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Chan LML, Choi EPH, Lam WWT, Chan KH, Pang SYY, Kwok JYY. Palliative Care Need and Quality of Life Mediated by Psychological Distress in Neurologic Diseases. J Pain Symptom Manage 2025; 69:641-653.e3. [PMID: 40081623 DOI: 10.1016/j.jpainsymman.2025.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2024] [Revised: 03/05/2025] [Accepted: 03/06/2025] [Indexed: 03/16/2025]
Abstract
CONTEXT Patients with progressive neurologic diseases (PNDs) face a prolonged and fluctuating course of illness marked by increasing disability and a range of nonmotor symptoms. However, the impacts of nonmotor symptoms and unmet care needs remain underexplored. Palliative care needs arise from the multifaceted sufferings associated with PNDs, encompassing not only physical pain but also psychological, social, and spiritual distress. Despite recommendations for early palliative care for PNDs to address these multidimensional sufferings, access to such supportive care is often restricted to advanced stages of the disease. OBJECTIVES This cross-sectional study aimed to examine palliative care needs, psychological distress, health-related quality of life, and the mediating effects of psychological distress on palliative care needs and health-related quality of life among patients with PNDs. METHODS A total of 210 patients with PNDs (Parkinson's disease or multiple sclerosis) were recruited using convenience sampling from regional neurology outpatient clinics and patient support groups in Hong Kong. Participants responded to Palliative Care Outcome Scale (POS), Hospital Anxiety and Depression Scale (HADS), and EQ-5D-5L surveys. RESULTS Most respondents (59.0%) walked without aid, whereas 26.2% required assistance and 14.8% were wheelchair-restricted. The most prevalent palliative care needs were physical symptoms other than pain, psychosocial support, and spiritual burden. A significant portion of participants exhibited possible anxiety (41.1%) or depression (48.6%). Hierarchical regression analysis indicated that mobility, palliative care needs, anxiety, and depression were significantly associated with the health-related quality of life. Anxiety and depression partially mediated the relationship between palliative care needs and quality of life. CONCLUSION Given the chronic, fluctuating illness trajectory, early recognition and management of emerging palliative care needs, particularly psychospiritual distress, is crucial for enhancing health-related quality of life for patients with PNDs.
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Affiliation(s)
- Lily Man Lee Chan
- School of Nursing (L.M.L.C., E.P.H.C., J.Y.Y.K.), Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR
| | - Edmond Pui Hang Choi
- School of Nursing (L.M.L.C., E.P.H.C., J.Y.Y.K.), Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR
| | - Wendy Wing Tak Lam
- Centre for Psycho-Oncological Research and Training (W.W.T.L.), Division of Behavioural Sciences, School of Public Health, The University of Hong Kong, Hong Kong SAR; Jockey Club Institute of Cancer Care (W.W.T.L.), LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR
| | - Koon Ho Chan
- Department of Medicine (K.H.C.), School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong SAR; Neuroimmunology and Neuroinflammation Research Laboratory (K.H.C.), Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR; Research Center of Heart, Brain, Hormone and Healthy Aging (K.H.C.), Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR
| | - Shirley Yin Yu Pang
- Department of Medicine (S.Y.Y.P.), Queen Mary Hospital, Pok Fu Lam, Hong Kong SAR
| | - Jojo Yan Yan Kwok
- School of Nursing (L.M.L.C., E.P.H.C., J.Y.Y.K.), Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR; Center on Behavioral Health (J.Y.Y.K.), Faculty of Social Sciences, The University of Hong Kong, Hong Kong SAR.
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Doherty M, Chukwusa E, McQuillan R, Cranfield F, Gao W. The Palliative Care Needs of Patients with Multiple Sclerosis, Parkinson's Related Diseases, and Motor Neurone Disease: A Secondary Analysis of the OPTCARE Neuro Trial Data. J Palliat Med 2024; 27:622-629. [PMID: 38597932 DOI: 10.1089/jpm.2023.0437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024] Open
Abstract
Background: Long-term neurological conditions include multiple sclerosis, Parkinson's-related diseases, and motor neurone disease. National and international guidelines recommend a palliative approach for advancing neurological disease, but there is little research describing and comparing the palliative care needs of these patients side by side. Objective: The aim of this study was to describe and compare the symptom burden and psychological distress of patients with multiple sclerosis, Parkinson's-related diseases, and motor neurone disease. Design: A cross-sectional secondary analysis of the OPTCARE Neuro trial data was performed. Setting/Subjects: Recruitment was from seven sites across the United Kingdom. Patients aged 18 years or older, severely affected by advanced stages of multiple sclerosis or Parkinson's-related diseases or any stage of motor neurone disease, with an unresolved symptom, and one other issue despite usual care were eligible. Measurements: Baseline demographics, Integrated Palliative care Outcome Scale (IPOS) Neuro, and Hospital Anxiety and Depression Scale (HADS) results were analyzed. Results: Data from 348 participants were analyzed. The mean IPOS Neuro-S24 score was 27, with no statistical difference found between groups (p = 0.341). The most common symptoms were poor mobility (68.5%), problems using legs (63%), and fatigue (34.8%). The HADS revealed that a quarter of participants met the criteria for a diagnosis of anxiety and depression. Conclusions: Multiple sclerosis, Parkinson's-related disease, and motor neurone disease patients who were eligible for the OPTCARE Neuro trial have unmet needs in the form of distressing physical and psychological symptoms. It is unclear how to address these needs. The answer likely lies in a collaborative approach between neurology, palliative care, psychology, and specialized allied health professionals. Future work should focus on investigating this.
