Neurological Symptoms in Palliative Care Patients

Abstract

BackgroundNeurological expertise in palliative care may be required not only for patients with primary neurological disorders but also for patients with non-neurological diseases suffering from burdensome neurological symptoms. The aim of this study was to determine the prevalence of neurological diagnoses and symptoms in palliative care patients, as well as the related burden and impact on everyday life.MethodsWe analyzed retrospectively the medical records of 255 consecutive patients from a tertiary medical center, at the time point of referral to an inpatient palliative care consultation service. In addition, 100 patients prospectively answered a questionnaire which included the assessment of neurological symptoms, as well as numeric rating scales for quality of life, symptom-specific burden, and restrictions in everyday life.ResultsForty-one patients (16%) suffered from a primary neurological disease. Most decisions regarding the termination of life-sustaining measures concerned this group (20/22, 91%). Neurological symptoms (excluding pain) were documented in 122 patients (48%) with an underlying non-neurological disease. In the questionnaire study, 98/100 patients reported at least one neurological or neuropsychiatric symptom, most frequently sleeping problems (N = 63), difficulty concentrating (N = 55), and sensory symptoms (N = 50). Vertigo/dizziness (N = 19) had the greatest impact on everyday life (7.57/10 ± 2.17) and the highest symptom-specific burden (7.14 ± 2.51). Difficulty concentrating (restrictions in everyday life/burden) and pain intensity were the only symptoms significantly correlated with quality of life (r = −0.36, p = 0.009/r = −0.32; p = 0.04; r = −0.327, p = 0.003).ConclusionNeurological diseases and symptoms are frequent among palliative care patients and are often associated with a high symptom burden, which may severely affect the patients’ lives. It is thus of paramount importance to implement neurological expertise in palliative care.

Palyatif Bakım Ünitemizde Yatan Hastaların Retrospektif Analizi

“…Bu endikasyonla yatırılan hasta grubunun literatürden fazla olduğu görülmektedir. [7,8] Yürüyen M. ve ark. [2] 2 yıllık sürede yatan 319 hastayı inceledikleri çalışmalarında komorbid hastalık sayısının ort 2,2±1,05 olduğunu ve en sık olarak malnütrisyon %59 (n:187), malignite %44 (n:143), enfeksiyon hastalığı %33 (n:104), bası yarası %33 (n:107) ve SVO %10 (n:31) görüldüğünü belirtmişlerdir.…”

“…Nörolojik hastalıkların palyatif bakım hastalarının günlük yaşamlarında önemli semptom yüküne ve kısıtlamalara neden olduğu belirtilmiştir. [8] Çalışmamız da açıkça ortaya konan başka bir gerçek; PBM'mizde yatan hastaların yaklaşık yarısını %43,3 (139)'ünü kanser hastalarının oluşturmasıdır. Yürüyen M ve ark.…”

Analysis of Parkinson’s Disease Outpatient Counselling for Advance Directive Creation: A Cross-Sectional Questionnaire-Based Survey of German General Practitioners and Neurologists

“…As no curative treatment has been found yet, the disease inevitably leads to progressing motor and non-motor symptoms [ 2 ]. Those symptoms can cause a loss of autonomy, forcing the treating physicians to adapt therapies regularly in order to meet the needs of people with PD (PwP) [ 3 , 4 , 5 , 6 , 7 ]. Further, physicians have to support PwP in planning future treatments in advance for when PwP become unable to express their wishes [ 8 , 9 ].…”

“…Regarding PD, the benefit and increasing demand of palliative care has been demonstrated before [ 6 , 15 , 16 , 17 , 18 ]. One major aspect of palliative care is advance care planning.…”

“…It involves education about diagnosis and prognosis, assignment of a health care power of attorney, and, in the optimal case, writing of a specific advance directive (AD) to identify goals, preferences and values of the patients [ 19 ]. In Germany and other western countries, ADs are essential instruments to improve medical decision making according to the patient’s will [ 6 , 16 , 20 ]. Previous research displayed that the majority of PwP in an advanced disease stage in Germany has a written AD [ 21 ].…”