Wei Li1,2, Hwee Lan Ng1,2, Wenyun Li3, Anthony N Piano1,2, Shireen Abdul Karim1,2, Kay Yaw Tay1,2,4, Wing Lok Au1,2,4, Louis Cs Tan1,2,4. 1. Department of Neurology National Neuroscience Institute Singapore. 2. Parkinson's Disease and Movement Disorders Centre National Neuroscience Institute Singapore. 3. Centre for Quantitative Medicine Duke-NUS Graduate Medical School Singapore. 4. Duke-NUS Graduate Medical School Singapore.
Abstract
BACKGROUND: Few studies have been performed on palliative care in Parkinson's disease (PD). This study was undertaken to understand treatment preferences of PD patients toward end-of-life care. METHODS: A questionnaire modified from the Willingness to Accept Life-Sustaining Treatment instrument was administered to participants. Four different scenarios based on the burden of care and outcome of the treatment were presented in detail to obtain decisions for end-of-life care. The responses in each scenario were compared between PD patients and controls. Further analyses were performed to identify factors that influenced treatment preferences among PD patients. RESULTS: In total, 136 PD patients and 60 controls were recruited. Parkinson's disease patients and controls were demographically similar, except that PD patients had more previous hospital admissions (P = 0.0195). Parkinson's disease patients were more likely to opt for high-burden care with poor outcome than controls (odds ratio [OR] = 2.11, P = 0.04).In the subgroup analysis for PD patients, the factors that influenced treatment preference toward end-of-life care were belief in religion (OR: 7.43, 95% confidence interval:1.97-28.07), higher Unified Parkinson's Disease Rating Scale (UPDRS) motor score (2.51, 1.14-5.50) in scenario B; belief in religion (6.93, 2.23-21.43), married patients (6.93, 2.23-21.43) in scenario C; and Chinese patients (0.29, 0.10-0.79), better PD knowledge (0.37, 0.17-0.80), and higher UPDRS motor scores (3.05, 1.35-6.9) in scenario D. CONCLUSION: Parkinson's disease patients were more likely to agree to high-burden care with a poor outcome compared to controls. Among PD patients, race, marital status, religious status, knowledge about PD, and severity of motor impairment significantly influenced their end-of-life treatment preferences.
BACKGROUND: Few studies have been performed on palliative care in Parkinson's disease (PD). This study was undertaken to understand treatment preferences of PD patients toward end-of-life care. METHODS: A questionnaire modified from the Willingness to Accept Life-Sustaining Treatment instrument was administered to participants. Four different scenarios based on the burden of care and outcome of the treatment were presented in detail to obtain decisions for end-of-life care. The responses in each scenario were compared between PD patients and controls. Further analyses were performed to identify factors that influenced treatment preferences among PD patients. RESULTS: In total, 136 PD patients and 60 controls were recruited. Parkinson's disease patients and controls were demographically similar, except that PD patients had more previous hospital admissions (P = 0.0195). Parkinson's disease patients were more likely to opt for high-burden care with poor outcome than controls (odds ratio [OR] = 2.11, P = 0.04).In the subgroup analysis for PD patients, the factors that influenced treatment preference toward end-of-life care were belief in religion (OR: 7.43, 95% confidence interval:1.97-28.07), higher Unified Parkinson's Disease Rating Scale (UPDRS) motor score (2.51, 1.14-5.50) in scenario B; belief in religion (6.93, 2.23-21.43), married patients (6.93, 2.23-21.43) in scenario C; and Chinese patients (0.29, 0.10-0.79), better PD knowledge (0.37, 0.17-0.80), and higher UPDRS motor scores (3.05, 1.35-6.9) in scenario D. CONCLUSION: Parkinson's disease patients were more likely to agree to high-burden care with a poor outcome compared to controls. Among PD patients, race, marital status, religious status, knowledge about PD, and severity of motor impairment significantly influenced their end-of-life treatment preferences.
Authors: Karin T Kirchhoff; Bernard J Hammes; Karen A Kehl; Linda A Briggs; Roger L Brown Journal: J Am Geriatr Soc Date: 2012-03-28 Impact factor: 5.562
Authors: Carmen H M Houben; Martijn A Spruit; Miriam T J Groenen; Emiel F M Wouters; Daisy J A Janssen Journal: J Am Med Dir Assoc Date: 2014-03-02 Impact factor: 4.669
Authors: Ana Isabel Gonzalez; Christine Schmucker; Joerg J Meerpohl; Christiane Muth; Julia Nothacker; Edith Motschall; Truc Sophia Nguyen; Maria-Sophie Brueckle; Jeanet Blom; Marjan van den Akker; Kristian Röttger; Odette Wegwarth; Tammy Hoffmann; Sharon E Straus; Ferdinand M Gerlach Journal: BMJ Open Date: 2019-12-15 Impact factor: 2.692
Authors: Leonard L Sokol; Michael J Young; Jack Paparian; Benzi M Kluger; Hillary D Lum; Jessica Besbris; Neha M Kramer; Anthony E Lang; Alberto J Espay; Ornella M Dubaz; Janis M Miyasaki; Daniel D Matlock; Tanya Simuni; Moran Cerf Journal: NPJ Parkinsons Dis Date: 2019-11-22