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Affiliation(s)
| | - Emeka Chukwusa
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, United Kingdom
| | | | | | - Wei Gao
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, United Kingdom
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Dillen K, Goereci Y, Dunkl V, Müller A, Fink GR, Voltz R, Hocaoglu M, Warnke C, Golla H. Cultural adaptation of the Integrated Palliative care Outcome Scale for neurological symptoms. Palliat Support Care 2023; 21:1059-1068. [PMID: 37039454 DOI: 10.1017/s1478951523000238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
OBJECTIVES Standardized measures for assessing neurological patients needing palliative care remain scarce. The Integrated Palliative care Outcome Scale for neurological patients in its short form (IPOS Neuro-S8) helps assess and identify patients' symptom burden and needs early but has not yet been validated in German. The aim was to culturally adapt and translate the IPOS Neuro-S8 into the German health-care context and evaluate its face and content validity. METHODS Cultural adaptation study following the first 6 out of 8 phases of the Palliative care Outcome Scale measures manual: (1) conceptual definition, (2) forward translation to German, (3) backward translation to English, (4) expert review, (5) cognitive debriefing, (6) proofreading. Neurological patients needing palliative care and clinical staff of the Department of Palliative Medicine or Neurology of the University Hospital of Cologne were included. Data were analyzed using thematic content analysis and descriptive statistics. RESULTS A total of 13 patients and 16 clinical staff participated in this study. The expert review panel (phase 4) consisted of 11 additional members. While patients (n = 9) and clinical staff (n = 11) confirmed that the IPOS Neuro-S8 is an intelligible tool that is well accepted (phase 5), some linguistic and cultural differences were found between the original English and German versions. These mainly concerned the items mouth problems and spasms. SIGNIFICANCE OF RESULTS The German version of the IPOS Neuro-S8 has demonstrated face and content validity and captures relevant symptoms of neurological patients needing palliative care. Its psychometric properties, including construct and criterion validity, will be investigated next.
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Affiliation(s)
- Kim Dillen
- Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Yasemin Goereci
- Department of Neurology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Veronika Dunkl
- Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Anne Müller
- Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Gereon R Fink
- Department of Neurology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Jülich, Germany
| | - Raymond Voltz
- Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
- Clinical Trials Centre Cologne (CTCC), Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
- Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
- Center for Health Services Research (ZVFK), Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Mevhibe Hocaoglu
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, London, UK
| | - Clemens Warnke
- Department of Neurology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Heidrun Golla
- Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
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O'Shea N, Lyons S, Higgins S, O'Dowd S. Neurological update: the palliative care landscape for atypical parkinsonian syndromes. J Neurol 2023; 270:2333-2341. [PMID: 36688987 DOI: 10.1007/s00415-023-11574-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 01/12/2023] [Indexed: 01/24/2023]
Abstract
Atypical parkinsonian syndromes are neurodegenerative conditions, characterised by rapid disease progression and shorter life expectancy compared to idiopathic Parkinson's disease. These conditions inflict substantial physical and psychosocial burden on patients and their families; hence, there is a clear rationale for a palliative care approach from diagnosis. An interdisciplinary care model has been shown to improve symptom burden, quality of life and engagement with advance care planning, in a heterogeneous group of neurodegenerative conditions. In this update, we summarise how the landscape for treating these patients has changed and the questions that still need to be resolved.
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Affiliation(s)
- Noreen O'Shea
- Department of Neurology, Tallaght University Hospital, Tallaght, Dublin 24, D24NR0A, Ireland.
