Multiple sclerosis: care needs for 2000 and beyond

Gender differences in caregiver strain, needs for support, social support, and quality of life among spousal caregivers of persons with multiple sclerosis

BACKGROUND

Caregivers of individuals with MS may experience unique caregiver strain due to the age at onset and progressive nature of the disease. Additionally, because MS is more prevalent in women, men often become spousal caregivers. However, gender differences in psychosocial adjustment among caregivers have not been fully explored.

OBJECTIVE

The purpose of this study was to explore gender differences in the need for various supports and type of social support needed, caregiver strain, and quality of life among caregivers for individuals with MS.

METHODS

106 caregivers participated in this study. Independent sample t-tests and multiple regression analyses were conducted to examine gender differences in strain, need for supports, social support, and quality of life.

RESULTS

Analyses revealed gender difference among important psychosocial variables. Specifically, women reported higher levels of caregiver strain, higher needs for emotional support, and higher perceived social support. Additionally, multiple regression analyses revealed an inverse relationship between expressed emotional needs and quality of life for men, but not for women.

CONCLUSIONS

MS caregivers experience significant strain that diminishes quality of life. Social support and needs fulfillment can act to buffer this stress; however, results indicate that this varies by gender, with gender differences observed in strain, perceived support, and expressed needs among MS caregivers. The study implications for rehabilitation research are discussed.

Caregivers of people with multiple sclerosis: experiences of support

The aim of this pheno menological study was to gain an understanding of the experiences of a group of caregivers of people with multiple sclerosis (MS). Sixteen caregivers from Northern Ireland and the Republic of Ireland participated in focus group interviews. The theme of support, either sought or received, emerged as a major aspect of the experiences described. C aregivers’ feelings about, and experiences of, support appeared to change over time. Four common phases that caregivers experienced in relation to support were identified as: ‘rejecting’, ‘resisting’, ‘seeking’ and ‘accepting’ support. This paper will present and discuss these four phases. The study findings highlight the complexity of issues surrounding a caregiver’s decision to seek and accept support. It is hoped that the phases identified within this study are useful in depicting how caregivers of people with MS may progress through stages in their desire for, and acceptance of, support. Findings from this study are useful to healthcare professionals who work with people with MS and their caregivers by increasing awareness that a caregiver’s attitude toward and acceptance of support changes over time.

The challenges of healthcare delivery to people with multiple sclerosis in Iran

BACKGROUND

Multiple sclerosis (MS) is a chronic disease prevalent in young and middle-aged people. Patients with MS often have numerous complicated needs and, consequently, require a broad range of health services. Results of a number of studies indicate that patients' needs are only partially met.

AIMS

This study was conducted to explore the challenges of healthcare delivery to patients with MS in Iran.

MATERIALS AND METHODS

In this qualitative case study, 43 participants selected through purposeful sampling were interviewed using semi-structured method in the cities of Isfahan and Tehran in 2012-2013. Besides the interview, documentations relevant to healthcare delivery were collected from different sources, including websites of all Iranian universities of medical sciences, insurance organizations, patients' weblogs, news agencies, the MS Center forum for MS patients, and MS Payam bimonthly. The data were analyzed through the constant comparative analysis.

RESULTS

The data were categorized into four main categories, including functional challenges (diagnosis problems, failure to pay attention to patient needs, failure to follow-up, and miscommunication), administrative challenges (resource allocation and supervision), policy-making challenges (lack of comprehensive services, bureaucracy, and problems in provision of medications), and structural challenges (difficult access to services, lack of comprehensive centers, space limit, and long wait).

CONCLUSION

Despite all attempts of governmental and nongovernmental organizations for healthcare delivery to MS patients, these services cannot satisfy all needs of the patients. In this regard, service providers and administrators should pay more attention to the needs and expectations of patients and their families.

Patients' experiences of health and social care in long-term neurological conditions in England: a cross-sectional survey

OBJECTIVES

To investigate patients' experiences of health and social care services in long-term neurological conditions in England.

METHOD

Cross-sectional survey of 5209 patient members of the Motor Neurone Disease Association (MND, n = 890), Multiple Sclerosis Society (MS, n = 2345) or Parkinson's UK (PD, n = 1974). A questionnaire on patient experiences of health and social care was completed by 2563 (49%) (505 MND, 1157 MS and 901 PD).

