What Can Multidisciplinary Care Do for You? Key Learnings from the Multidisciplinary Multiple Sclerosis Comprehensive and Palliative Care Program
Ali Bateman1, Courtney Casserly2, Luxshmi Nageswaran3, Sarah Morrow4, Teneille Gofton2
1Physical Medicine and Rehabilitation, 2Clinical Neurological Sciences, 3Faculty of Health Sciences, Western University, 4Department of Clinical Neurological Sciences, Cumming School of Medicine, University of Calgary
Objective:
Characterize the medical, physical, and psychosocial concerns of persons with advanced disability from MS and describe the recommended interventions of the Multiple Sclerosis Comprehensive and Palliative Care (MSCPC) Program.
Background:
Persons with advanced multiple sclerosis (MS) require care beyond the disease modifying treatments offered in conventional MS clinics, to address their complex physical and psychosocial needs. In this novel MSCPC Program, an MS neurologist, palliative care specialist, and physiatrist collaborate to jointly assess patients, identify their needs, improve symptom control, and support advanced care planning.
Design/Methods:
Retrospective chart review of consecutive patients seen in the MSCPC Program from 2019-2022.
Results:
54 patients were assessed over 74 clinic appointments. Patients’ mean age was 59.4±10.8 years (range 37-81) and mean duration of MS was 24.8±11.8 years (range 2-52); 79.7% of patients had secondary progressive MS with median and mode disease severity (EDSS) of 7.5 and 8.5, respectively (range 4-9.5). 70.3% lived at home with a caregiver; the primary caregiver was the spouse for 51.4% of cases. 85.1% of patients received publicly funded in-home assistance for activities of daily living. The most prevalent complications of MS were incontinence (89.9%), spasticity (82.6%), and pain (78.3%). ≥1 symptom was addressed at 95.7% of appointments, most often pain (63.8%), spasticity (60.9%), and bowel (59.4%); deprescribing was recommended at 29.0% of appointments. Caregiver burnout was identified at 56.5% of appointments.
Conclusions:
Patients seen in the MSCPC program ranged widely in age and MS duration, but frequently had high levels of disability (EDSS mode 8.5). Incontinence, constipation, spasticity, and pain were the most frequently addressed symptoms; 95.7% of appointments resulted in recommendations for symptom control, suggesting a high prevalence of unmet symptom control needs in persons with advanced disability from MS. Consequently, persons living with advanced disability from MS may benefit from assessment in similar programs.
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