- Department of Palliative Medicine, Tallaght University Hospital, Tallaght, Dublin 24, D24NR0A, Ireland.
| | - Shane Lyons
- Department of Neurology, Tallaght University Hospital, Tallaght, Dublin 24, D24NR0A, Ireland
| | - Stephen Higgins
- Department of Palliative Medicine, Tallaght University Hospital, Tallaght, Dublin 24, D24NR0A, Ireland
- Our Lady's Hospice & Care Services, Harold's Cross, Dublin, D6WRY72, Ireland
| | - Sean O'Dowd
- Department of Neurology, Tallaght University Hospital, Tallaght, Dublin 24, D24NR0A, Ireland
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Effects of Palliative Care for Progressive Neurologic Diseases: A Systematic Review and Meta-Analysis. J Am Med Dir Assoc 2023; 24:171-184. [PMID: 36481217 DOI: 10.1016/j.jamda.2022.11.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 10/30/2022] [Accepted: 11/01/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To determine the association of palliative care for progressive neurologic diseases with patient- and caregiver-centered outcomes. DESIGN Systematic review and meta-analysis of randomized controlled trials and quasi-experimental studies, including pilot studies. SETTING AND PARTICIPANTS Adults with progressive neurologic diseases (dementia, multiple sclerosis, Parkinson's disease, motor neuron disease, multiple system atrophy, and progressive supranuclear palsy) and their caregivers. METHODS MEDLINE, EMBASE, CINAHL PLUS, Cochrane CENTRAL, and PubMed were searched from inception to September 2021. Two reviewers independently screened studies, extracted data, and assessed risk of bias using the Cochrane risk of bias tools. Narrative synthesis was conducted. Patient quality of life (QoL), symptom burden, caregiver burden, and satisfaction with care were meta-analyzed using a random-effects model. RESULTS Fifteen trials provided data on 3431 patients (mean age, 73.9 years). Compared with usual care, palliative care was statistically significantly associated with lower symptom burden [standardized mean difference (SMD), -0.34 (95% Cl, -0.59 to -0.09)] and higher caregiver satisfaction [SMD, 0.41 (95% Cl, 0.12 to 0.71)] and patient satisfaction [SMD, 0.43 (95% Cl, -0.01 to 0.87)]. However, the associations were not significant after excluding studies with high risk of bias. Insignificant associations of palliative care with caregiver burden [SMD, -0.09 (95% Cl, -0.21 to 0.03)] and patient QoL [SMD, 0.19 (95% Cl, -0.07 to 0.44)] were observed. CONCLUSIONS AND IMPLICATIONS Palliative care is likely to improve symptom burden and satisfaction with care among patients with progressive neurologic diseases and their caregivers, while its effects on QoL and caregiver burden remains inconclusive. Specific intervention components including interdisciplinary team, palliative care physicians, home visits, and spiritual care appeared to be associated with increased effects on improving palliative outcomes. More rigorous designed studies are warranted to examine the effects of neuropalliative care, effective intervention components, optimal timing, and symptom triggers of palliative care referrals.
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Symptom Burden and Unmet Support Needs of Patients With Parkinson's Disease: A Cross-Sectional Study in Asia-Pacific Regions. J Am Med Dir Assoc 2020; 22:1255-1264. [PMID: 33268298 DOI: 10.1016/j.jamda.2020.09.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 08/17/2020] [Accepted: 09/08/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Support care is rarely assessed and offered to people with long-term neurologic conditions, particularly Parkinson's disease. This study aimed to assess the symptom burden and unmet support care needs in people with mild to severe Parkinson's disease. DESIGN Cross-sectional study. SETTING AND PARTICIPANTS Patients with Parkinson's disease were recruited from neurologic outpatient clinics from 3 East and Southeast Asian regions, including Hong Kong, Taiwan, and Thailand. METHODS A standardized set of questionnaires assessing unmet care needs [Palliative care Outcome Scale (POS)], disease-specific symptom burden (POS-Symptoms-Parkinson's Disease), generic health-related quality of life (HRQOL) (EQ-5D-3L), and sociodemographic and clinical background. RESULTS Completed questionnaires (n = 186) were collected from 64 Hong Kong Chinese, 64 Taiwanese, and 58 Thai patients. Their mean age was 67.23 ± 8.07, 54% were female, and 80% had mild-to-moderate disease. Their mean POS score was 10.48 ± 6.38, indicating moderate unmet support needs. Two-thirds of the participants rated constipation, fatigue, leg problem, and daytime somnolence as the most prevalent and burdensome symptoms. Patients from Hong Kong and Taiwan prioritized psychosocial and spiritual support, whereas Thai patients prioritized physical needs and emotional concerns. Multivariate adjustment for demographics and clinical characteristics showed that high psychological, spiritual, and practical burdens are associated with young age, male gender, and advanced disease stages. CONCLUSIONS AND IMPLICATIONS Patients experience significant symptom burden and moderate unmet support needs at the early to middle stage of Parkinson's disease. Routine assessment of changes in symptom burden should start early. The timely referral of support care services should provide appropriate psychospiritual and practical support in addition to motor training. Planning for support care services should consider cultural and health service contexts.
