Search

Patients with neurological illnesses have many palliative care needs that need to be addressed in the outpatient clinical setting. This review discusses existing models of care delivery, including services delivered by neurology teams, palliative care specialists, telehealth, and home-based programs. We review the existing literature that supports these services and ongoing limitations that continue to create barriers to necessary clinical care for this vulnerable patient population. [ABSTRACT FROM AUTHOR]

Background : All physicians encounter patients with serious illness. Medical students recognize the value of hospice and palliative medicine (HPM) and desire more knowledge and skills in this area. However, both pre-clinical and clinical HPM content are underrepresented within medical school curricula. Objectives : To conduct a pilot study examining the impact of a novel required HPM clinical experience on pre-clinical medical and dental students' learning through mixed methods evaluation of student responses. Design : Students completed a two-part electronic survey following a half-day HPM mentored clinical shadowing experience (HPM-MCSE) which included an introductory session, a faculty-mentored shadowing experience and a debriefing session. Setting/subjects: 163 first-year students at Harvard Medical School in Boston, Massachusetts, USA in 2022. Measurements : The survey collected demographic information and student responses to both closed-ended (Likert-scale) and open-ended prompts. Data were analyzed quantitatively using descriptive statistics and qualitatively using constant comparative methodology. Results : 127 medical and dental students responded (78% response rate). Qualitative analysis yielded three overarching themes: acquisition of knowledge about operational dimensions of HPM, acquisition of knowledge about psychosocial dimensions of HPM, and personal impact including an awareness of discordance between expectations and lived experience of HPM practice. Of the 109 students who completed the entire survey, 67% indicated that this experience increased their interest in palliative care and 98% reported an increase in their understanding of how palliative care enhances patient care. Conclusions : Early clinical exposure to HPM for first year students stimulates multi-dimensional learning about HPM and evokes personal reflection about serious illness care. [ABSTRACT FROM AUTHOR]

To develop a checklist to facilitate coordination of care and communication of patients with brain tumors and assess the benefit of the checklist using a quality improvement survey Rehabilitation teams are challenged to respond to the unique needs of patients with brain tumors as this population requires coordinated care across multiple disciplines with frequent communication. To improve care of this patient population in an IRF setting, we developed a novel checklist using a multidisciplinary team of clinicians. Our checklist aims to improve communication between multiple treatment teams, achieve appropriate goals during the IRF stay, involve services as needed and arrange post-discharge services for patients with brain tumors. We then used a quality improvement survey among clinicians to assess the efficacy and general opinion of the checklist. A total of 15 clinicians completed the survey. 66.7% felt that the checklist improved care delivery, and 66.7% felt the checklist improved communication between providers internally and with external institutions. More than half felt the checklist improved the patient experience and care delivery. A care coordination checklist has the potential to address the unique challenges experienced by patients with brain tumors to improve overall care for this population. Successful clinical care and rehabilitation of patients with brain tumors requires the coordinated efforts of an interdisciplinary team that often spans multiple care settings. A care coordination checklist has the potential to address the unique challenges experienced by patients with brain tumors to improve overall care for this population in the inpatient rehabilitation setting. [ABSTRACT FROM AUTHOR]

Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease characterized by progressive weakness and eventual death, usually within 3-5 years. An ALS diagnosis is associated with substantial emotional distress for both the affected person and their family care-partners which impairs the ability to engage in important conversations about long term care planning, negatively impacts ALS symptoms for the patient, and quality of life for both patient and care-partner. Here we 1) discuss published works identified by the authors about psychosocial interventions for the ALS population, 2) identify a lack of early, dyadic interventions to support psychosocial needs of people with ALS and care-partners; 3) describe the Neurodegenerative Diseases (NDD) framework for early dyadic intervention development and 4) propose an adaptation of an evidence-based early dyadic psychosocial intervention, Recovering Together, for the unique needs of people with ALS and their care-partners (Resilient Together-ALS; RT-ALS) using the NDD framework. Future work will use stakeholder feedback to optimize the intervention for subsequent efficacy testing. [ABSTRACT FROM AUTHOR]

1. Through exploration of art and stories, participants will gain a patient-centered understanding of the spiritual, relationship and psychological dimensions of living with ALS. 2. Through the exploration of art and stories participants will be able to report the value of medical humanities in patient-centered education. Amyotrophic lateral sclerosis (ALS) challenges almost every domain of personhood, thereby causing suffering and impacting patients' sense of dignity. Yet some patients lean into the stillness of the disease and thrive despite the suffering. In this session, we will learn from these teachers, people who have lived with ALS, through the arts, about this experience of stillness and resilience. Amyotrophic lateral sclerosis (ALS) challenges almost every element of personhood,causing suffering and impacting patients' sense of dignity. Yet many people who live with ALS seek joy, deepen relationships, and find meaning despite the relentless progression of their debilities. Our greatest teachers are our patients, yet rarely do they have a voice at medical conferences. In this session, people who have lived with ALS will teach participants about their experiences through art and stories. Art and stories by patients and their caregivers are a profound teaching modality for clinicians seeking to better understand the psychological, social, and existential domains of living with serious illness. Engaging literature and arts, the voice of patients who have lived with ALS will teach participants about how they lived with loss and disability and how they found wonder, purpose, and joy amidst this suffering. Medical humanities and patient stories have long been sources of teaching and meaning-making, protecting against burnout and fostering resilience for clinicians in the field of hospice and palliative care. They offer lessons on the spiritual, psychological and relational domains of being that are often missed in traditional evidence-based, scientific presentations and articles. Art and storiesby patients and their caregivers are windows into the patient experience of illness and spiritual, relational and psychological wellbeing in the face of suffering. Patient and caregiver created literature and art can serve as a valuable addition to clinical education. Existential / Humanities / Spirituality / Religion Resilience / Well being [ABSTRACT FROM AUTHOR]

