The What and When of Palliative Care for Multiple Sclerosis: A Scoping Review (P6.088)
Bibliographic record
Abstract
Objective: We have undertaken a scoping review aimed at identifying the literature describing what palliative care is for MS and when it is initiated. Background: Multiple Sclerosis (MS) is viewed as a chronic, rather than terminal illness, however MS has been shown to be a life-shortening disease. While the time course of MS is highly variable, approximately 75[percnt] of patients will go on to have a progressive disease course. Care in progressive MS is not aimed at curative intent, but rather with the goal of alleviating suffering from symptoms, as well as providing patient and caregiver support, similar to palliative care offered for other terminal illnesses such as cancer. Thus, there is a defined need for palliative care in MS populations, however what defines palliative intervention in MS is unclear, as is the timing for this intervention. Methods: Six electronic databases were searched using keywords related to Multiple Sclerosis, palliative care, and terminal or end-of-life care. Results: The search yielded 556 possibly relevant papers once duplicates were removed. Of these, 406 were excluded by consensus from two independent expert reviewers due to lack of relevance or specific mention of palliative care in MS, while 150 were found to meet inclusion criteria. Conclusions: Our search revealed several broad categories defining areas of palliative care for MS patients, including issues related to quality of life, psychosocial and spiritual support, caregiver relief, symptom burden and management, advanced care planning, and discussion around euthanasia and/or physician-assisted suicide. The literature was mainly comprised of expert opinion, with little evidence-based components to MS palliative care. There was little consensus or mention of the optimal timing of palliative care intervention in MS. We conclude that despite the need for palliative care strategies in MS treatment, there is minimal evidence for palliative care involvement in MS populations.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.023 | 0.104 |
| Meta-epidemiology (narrow) | 0.002 | 0.002 |
| Meta-epidemiology (broad) | 0.006 | 0.006 |
| Bibliometrics | 0.021 | 0.022 |
| Science and technology studies | 0.002 | 0.002 |
| Scholarly communication | 0.007 | 0.008 |
| Open science | 0.003 | 0.003 |
| Research integrity | 0.006 | 0.003 |
| Insufficient payload (model declined to judge) | 0.008 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".