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Wilson R, Hepgul N, Saha RA, Higginson IJ, Gao W. Symptom dimensions in people affected by long-term neurological conditions: a factor analysis of a patient-centred palliative care outcome symptom scale. Sci Rep 2019; 9:4972. [PMID: 30899063 PMCID: PMC6428819 DOI: 10.1038/s41598-019-41370-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 02/25/2019] [Indexed: 11/19/2022] Open
Abstract
Long-term neurological conditions (LTNCs) often cause debilitating symptoms. Better understanding of symptom dimensions in LTNCs is needed to support health professionals and improve care. This can be achieved by exploring the factor structure of a standardised measure of symptoms in LTNC patients. The symptom subscale of the Integrated Palliative Outcome Scale for LTNCs (IPOS Neuro-S24) comprises 24 items measuring symptom severity. Descriptive statistics and psychometric properties of the scale were assessed, followed by differential item functioning (DIF), exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). Data from N = 238 patients were analysed. The mean IPOS Neuro S-24 score was 27.0 (possible range 0-96) and floor effects were found for 21 items. The scale had good internal consistency (Cronbach's alpha = 0.77). Weak evidence of DIF was found for nine items. All but one item (falls) loaded onto four factors with loadings > 0.3. The factors represented four clinically meaningful symptom dimensions: fatigue, motor symptoms, oral problems and non-motor symptoms. We identified a reliable four-factor structure of symptom experience in LTNC patients. The results suggest that symptom dimensions are common across LTNCs. The IPOS Neuro S-24 is an appropriate tool to measure symptoms in LTNC patients, which may improve care.
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Affiliation(s)
- Rebecca Wilson
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, Bessemer Road, London, SE5 9PJ, UK.
| | - Nilay Hepgul
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, Bessemer Road, London, SE5 9PJ, UK
| | - Romi A Saha
- Hurstwood Park Neurological Centre, Brighton and Sussex University Hospitals, Lewes Road, Haywards Heath, RH16 4EX, UK
| | - Irene J Higginson
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, Bessemer Road, London, SE5 9PJ, UK
| | - Wei Gao
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, Bessemer Road, London, SE5 9PJ, UK
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de Silva R, Greenfield J, Cook A, Bonney H, Vallortigara J, Hunt B, Giunti P. Guidelines on the diagnosis and management of the progressive ataxias. Orphanet J Rare Dis 2019; 14:51. [PMID: 30786918 PMCID: PMC6381619 DOI: 10.1186/s13023-019-1013-9] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Accepted: 01/29/2019] [Indexed: 11/26/2022] Open
Abstract
The progressive ataxias are a group of rare and complicated neurological disorders, knowledge of which is often poor among healthcare professionals (HCPs). The patient support group Ataxia UK, recognising the lack of awareness of this group of conditions, has developed medical guidelines for the diagnosis and management of ataxia. Although ataxia can be a symptom of many common conditions, the focus here is on the progressive ataxias, and include hereditary ataxia (e.g. spinocerebellar ataxia (SCA), Friedreich’s ataxia (FRDA)), idiopathic sporadic cerebellar ataxia, and specific neurodegenerative disorders in which ataxia is the dominant symptom (e.g. cerebellar variant of multiple systems atrophy (MSA-C)). Over 100 different disorders can lead to ataxia, so diagnosis can be challenging. Although there are no disease-modifying treatments for most of these entities, many aspects of the conditions are treatable, and their identification by HCPs is vital. The early diagnosis and management of the (currently) few reversible causes are also of paramount importance. More than 30 UK health professionals with experience in the field contributed to the guidelines, their input reflecting their respective clinical expertise in various aspects of ataxia diagnosis and management. They reviewed the published literature in their fields, and provided summaries on “best” practice, including the grading of evidence available for interventions, using the Guideline International Network (GIN) criteria, in the relevant sections. A Guideline Development Group, consisting of ataxia specialist neurologists and representatives of Ataxia UK (including patients and carers), reviewed all sections, produced recommendations with levels of evidence, and discussed modifications (where necessary) with contributors until consensus was reached. Where no specific published data existed, recommendations were based on data related to similar conditions (e.g. multiple sclerosis) and/or expert opinion. The guidelines aim to assist HCPs when caring for patients with progressive ataxia, indicate evidence-based (where it exists) and best practice, and act overall as a useful resource for clinicians involved in managing ataxic patients. They do, however, also highlight the urgent need to develop effective disease-modifying treatments, and, given the large number of recommendations based on “good practice points”, emphasise the need for further research to provide evidence for effective symptomatic therapies. These guidelines are aimed predominantly at HCPs in secondary care (such as general neurologists, clinical geneticists, physiotherapists, speech and language therapists, occupational therapists, etc.) who provide care for individuals with progressive ataxia and their families, and not ataxia specialists. It is a useful, practical tool to forward to HCPs at the time referrals are made for on-going care, for example in the community.
