The ALS patient care database: Insights into end-of-life care in ALS

R. N. Mandler*, F. A. Anderson, R. G. Miller, L. Clawson, M. Cudkowicz, M. Del Bene, Walter G. Bradley, Linda I. Boynton de Sepulveda, Benjamin R. Brooks, Neil R. Cashman, Michael Graves, Yadollah Harati, Terry Heiman-Patterson, Mary Lyon, Hiroshi Mitsumoto, Dan Moore, Steven P. Ringel, Jeffrey Rosenfeld, Mark A. Ross, Michael J. StrongRobert L. Sufit

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

64 Scopus citations

Abstract

Objective: To study clinical practices and patient outcomes near the end of life in amyotrophic lateral sclerosis (ALS). Background: Patients, families, and healthcare providers face several dilemmas in selecting and delivering care near the end of life in ALS. Published data on clinical practices and their benefits during end-of-life care for ALS patients consist of anecdotal reports based on small case series or individual case reports. Methods: Data were obtained from 1014 American and Canadian patients with ALS who died while participating in a large observational registry (the ALS Patient Care Database) during the past four years. Following death, a caregiver or family member provided data for each patient using a standard questionnaire. Data were principally generated through American and Canadian ALS multidisciplinary centers of excellence. Results: Most patients died peacefully (90.7%) and 62.4% died in a hospice-supported environment. Advance directives were in place for 88.9% of patients and were followed in 96.8%. Among the 67 patients who exhibited distress in the dying process, symptoms included breathing difficulties (82.1%), fear/anxiety (55.2%), pain (23.9%), insomnia (14.9%), and choking (14.93%). Oxygen was given to 52.6% of patients, and pain medications were given to 74%. Conclusion: These data suggest that palliative care at the end of life was relatively well managed for most patients with ALS who participated in this study; nevertheless, several opportunities for improvement were identified.

Original languageEnglish (US)
Pages (from-to)203-208
Number of pages6
JournalAmyotrophic Lateral Sclerosis and Other Motor Neuron Disorders
Volume2
Issue number4
DOIs
StatePublished - Dec 1 2001

Keywords

  • Advance directives
  • End-of-life care
  • Motor neuron disease

ASJC Scopus subject areas

  • Clinical Neurology

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