title: Palliative care for advanced Parkinson disease: an interdisciplinary clinic and new scale, the ESAS-PD.
abstract: Palliative care provides a holistic approach to symptom relief using a multidisciplinary team approach to enhance quality of life throughout the entire course of a particular illness. The care team consists of movement disorders neurologist, a palliative care physician, a wound care nurse, a spiritual counselor and a care coordinator. Palliative care concepts were applied to a group of advanced Parkinson disease (PD) patients in a dedicated Palliative Care Clinic.
  
  
  METHODS
  A modified Edmonton Symptom Assessment System Scale for PD (ESAS-PD) was developed and applied to 65 PD patients at their initial consultation and following recommended interventions. Scores were compared to those of metastatic cancer patients reported in the palliative care literature.
  
  
  RESULTS
  The ESAS-PD scores significantly improved after the interventions (56 and 40 respectively, p = 0.0001). The most improved items were constipation, dysphagia, anxiety, pain and drowsiness. ESAS-PD scores were not significantly different from metastatic cancer patients' ESAS scores.
  
  
  CONCLUSIONS
  ESAS-PD is a quick, effective scale for assessment of late stage PD symptoms. Scores are sensitive to intervention, and therefore have potential clinical utility for physicians and other healthcare providers. Advanced PD patients have a similar degree of symptoms as metastatic cancer patients, respond to treatment in a similar way, and therefore should have access to palliative care services.
authors.affiliation: The Palliative Program for Parkinson Disease and Related Disorders, The Morton and Gloria Shulman Movement Disorders Centre, Toronto Western Hospital, University of Toronto, Canada. miyasaki@uhnresearch.ca
authors.forename: Janis M
authors.initials: JM
authors.lastname: Miyasaki
authors.forename: J
authors.initials: J
authors.lastname: Long
authors.forename: D
authors.initials: D
authors.lastname: Mancini
authors.forename: E
authors.initials: E
authors.lastname: Moro
authors.forename: S H
authors.initials: SH
authors.lastname: Fox
authors.forename: A E
authors.initials: AE
authors.lastname: Lang
authors.forename: C
authors.initials: C
authors.lastname: Marras
authors.forename: R
authors.initials: R
authors.lastname: Chen
authors.forename: A
authors.initials: A
authors.lastname: Strafella
authors.forename: R
authors.initials: R
authors.lastname: Arshinoff
authors.forename: R
authors.initials: R
authors.lastname: Ghoche
authors.forename: J
authors.initials: J
authors.lastname: Hui
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000554:Ambulatory Care Facilities; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods*; D010300:Parkinson Disease / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D010348:Patient Care Team; D012720:Severity of Illness Index