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Affiliation(s)
- Rajith de Silva
- Department of Neurology, Essex Centre for Neurological Sciences, Queen's Hospital, Romford, RM7 0AG, UK
| | | | - Arron Cook
- Ataxia Centre, Department of Molecular Neurosciences, UCL Queen Sqaure Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | | | | | - Barry Hunt
- Ataxia UK, 12 Broadbent Close, London, N6 5JW, UK
| | - Paola Giunti
- Ataxia Centre, Department of Molecular Neurosciences, UCL Queen Sqaure Institute of Neurology, Queen Square, London, WC1N 3BG, UK.
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Oliver D. Palliative Care for People with Progressive Neurological Disease: What is the Role? J Palliat Care 2018. [DOI: 10.1177/082585971403000411] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- David Oliver
- Wisdom Hospice, High Bank, Rochester, Kent ME1 2NU UK
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Bužgová R, Kozáková R, Juríčková L. The Unmet Needs of Patients With Progressive Neurological Diseases in the Czech Republic: A Qualitative Study. J Palliat Care 2018; 34:38-46. [DOI: 10.1177/0825859718800489] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Aim: The aim of our research was to explore the unfulfilled needs of patients with a progressive neurological disease in advanced stage of the illness within the current system of health and social care in the Czech Republic. Design and Setting: Qualitative research (grounded theory) was used to conceptualize the patterns of unmet palliative care needs in Czech Republic. Methods: The data collection method comprised individual, in-depth interviews (n = 19) and focus groups (n = 4) where a total of 52 respondents participated (patients with progressive neurological diseases [PNDs], family members, and professionals). Results: Two main categories of unfulfilled needs were determined (life with the disease, professional help), and they were described in the context of the 3 crucial themes identified in the study—the symptoms of the advanced stage of the disease resulted in substantial reduction of physical self-sufficiency, loss of autonomy, and social isolation; the level of dependence on the support and help of others increased; the patients also highlighted several problems related to health-care services. Conclusion: The unmet needs should be taken into consideration when creating the concept of the neuropalliative and rehabilitation care, including the mental health support plan, because of the emotional, behavioral, and cognitive disorders that frequently occur in the lives of a substantial amount of patients with PND.
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Affiliation(s)
- Radka Bužgová
- Department of Nursing and Midwifery, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Radka Kozáková
- Department of Nursing and Midwifery, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Lubica Juríčková
- Department of Nursing and Midwifery, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
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Harris N, Baba M, Mellor C, Rogers R, Taylor K, Beringer A, Sharples P. Seizure management in children requiring palliative care: a review of current practice. BMJ Support Palliat Care 2017; 10:e22. [PMID: 28687558 DOI: 10.1136/bmjspcare-2017-001366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 06/05/2017] [Accepted: 06/07/2017] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Controlling seizures in children approaching death can be difficult, and there is a limited evidence base to guide best practice. We compared current practice against the guidance for seizure management produced by the Association of Paediatric Palliative Medicine (APPM). METHODS Retrospective case note review of episodes of challenging seizure management in children receiving end-of-life care over a 10-year period (2006-2015) in the south-west region of England. RESULTS We reviewed 19 admissions, in 18 individuals. Six (33%) had a malignancy, nine (50%) had a progressive neurodegenerative condition and three (17%) had a static neurological condition with associated epilepsy. Thirteen (72%) died in their local hospice, four (22%) at home, and one (6%) in hospital. Seventeen of 19 episodes involved the use of subcutaneous or intravenous midazolam infusion, for a mean of 11 days (range 3-27). There was a wide range of starting doses of midazolam, and 9/17 (53%) received final doses in excess of current dose recommendations. Six individuals received subcutaneous phenobarbital infusions, with four of these (67%) receiving final doses in excess of current dose recommendations. Plans for adjustments of infusion rates, maximal doses or alternative approaches should treatment fail were inconsistent or absent. In 16/18 (88%) cases seizures were successfully controlled prior to the day of the child's death. Staff found the experience of managing seizures at end of life challenging and stressful. CONCLUSIONS Pharmacological approaches to seizure management in end-of-life care are variable, often exceeding APPM dose recommendations. Despite this, safe and effective seizure control was possible in all settings.
