palliative care for patients with PD and sheds light on issues within current palliative care healthcare systems. The findings emphasize the necessity for individualized interventions and services to address the diverse unmet palliative care needs of people with PD.

Conclusion

The study reveals the complex landscape of palliative care for individuals with advanced PD, emphasizing the inadequacies within existing healthcare systems. The identified themes underscore the importance of tailored interventions to address the varied unmet palliative care needs of this population.

Exploring the Holistic Needs of People Living with Cancer in Care Homes: An Integrative Review

Up to 26% of individuals residing in care homes are impacted by cancer. This underscores the importance of understanding the holistic needs of care home residents living with cancer to enhance the quality of their care. The primary objective of this integrative literature review was to consolidate the available evidence concerning the comprehensive needs of people living with cancer in care home settings, providing valuable insights into addressing their diverse needs. An integrative literature review was conducted using a systematic approach. Extensive searches were conducted in three databases, complemented by a thorough examination of grey literature and reference lists of relevant papers. The review focused on literature published between 2012 and 2022. The screening process involved two independent reviewers, with a third reviewer resolving any discrepancies. The review identified twenty research papers that met the eligibility criteria. These papers shed light on three primary themes related to the holistic needs of care home residents with cancer: physical, psychological, and end-of-life needs. Physical needs encompassed pain management, symptom control, and nutrition, while psychological needs involved social support, emotional well-being, and mental health care. End-of-life needs addressed end-of-life care and advance care planning. These themes highlight the multifaceted nature of cancer care in care homes and underscore the importance of addressing residents' holistic needs in a comprehensive and integrated manner. Improving care home education about cancer and integrating palliative and hospice services within this setting are vital for addressing the diverse needs of residents with cancer.

Dopamine D1 Agonists: First Potential Treatment for Late-Stage Parkinson's Disease

Current pharmacotherapy has limited efficacy and/or intolerable side effects in late-stage Parkinson's disease (LsPD) patients whose daily life depends primarily on caregivers and palliative care. Clinical metrics inadequately gauge efficacy in LsPD patients. We explored if a D1/5 dopamine agonist would have efficacy in LsPD using a double-blind placebo-controlled crossover phase Ia/b study comparing the D1/5 agonist PF-06412562 to levodopa/carbidopa in six LsPD patients. Caregiver assessment was the primary efficacy measure because caregivers were with patients throughout the study, and standard clinical metrics inadequately gauge efficacy in LsPD. Assessments included standard quantitative scales of motor function (MDS-UPDRS-III), alertness (Glasgow Coma and Stanford Sleepiness Scales), and cognition (Severe Impairment and Frontal Assessment Batteries) at baseline (Day 1) and thrice daily during drug testing (Days 2-3). Clinicians and caregivers completed the clinical impression of change questionnaires, and caregivers participated in a qualitative exit interview. Blinded triangulation of quantitative and qualitative data was used to integrate findings. Neither traditional scales nor clinician impression of change detected consistent differences between treatments in the five participants who completed the study. Conversely, the overall caregiver data strongly favored PF-06412562 over levodopa in four of five patients. The most meaningful improvements converged on motor, alertness, and functional engagement. These data suggest for the first time that there can be useful pharmacological intervention in LsPD patients using D1/5 agonists and also that caregiver perspectives with mixed method analyses may overcome limitations using methods common in early-stage patients. The results encourage future clinical studies and understanding of the most efficacious signaling properties of a D1 agonist for this population.

Facilitators and barriers to the delivery of palliative care to patients with Parkinson's disease: a qualitative study of the perceptions and experiences of stakeholders using the socio-ecological model

OBJECTIVE

Palliative care (PC) can improve the quality of life of Parkinson's disease (PD) patients and their carers. However, the impact of PC services on patients with PD remains unclear. This research was conducted to identify the barriers and facilitators influencing PC services for patients with PD based on the Social Ecological Model (SEM) framework.

METHODS

This research was conducted through semi-structured interviews, employing SEM to organize themes and identify potential solutions across multiple levels.