RESULTS

A mixed picture of experiences of health and social care in MND, MS or PD was found with few problems reported for some aspects of services such as obtaining information about medication (n = 117, 6.1%). In contrast, problems with planning and integration of care were reported frequently, with 78.0% of patients not having a care plan and 61.9% reporting that services do not collaborate well in planning care. Other problems included delays with diagnosis, information about medication side effects, and management of conditions whilst in hospital. Significant differences between the three conditions were found for most aspects of care, with MND patients generally reporting fewer problems. The findings highlight which areas of health and social care need to be improved and monitored. While a larger sample size was obtained than in other studies, possible limitations include the sampling frame and the 49% response rate.

CONCLUSION

Planning and integration of care are key areas that require improvement.

The nature of care giving in a community sample of people with multiple sclerosis

PURPOSE

The provision of informal care plays a crucial role in supporting those with long term illness such as MS to stay in the community, but there is no recent United Kingdom (UK) research into the nature of this care provision and how it interacts with professional community care. The aim of this study was to investigate the nature of informal and professional care in a community population of people with MS living in the UK from the perspectives of people with MS.

METHOD

Data on the Standard Day Dependency Record (SDDR), Barthel Index, a measure of disability, and SF-36 were collected from a community sample of volunteers with MS from a postal questionnaire and visits from researchers.

RESULTS

The response rate was 61%, (n = 169). Respondents in this study were most likely to be assisted by family rather than health or social service professionals and the help was considered essential for approximately 70% of individuals. Only 15% of respondents in this survey received visits from a professional in the preceding 24 h. There was a subgroup who considered help to be significantly more essential and who required assistance on more occasions by the SDDR (t = 13.01, df = 622, p < 0.001, t = 10.38, df = 36.4, p < 0.001). Other subgroups were also identified who may be in need of support from professionals but who were not receiving it.

CONCLUSIONS

There are reports of considerable amounts of care being provided by families to people with MS who may not be receiving the support required from professional caregivers. Further work needs to establish which groups need assistance and what form this assistance should take.

A UK literature review of progressive long-term neurological conditions

Progressive long-term neurological conditions are relatively rare, and policy attention has only recently been directed at community services for people with these conditions. This literature review draws together findings from 16 UK studies relating to the provision of care in the community for people with progressive long-term neurological conditions. The purpose is to identify elements of best practice which could be promoted at a national level to improve services. The findings point to the uneven coverage of services and their lack of flexibility. Multidisciplinary care delivery was considered essential and patients and carers highly valued the use of key workers. The studies also highlighted the potential for self-managed care. This evidence can be used to inform service developments for the delivery of community care for people with progressive long-term neurological conditions.

The effect of interferon-beta1a on relapses and progression of disability in patients with clinically isolated syndromes (CIS) suggestive of multiple sclerosis

OBJECTIVES

In 85% of young adults with multiple sclerosis (MS), onset is a subacute clinically isolated syndrome (CIS) of the optic nerves, brain stem or spinal cord. The advent of disease-modifying treatments for MS has increased attention on early stages of the disease. Therefore, the aim of this study was to evaluate the effect of interferon on relapses and progression of disability in patients with a CIS.

PATIENTS AND METHODS

This randomized, clinical trial was conducted in 25 patients who presented with a CIS indicative of MS. They were evaluated in two groups: 11 patients who were receiving interferon-beta(1a) (Rebif, Serono) subcutaneous injections three times a week (group A), and 14 patients who were not receiving disease-modifying treatment (group B). The progression of disability was determined using the Kurtzke Expanded Disability Status Scale (EDSS) and the numbers of new relapses were recorded during 21 months of follow-up.

RESULTS

The mean numbers of new relapses and changes in EDSS at the end of study period were 0.68 (standard deviation [S.D.]=0.80) and -1.09 (S.D.=0.49), and 1.79 (S.D.=1.05) and -0.64 (S.D.=0.49) in groups A and B, respectively. Statistical analysis showed that disease-modifying treatment with interferon-beta(1a) may reduce relapses (P=0.007) and prevent progressive disability (P=0.034).

CONCLUSION

Interferon-beta(1a) significantly delayed progression to disability and incidence of new relapses.

Nursing at a specialist diagnostic clinic for multiple sclerosis

People with multiple sclerosis (MS) need support, information, education and guidance in order to adapt effectively to the impact of the disease (Sheridan, 1997). The care received at the time of diagnosis is central to this adaptation process as the information given and received may impact on the person with MS for the rest of his/her life. In order to achieve effective coping strategies, the person with MS needs to develop a collaborative relationship with the team of healthcare professionals. At the National Hospital for Neurology and Neurosurgery (NHNN), University College London Hospital (UCLH), the MS team believes that the foundations of this relationship should be cemented at the diagnostic stage. This article describes a diagnostic model that facilitates accurate timely diagnosis of MS and the role of the MS nurse in providing expert clinical assessment, guidance, support and education in order to help the patient adjust to the disease.