Abstract Details

Title What Can Multidisciplinary Care Do for You? Key Learnings from the Multidisciplinary Multiple Sclerosis Comprehensive and Palliative Care Program

Topic Multiple Sclerosis

Presentation(s) S3 - Multiple Sclerosis: Clinical Trials (2:12 PM-2:24 PM)

Poster/Presentation
Number 007

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.

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.

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.

Authors/Disclosures
E. Ali A. Bateman, MD PRESENTER	Dr. Bateman has received research support from Academic Medical Organization of Southwestern Ontario. Dr. Bateman has received research support from Ministry of Health (Province of Ontario). Dr. Bateman has received research support from New Frontiers in Research Fund (Government of Canada). Dr. Bateman has received research support from Paralyzed Veterans of America.
Courtney S. Casserly, MD, FAAN (London Health Sciences Center)	Dr. Casserly has received personal compensation in the range of $500-$4,999 for serving as a Consultant for EMD Serono. Dr. Casserly has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Soliris. Dr. Casserly has received personal compensation in the range of $500-$4,999 for serving as a Consultant for biogen idec. Dr. Casserly has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for sanofi genzyme. Dr. Casserly has received personal compensation in the range of $500-$4,999 for serving as a Consultant for roche. Dr. Casserly has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Novartis. Dr. Casserly has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Horizon Theraputics. Dr. Casserly has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for roche. Dr. Casserly has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Soliris. Dr. Casserly has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for novartis. Dr. Casserly has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biogen Idec. Dr. Casserly has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for EMG Serono. The institution of Dr. Casserly has received research support from Biogen Idec. The institution of Dr. Casserly has received research support from Western Libraries. The institution of Dr. Casserly has received research support from Western University.
Luxshmi Nageswaran	Miss Nageswaran has nothing to disclose.
Sarah A. Morrow, MD, MSC, FRCPC, FAAN	Dr. Morrow has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for BIogen Idec. Dr. Morrow has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for EMD Serono/Merck. Dr. Morrow has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Celgene. Dr. Morrow has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis. Dr. Morrow has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche. Dr. Morrow has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for SanofiGenzyme. Dr. Morrow has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Biogen Idec. Dr. Morrow has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Novartis. Dr. Morrow has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Roche. The institution of Dr. Morrow has received research support from Celgene.
Teneille Gofton, MD (London Health Sciences Centre)	The institution of Dr. Gofton has received research support from Government of Canada. The institution of Dr. Gofton has received research support from Canadian Institutes of Health Research. The institution of Dr. Gofton has received research support from Academic Medical Organisation of Southwestern Ontario. The institution of Dr. Gofton has received research support from Lawson Health Research Institute. Dr. Gofton has a non-compensated relationship as a Medical Advisory Board Member with NORSE Institute that is relevant to AAN interests or activities.

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