Tasks and interfaces in primary and specialized palliative care for Duchenne muscular dystrophy – A patients’ perspective

Research output: Contribution to journalResearch articleContributedpeer-review

Contributors

  • Maria Janisch - , Department of Paediatrics, Division of Neuropediatrics (Author)
  • Kristin Boehme - , Dresden University of Technology (Author)
  • Simone Thiele - , Ludwig Maximilian University of Munich (Author)
  • Annette Bock - , Stiftung Kreuznacher Diakonie (Author)
  • Janbernd Kirschner - , University of Bonn (Author)
  • Ulrike Schara - , University of Duisburg-Essen (Author)
  • C. Walter - , Ludwig Maximilian University of Munich (Author)
  • Silke Nolte-Buchholtz - , Dresden University of Technology (Author)
  • Maja von der Hagen - , Department of Paediatrics, Division of Neuropediatrics (Author)

Abstract

In spite of the improvements in care and the emergence of disease-modifying treatments, Duchenne muscular dystrophy (DMD) remains a life-limiting disease of adolescence and (young) adulthood. Palliative care approaches and principles should be integrated from the point of diagnosis and implemented throughout the lifespan. A nationwide cross-sectional survey based on a mixed-method-design of qualitative and quantitative research approaches evaluated the structural implementation and perception of palliative care for DMD in Germany. Data analyses revealed that palliative care was predominantly provided at the primary care level by pediatricians, general practitioners and specialized multi-professional outpatient structures. The majority of patients did not utilize the scopes of specialized palliative structures. Simultaneously, insufficiently treated complex symptoms, emergent and elective hospitalizations and barriers in transitioning into adult care presented a considerable burden. A collaborative integrated model with a close cooperation of patients, families and care providers is proposed involving task areas and interfaces complementing primary and specialized palliative care (1) management of complex symptoms, (2) crisis support, (3) intermittent relief of the strain for caregivers, (4) coordination of care, (5) advance care planning and (6) end-of-life care. Specialized palliative care should be used as an "add-on" approach in time of need rather than as a prognosis or disease stage.

Details

Original languageEnglish
Pages (from-to)975-985
Number of pages11
JournalNeuromuscular disorders
Volume30
Issue number12
Publication statusPublished - Dec 2020
Peer-reviewedYes

External IDs

PubMed 33214012

Keywords

Keywords

  • Duchenne muscular dystrophy, Life limiting diseases, Health services research, Neuromuscular disorders, Palliative care, Pediatric palliative care