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Affiliation(s)
- Nicola Harris
- Centre for Health and Clinical Research, University of the West of England, Bristol, UK
| | - Megumi Baba
- Medical Director, Children's Hospice South West, nr Bristol, UK
| | - Charlotte Mellor
- Paediatric Palliative Medicine, United Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Rebekah Rogers
- Paediatric Pharmacy, United Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Kirsty Taylor
- Community Children's Nursing Team, Devon VirginCare, Dartington, UK
| | - Antonia Beringer
- Faculty of Health and Allied Sciences, University of the West of England, Bristol, UK
| | - Peta Sharples
- Paediatric Neurology, United Hospitals Bristol NHS Foundation Trust, Bristol, UK
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12
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Gao W, Crosby V, Wilcock A, Burman R, Silber E, Hepgul N, Chaudhuri KR, Higginson IJ, on behalf of the OPTCARE Neuro trial. Psychometric Properties of a Generic, Patient-Centred Palliative Care Outcome Measure of Symptom Burden for People with Progressive Long Term Neurological Conditions. PLoS One 2016; 11:e0165379. [PMID: 27780237 PMCID: PMC5079599 DOI: 10.1371/journal.pone.0165379] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 09/15/2016] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND There is no standard palliative care outcome measure for people with progressive long term neurological conditions (LTNC). This study aims to determine the psychometric properties of a new 8-item palliative care outcome scale of symptom burden (IPOS Neuro-S8) in this population. DATA AND METHODS Data were merged from a Phase II palliative care intervention study in multiple sclerosis (MS) and a longitudinal observational study in idiopathic Parkinson's disease (IPD), multiple system atrophy (MSA) and progressive supranuclear palsy (PSP). The IPOS Neuro-S8 was assessed for its data quality, score distribution, ceiling and floor effects, reliability, factor structure, convergent and discriminant validity, concurrent validity with generic (Palliative care Outcome Scale) and condition specific measures (Multiple Sclerosis Impact Scale; Non-motor Symptoms Questionnaire; Parkinson's Disease Questionnaire), responsiveness and minimally clinically important difference. RESULTS Of the 134 participants, MS patients had a mean Extended Disability Status Scale score 7.8 (SD = 1.0), patients with an IPD, MSA or PSP were in Hoehn & Yahr stage 3-5. The IPOS Neuro-S8 had high data quality (2% missing), mean score 8 (SD = 5; range 0-32), no ceiling effects, borderline floor effects, good internal consistency (Cronbach's α = 0.7) and moderate test-retest reliability (intraclass coefficient = 0.6). The results supported a moderately correlated two-factor structure (Pearson's r = 0.5). It was moderately correlated with generic and condition specific measures (Pearson's r: 0.5-0.6). There was some evidence for discriminant validity in IPD, MSA and PSP (p = 0.020), and for good responsiveness and longitudinal construct validity. CONCLUSIONS IPOS Neuro-S8 shows acceptable to promising psychometric properties in common forms of progressive LTNCs. Future work needs to confirm these findings with larger samples and its usefulness in wider disease groups.
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Affiliation(s)
- Wei Gao
- King's College London, Faculty of Life Sciences and Medicine, Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, London, United Kingdom
| | - Vincent Crosby
- Palliative Medicine, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Andrew Wilcock
- Palliative Medicine and Medical Oncology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Rachael Burman
- King's College London, Faculty of Life Sciences and Medicine, Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, London, United Kingdom
| | - Eli Silber
- Department of Neurology, Kings' College Hospital, London, United Kingdom
| | - Nilay Hepgul
- King's College London, Faculty of Life Sciences and Medicine, Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, London, United Kingdom
| | - K Ray Chaudhuri
- National Parkinson Foundation Centre of Excellence, Kings College Hospital and Kings College, London, United Kingdom
| | - Irene J. Higginson
- King's College London, Faculty of Life Sciences and Medicine, Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, London, United Kingdom
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Oliver DJ, Veronese S. Symptomatic management of neurodegenerative disease in the elderly. PROGRESS IN PALLIATIVE CARE 2016. [DOI: 10.1080/09699260.2016.1193968] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Veronese S, Gallo G, Valle A, Cugno C, Chiò A, Calvo A, Cavalla P, Zibetti M, Rivoiro C, Oliver DJ. Specialist palliative care improves the quality of life in advanced neurodegenerative disorders: NE-PAL, a pilot randomised controlled study. BMJ Support Palliat Care 2015; 7:164-172. [DOI: 10.1136/bmjspcare-2014-000788] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Revised: 04/30/2015] [Accepted: 06/23/2015] [Indexed: 12/25/2022]
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Veronese S, Gallo G, Valle A, Cugno C, Chiò A, Calvo A, Rivoiro C, Oliver DJ. The palliative care needs of people severely affected by neurodegenerative disorders: A qualitative study. PROGRESS IN PALLIATIVE CARE 2015. [DOI: 10.1179/1743291x15y.0000000007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Abstract
This review assesses the current opinion towards early palliative care in neurology and discusses the existing evidence base. A comprehensive literature search resulted in 714 publications with 53 being directly relevant to the scope of this review. The current literature reflects primarily expert opinion and describes a growing interest in the early introduction of palliative principles into neurological care. Early initiation of palliative interventions has the potential to improve quality of life, enhance symptom management and assist in advance care planning. Further data is required to determine whether this shift in philosophy has a positive impact on patient care.