RESULTS

A total of 29 interviewees (5 PD clinicians, 7 PD registered nurses, 8 patients, 5 caregivers, and 4 policy makers) completed the interviews. Facilitators and barriers were identified according to the levels of the SEM. Several facilitators were identified, i.e., (1) individual level: the critical needs among PD patients and their relatives and the desire for PC knowledge among health professionals; (2) interpersonal level: social support; (3) organizational level: the investments towards systematization of PC; and nurses are the bridge between patients and doctors; (4) community level: the convenience of community services; and hospital-community-family-based services; (5) culture and policy level: existing policy.

CONCLUSION

The social-ecological model proposed in this study helps illuminate the complex and multilevel factors that may influence PC delivery to PD patients.

Referral criteria to palliative care for patients with Parkinson's disease: a systematic review

OBJECTIVE

This systematic review aimed to identify the referral criteria for palliative care in patients with Parkinson's disease.

METHODS

We conducted an electronic search for publications on referral criteria for palliative care in patients with Parkinson's disease in six electronic databases. The articles were thoroughly reviewed by two independent reviewers for inclusion using a predefined data extraction list. The referral criteria were thematically classified using a coding methodology.

RESULTS

This systematic review included 36 publications. We identified 14 referral criteria themes. The most common referral indicators were functional decline (n = 11 [31%]), needs assessment tools (n = 11 [31%]), physical or emotional symptoms (n = 10[28%]), need for palliative care (n = 10 [28%]), decision support (n = 9 [25%]), advanced Parkinson's disease (n = 7[19%]), and diagnosis of Parkinson's disease (n = 7 [19%]). However, there was a lack of consensus on symptom assessment tools. In addition, there were no agreed cut-offs or defined time for palliative care referral for patients with Parkinson's disease.

CONCLUSIONS

The 14 themes identified in this systematic review were categorized into disease- and needs-based criteria. These themes show the wide range of referral timing and procedures. Further studies should be conducted to reveal standardized referral criteria.

The Impact of Triangle Hierarchical Management on Self-Management Behavior and Quality of Survival in Parkinson's Patients

Objective

To investigate the effect of Triangle tiered and graded management on the self-management behavior and quality of survival of Parkinson's Disease (PD) patients.

Methods

Eighty ambulatory PD patients admitted to the neurology outpatient clinic of our hospital from June 2020 to January 2021 were selected for the study. Eighty patients were divided into 40 cases each in the test group and the control group using the random number table method. Patients in the control group were given conventional treatment and care, while in the test group, Triangle hierarchical management was applied on the basis of the control group. Non-motor symptoms [assessed by the Montreal Cognitive Inventory (MoCA), the Scale for Outcomes in PD for Autonomic Symptoms disability Scale (SCOPA-DS) and the Nocturnal Scale (SCOPA-NS)], motor symptoms [assessed by the Functional Gait Assessment (FGA), the Modified Ashworth Scale, and the Unified Parkinson's Disease Rating Scale (UPDRS-III)], quality of life (assessed by Barthel Index), medication adherence (self-administered medication adherence questionnaire), quality of survival (assessed by the 39-item Parkinson's Disease Quality of Survival Questionnaire, PDQ-39), and self-management effectiveness (assessed by the Chronic Disease Self-Efficacy Scale, symptom management and disease co-management) were compared between the two groups before and after the intervention. The two groups were also observed for satisfaction with care.

Results

After the intervention, the MoCA score, FGA score, Barthel Index, Medication adherence and all scores of self-management effectiveness were significantly higher in the test group than in the control group (P < 0.05); the SCOPA-DS score, SCOPA-NS score, Ashworth score, UPDRS-III score and PDQ-39 score were significantly lower than in the control group (P < 0.05). Satisfaction with nursing care was significantly higher in the test group than in the control group (P < 0.05).

Conclusion

The application of Triangle's tiered and graded management to the home care of ambulatory PD patients was effective in improving their non-motor and motor symptoms, their ability to perform daily activities, medication adherence and self-management effectiveness, and their overall survival outcome.