Authors (including presenting author) :
MA IV (1), CHIU PH (1), TAI LF (1), HO CW (2), CHAN MC (3), KWOK PL (4), CHAN K (5), CHIU WC (6), WONG WT (2), YIP W (7), FONG YT (8), CHOW MC (1), LAU WS (1), MIU PL (1), CHEUNG CM (1)
Affiliation :
Departments of (1) Medicine, (2) Palliative Care, (3) Psychiatry, (4) Clinical Psychology, (5) Dietetics, (6) Occupational Therapy, (7) Physiotherapy, (8) Speech Therapy of Pamela Youde Nethersole Eastern Hospital
Introduction :
Motor neuron diseases (MND) are neurodegenerative conditions with poor prognosis. In the past, patients were cared by individual specialties without collaboration and care planning. Physical parameters and functional status were not systematically monitored. Psychosocial issues were often overlooked. Patients have unexpected admissions for disease progression, malnutrition, aspiration, and respiratory failure. These create unnecessary suffering and enormous burden to the medical system. Multidisciplinary care is therefore advocated by international guidelines to facilitate management planning and improve clinical outcome among MND patients.
Objectives :
MDT meeting was set up as a platform to facilitate communication among different specialties, which allow timely intervention to achieve the following goals: • Conjunct care to monitor disease progression and formulate management plan • Optimize timing of introduction of non-invasive ventilation (NIV), percutaneous endoscopic gastrostomy (PEG) feeding, advanced care planning (ACP) and palliative care (PC) • Reduce unplanned readmissions • Enhance quality of life • Prolong survival
Methodology :
Monthly MDT meetings were held since July 2020. The following specialties were included: Neurology, Respiratory, Gastroenterology, Palliative Care, Psychiatry, Clinical Psychology, Physiotherapy,Occupational Therapy, Speech Therapy and Dietetics. Up to two patients could be reviewed each time, with priorities given to those with clinical deterioration. To avoid frequent hospital visits which is difficult for these patients, they were assessed by different specialties on the same day in day-ward setting. MDT meetings were held on the same afternoon to discuss the findings and formulate management plan.
Result & Outcome :
12 patients have been discussed in MDT. Comparing with MND patients before the commencement of MDT service, more patients received NIV (20.7% vs 50%) and PEG feeding (13.8% vs 33.3%). Unplanned admissions were reduced (62% vs 41.7%) and fewer patients spent their last days as in-patients (78.2% vs 63.6%). Among patients under MDT services, 80% had advanced directive (AD) or DNACPR order. 80% patients received PC home care. 20% patients passed away in community hospice bed. 80% family have received bereavement support. Conclusion: MDT meeting can facilitate timely intervention and care planning for MND patients.
