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Prevalence and factors associated with advanced care directives in a motor neuron disease multidisciplinary clinic in Australia
  1. Chun Seng Phua1,2,
  2. Aloysius Ng3,
  3. Christopher Brooks2,4,
  4. Zinta Harrington2,5,
  5. Hima Vedam2,5,
  6. Thang Huynh2,6,
  7. Desi Seccombe2,6,
  8. Patrick Aouad1,2,
  9. Dennis Cordato1,2
  1. 1 Department of Neurology and Neurophysiology, Liverpool Hospital, Liverpool, Australia
  2. 2 School of Medicine, University of New South Wales, Sydney, Australia
  3. 3 Department of Intensive Care, Lismore Base Hospital, Lismore, Australia
  4. 4 Department of Neurosurgery, Liverpool Hospital, Liverpool, Australia
  5. 5 Department of Respiratory and Sleep Medicine, Liverpool Hospital, Liverpool, Australia
  6. 6 Department of Palliative Care, Liverpool Hospital, Liverpool, Australia
  1. Correspondence to Chun Seng Phua, Department of Neurophysiology, Liverpool Hospital, Elizabeth and Goulburn St, Liverpool, NSW 2170, Australia; cs.phua22{at}


Objectives Motor neuron disease (MND) is a neurodegenerative disorder leading to functional decline and death. Multidisciplinary MND clinics provide an integrated approach to management and facilitate discussion on advanced care directives (ACDs). The study objectives are to analyse (1) the prevalence of ACD in our MND clinic, (2) the relationship between ACD and patient demographics and (3) the relationship between ACD decision-making and variables such as NIV, PEG, hospital admissions and location of death.

Methods Using clinic records, all patients who attended the MND clinic in Liverpool Hospital between November 2014 and November 2019 were analysed. Data include MND subtypes, symptom onset to time of diagnosis, time of diagnosis to death, location and reason of death. ACD prevalence, non-invasive ventilation (NIV) and percutaneous endoscopic gastrostomy (PEG) requirements were analysed.

Results There were 78 patients; M:F=1:1. 44 (56%) patients were limb onset, 28 (36%) bulbar onset, 4 primary lateral sclerosis and 2 flail limb syndrome presentations. 27% patients completed ACDs, while 32% patients declined ACDs. Patients born in Australia or in a majority English-speaking country were more likely to complete ACDs compared to those born in a non-English-speaking country. There was no significant correlation between ACD completion and age, gender, MND subtype, symptom duration, NIV, PEG feeding, location of death.

Conclusion One-quarter of patients completed ACDs. ACDs did not correlate with patient age, gender, MND subtype and symptom duration or decision-making regarding NIV, PEG feeding or location of death. Further studies are needed to address factors influencing patients’ decisions regarding ACDs.

  • Epidemiology
  • neurology
  • neurophysiology
  • neuromuscular disease
  • motor neuron disease
  • adult neurology
  • ethics (see medical ethics)

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  • Contributors CSP and DC conceptualised the article. CSP collected the data, drafted and revised the manuscript. AN performed the statistical analysis, reviewed and reviewed the manuscript. CB collected the data and assisted in drafting and review of the manuscript. DC and CSP critically reviewed data collection and analysis. ZH, HV, TH, DS and PA critically reviewed and revised the manuscript. All authors approved the final manuscript for submission.

  • Funding This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data may be obtained from a third party and are not publicly available.