Promoting excellence in end-of-life care in ALS.
The type and quality of end-of-life care varies greatly in ALS; the time to initiate end-of-life care is not defined, and decision making is hampered by logistical and financial barriers. There has been no systematic review of these issues in ALS. The goals of this initiative are to: 1) improve end-of-life care for patients with ALS and families based on what limited evidence is available; 2) increase awareness, interest, and debate on the end-of-life care in ALS; and 3) identify areas needed for new prospective clinical research. The ALS Peer Workgroup reviewed the literature and 1) identified the current state of knowledge, 2) analysed the gaps in care, and 3) provided recommendations for standard of care and future research. It was shown that areas of investigation are needed on the incorporation of an interdisciplinary approach to care in ALS that includes: psychosocial evaluation and spiritual care; the use of validated instruments to assess patient and caregiver quality of life; and the establishment of proactive caregiver programs. Several public policy changes that will improve coverage for medical care, hospice, and caregiver costs are also reviewed. More clinical evidence is needed on how to provide optimal end-of-life care specifically in ALS.
Mitsumoto
Hiroshi
H
The Elenor & Lou Gehrig MDA/ALS Research Center, Columbia University Neurological Institute, New York, NY 10032, USA. hm264@columbia.edu
Bromberg
Mark
M
Johnston
Wendy
W
Tandan
Rup
R
Byock
Ira
I
Lyon
Mary
M
Miller
Robert G
RG
Appel
Stanley H
SH
Benditt
Josh
J
Bernat
James L
JL
Borasio
Gian Domenico
GD
Carver
Alan C
AC
Clawson
Lora
L
Del Bene
Maura L
ML
Kasarskis
Edward J
EJ
LeGrand
Susan B
SB
Mandler
Raul
R
McCarthy
Jane
J
Munsat
Theodore
T
Newman
Daniel
D
Sufit
Robert L
RL
Versenyi
Andrea
A
D032722:Advance Care Planning; D000690:Amyotrophic Lateral Sclerosis / Q000523:psychology*; D001293:Attitude to Death; D006302:Health Services Research; D006801:Humans; D011787:Quality of Health Care; D011788:Quality of Life; D029181:Spirituality; D013727:Terminal Care / Q000523:psychology*