The article focuses on analgesic strategies for managing pain in patients with Amyotrophic Lateral Sclerosis (ALS), covering primary disease-mediated pain such as spasticity and cramping, as well as secondary nociceptive pain arising from reduced mobility. Topics discussed include nonpharmacological interventions, pharmacological strategies, and specific medications used for pain relief in ALS patients.

Background: Palliative care consultation during serious life-limiting illness can reduce symptom burden and improve quality of care. However, quantifying the impact of palliative care is hindered by the limitations of manual chart review and administrative coding. Objectives: Using novel natural language process (NLP) techniques, we examined associations between palliative care consultations and performance on nationally endorsed metrics for high-quality end-of-life (EOL) care in patients with leptomeningeal disease (LMD) secondary to metastatic breast cancer. Methods: Patients with breast cancer with LMD were identified using administrative billing codes and NLP review of magnetic resonance imaging reports at 2 tertiary care centers between 2010 and 2016. Next, NLP was used to review clinical notes to (1) determine the presence of palliative care consultations and (2) determine the performance of process measures associated with high-quality EOL care, including discussions of goals of care, code status limitations, and hospice. Associations between palliative care consultation and documentation of EOL process measures were assessed using logistic regression. Results: We identified 183 cases of LMD. Median age was 56 (interquartile range [IQR]: 46-64) years and median survival was 150 days (IQR: 67-350). Within 6 months of diagnosis, 88.5% of patients had documentation of ≥1 process measure, including discussions of goals of care (63.4%), code status limitations (62.8%), or hospice (72.1%). Palliative care consultation was a predictor of subsequent documentation of goals of care (odds ratio [OR], 3.15; 95% confidence interval [CI], 1.58-6.27) and hospice discussions (OR, 4.61; 95% CI, 2.12-10.03). Conclusion: Palliative care involvement is associated with increased performance of EOL process measures in patients with breast cancer with LMD. [ABSTRACT FROM AUTHOR]

1. Identify patients who would benefit from a trial of buprenorphine low-dose initiation. 2. Review approaches to performing a buprenorphine low-dose initiation to decrease total opioid use in patients with cancer and non-cancer-related pain. Buprenorphine low-dose initiation is a novel approach that harnesses the unique pharmacological profile of this partial-opioid agonist to reduce both risk of precipitated opioid withdrawal and need for prolonged opioid tapers in vulnerable patients. Buprenorphine low-dose initiation is a novel approach that harnesses the unique pharmacological profile of this partial-opioid agonist to reduce both risk of precipitated opioid withdrawal and need for prolonged opioid tapers in vulnerable patients (1). A 65-year-old man with metastatic bladder cancer and significant non-cancer-related orthopedic spine concerns is followed in the palliative care clinic for both cancer and non-cancer-related pain. He was being treated with a multimodal pharmacologic approach, involving opioid therapy (hydromorphone 8mg every 4 hours), neuropathic agents (amitriptyline and pregabalin), muscle relaxants (baclofen), and anti-inflammatory agents (celecoxib). With this, he had recently noted improvement in his pain level and had a desire to wean opioids due to bothersome side-effects of fatigue, cognitive fogging, and occasional myoclonus. Given his chronic opioid use, a rotation to buprenorphine was performed using a low-dose initiation protocol with subutex (buprenorphine tablets). The patient successfully weaned his opioid use from 48mg oral hydromorphone daily to 12mg oral subutex with resolution of his opioid side-effects. Buprenorphine low-dose initiation involves adding increasing low-dose formulations of buprenorphine to an amount where the opioid receptors are nearly fully occupied, then reducing the frequency and dose of full-agonist opioids. In patients with both chronic non-cancer-related and cancer-related pain, this strategy can provide relief from opioid-related side effects, while still achieving good pain control. Evidence supports the use of buprenorphine rotation to reduce chronic pain, without precipitating opioid withdrawal or other serious adverse side effects (2). Managing Suffering and Distress / Pharmacotherapeutics / Pharmacopalliation [ABSTRACT FROM AUTHOR]

The article discusses the value of a weekly newsletter in neurology. It describes the weekly bulletin "Neurology Weekly Events" which provides details on lectures, academic conferences and departmental meetings for the Partners Neurology Residency Program of the neurology departments of Brigham and Women's and Massachusetts General Hospitals. Also noted are various neurological events including the Epilepsy Case Conference, Neurovascular Conference and Multiple Sclerosis Conference.