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Saleem TZ, Higginson IJ, Chaudhuri KR, Martin A, Burman R, Leigh PN. Symptom prevalence, severity and palliative care needs assessment using the Palliative Outcome Scale: a cross-sectional study of patients with Parkinson's disease and related neurological conditions. Palliat Med 2013. [PMID: 23208011 DOI: 10.1177/0269216312465783] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Palliative care is rarely being offered to patients with Parkinson's disease. AIM To assess symptom prevalence, severity and palliative care needs in advanced stages of Parkinsonism. DESIGN A cross-sectional survey using a palliative care assessment tool, the Palliative Outcome Scale was administered to patients. SETTING/PARTICIPANTS Eight-two patients with a diagnosis of idiopathic Parkinson's disease, multiple systems atrophy or progressive supranuclear palsy were included in the study. RESULTS Their mean age and disease stages 3-5 Hoehn and Yahr were 67 years and 4.1, respectively. Patients reported a mean of 10.7 (standard deviation = 3.9) physical symptoms. Over 80% had pain, fatigue, day time somnolence and problems with mobility. Other symptoms in 50%-80% included constipation, loss of bladder control, swallowing difficulties, drooling, breathlessness and sleep problems. Symptoms rated as causing severe problems were pain, fatigue, constipation and drooling. Assessment of mood revealed 70% of the patients felt anxiety and 60% had felt depressed. Eight-five per cent felt their families were anxious or worried about them. Thirty-eight per cent would have liked more information and 42% had practical problems that still needed to be addressed. There was a positive correlation between number of symptoms and disease severity (r = 0.39, p = 0.01). The total mean Palliative Outcome Scale score was 13.6 (standard deviation = 6.1), suggesting moderate palliative care needs. CONCLUSION This is the first study to describe the care needs of people with Parkinson's disease using the Palliative Outcome Scale tool. The burden of symptoms and concerns was high in advanced stages of disease. It might be appropriate that people severely affected by these conditions should be considered for referral to specialist palliative care services.
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Affiliation(s)
- Tariq Z Saleem
- Department of Clinical Neuroscience, Institute of Psychiatry, King's College London, London, UK.
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Multifunctional microelectrode array (mMEA) chip for neural-electrical and neural-chemical interfaces: Characterization of comb interdigitated electrode towards dopamine detection. Biosens Bioelectron 2013; 41:602-7. [DOI: 10.1016/j.bios.2012.09.030] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Revised: 09/14/2012] [Accepted: 09/20/2012] [Indexed: 11/22/2022]
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Hussain J, Adams D, Allgar V, Campbell C. Triggers in advanced neurological conditions: prediction and management of the terminal phase. BMJ Support Palliat Care 2013; 4:30-7. [PMID: 24644768 DOI: 10.1136/bmjspcare-2012-000389] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
CONTEXT The challenge to provide a palliative care service for individuals with advanced neurological conditions is compounded by variability in disease trajectories and symptom profiles. The National End of Life Care Programme (2010) recommended seven 'triggers' for a palliative approach to care for patients with advanced neurological conditions. OBJECTIVES To establish the frequency of triggers in the palliative phase, and if they could be reduced to fewer components. Management of the terminal phase also was evaluated. METHOD Retrospective study of 62 consecutive patients under the care of a specialist palliative neurology service, who had died. Principle component analysis (PCA) was performed to establish the interrelationship between triggers. RESULTS Frequency of triggers increased as each patient approached death. PCA found that four symptom components explained 76.8% of the variance. These represented: rapid physical decline; significant complex symptoms, including pain; infection in combination with cognitive impairment; and risk of aspiration. Median follow-up under the palliative care service was 336 days. In 56.5% of patients, the cause of death was pneumonia. The terminal phase was recognised in 72.6%. The duration of the terminal phase was 8.8 days on average, and the Liverpool Care of the dying Pathway was commenced in 33.9%. All carers were offered bereavement support. CONCLUSIONS Referral criteria based on the triggers can facilitate appropriate and timely patient access to palliative care. The components deduced through PCA have face validity; however larger studies prospectively validating the triggers are required. Closer scrutiny of the terminal phase is necessary to optimise management.
