title: 'Fighting for everything': service experiences of people severely affected by multiple sclerosis.
abstract: BACKGROUND
  No previous research exists specifically exploring the needs of those people severely affected by multiple sclerosis (MS).
  
  
  METHODS
  Semi-structured interviews were conducted with people identified by the referring health or social care professional as being severely affected by their MS and informal carers, in order to explore their perceptions of their illness and care. The data were analysed for themes using the constant comparative approach.
  
  
  RESULTS
  The data relate to 32 people severely affected by MS, who identified several broad themes, relating to loss and change, and provision of services and care. In relation to service provision, people with MS (PwMS) and their carers identified two, interlinked themes--a lack of continuity and co-ordination of care, and a lack of information about services, aids and adaptations, welfare benefits and end-of-life issues. A further theme was identified, which underpinned and linked the two other themes, that of ;fighting for everything'--a sense that people had to struggle for their needs to be met.
  
  
  CONCLUSIONS
  There is a need to develop models of care in order to better meet patients and carers needs for information, co-ordination, and to reduce the feeling of struggling to receive services.
authors.affiliation: Department of Palliative Care, Policy and Rehabilitation, King's College London, and King's College Hospital, Denmark Hill, London, UK. polly.edmonds@kcl.ac.uk
authors.forename: P
authors.initials: P
authors.lastname: Edmonds
authors.forename: B
authors.initials: B
authors.lastname: Vivat
authors.forename: R
authors.initials: R
authors.lastname: Burman
authors.forename: E
authors.initials: E
authors.lastname: Silber
authors.forename: I J
authors.initials: IJ
authors.lastname: Higginson
mesh_terms: D022126:Access to Information; D000293:Adolescent; D000328:Adult; D000368:Aged; D003142:Communication; D003266:Continuity of Patient Care; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D020528:Multiple Sclerosis, Chronic Progressive / Q000523:psychology* / Q000628:therapy*; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000523:psychology* / Q000628:therapy*; D020380:Needs Assessment; D010166:Palliative Care; D012720:Severity of Illness Index; D012947:Social Work