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Affiliation(s)
- Jamilla Hussain
- Department of Palliative Care, St. Catherine's Hospice, Scarborough, UK
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Abstract
Neurological disorders place a considerable burden upon individuals, their families, and society. Some like stroke are common, while others like amyotrophic lateral sclerosis are much rarer. Some conditions such as multiple sclerosis are reported to vary by latitude, while others such as traumatic brain injury can vary considerably by locality. Depending upon the nature of the lesion, and factors such as time since onset, the consequences to the individual may also vary considerably, not just among different disorders, but within a given disorder. Consequently the patterns of disease incidence, its prevalence, and its consequences are complex and may vary not just because of the condition itself, but also because, for example, case ascertainment may vary from study to study. The cumulative annual incidence of disabling neurological disorders is likely to exceed 1000 per 100000, or 1% of the population. The incidence is characterized by significant variation, which is mediated by genetic, geographical, demographic, and environmental factors. While useful comparisons can be made through standardization techniques, planning for local services should be based upon local epidemiology, whenever available.
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Higginson IJ, Gao W, Saleem TZ, Chaudhuri KR, Burman R, McCrone P, Leigh PN. Symptoms and quality of life in late stage Parkinson syndromes: a longitudinal community study of predictive factors. PLoS One 2012; 7:e46327. [PMID: 23144781 PMCID: PMC3492372 DOI: 10.1371/journal.pone.0046327] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2012] [Accepted: 08/29/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Palliative care is increasingly offered earlier in the cancer trajectory but rarely in Idiopathic Parkinson's Disease(IPD), Progressive Supranuclear Palsy(PSP) or Multiple System Atrophy(MSA). There is little longitudinal data of people with late stage disease to understand levels of need. We aimed to determine how symptoms and quality of life of these patients change over time; and what demographic and clinical factors predicted changes. METHODS We recruited 82 patients into a longitudinal study, consenting patients with a diagnosis of IPD, MSA or PSP, stages 3-5 Hoehn and Yahr(H&Y). At baseline and then on up to 3 occasions over one year, we collected self-reported demographic, clinical, symptom, palliative and quality of life data, using Parkinson's specific and generic validated scales, including the Palliative care Outcome Scale (POS). We tested for predictors using multivariable analysis, adjusting for confounders. FINDINGS Over two thirds of patients had severe disability, over one third being wheelchair-bound/bedridden. Symptoms were highly prevalent in all conditions - mean (SD) of 10.6(4.0) symptoms. More than 50% of the MSA and PSP patients died over the year. Over the year, half of the patients showed either an upward (worsening, 24/60) or fluctuant (8/60) trajectory for POS and symptoms. The strongest predictors of higher levels of symptoms at the end of follow-up were initial scores on POS (AOR 1.30; 95%CI:1.05-1.60) and being male (AOR 5.18; 95% CI 1.17 to 22.92), both were more predictive than initial H&Y scores. INTERPRETATION The findings point to profound and complex mix of non-motor and motor symptoms in patients with late stage IPD, MSA and PSP. Symptoms are not resolved and half of the patients deteriorate. Palliative problems are predictive of future symptoms, suggesting that an early palliative assessment might help screen for those in need of earlier intervention.
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Affiliation(s)
- Irene J. Higginson
- Cicely Saunders Institute, King's College London, London, United Kingdom
- * E-mail: (IJH); (WG)
| | - Wei Gao
- Cicely Saunders Institute, King's College London, London, United Kingdom
- * E-mail: (IJH); (WG)
| | | | - K. Ray Chaudhuri
- Institute of Psychiatry, King's College London, London, United Kingdom
- National Parkinson Foundation International Centre of Excellence, Kings College Hospital, London, United Kingdom
| | - Rachel Burman
- Cicely Saunders Institute, King's College London, London, United Kingdom
| | - Paul McCrone
- Institute of Psychiatry, King's College London, London, United Kingdom
| | - Peter Nigel Leigh
- Institute of Psychiatry, King's College London, London, United Kingdom
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Affiliation(s)
- Irene J Higginson
- Cicely Saunders Institute, King's College London, London SE5 9PJ, UK.
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