Balancing present-moment acceptance and future concerns: A qualitative study of illness experiences and perceptions of palliative care in progressive neurological diseases.

Abstract

Palliative care is advocated for improving quality of life and symptom control in people with progressive neurological diseases. However, most research has been conducted in Western culture, leaving a gap in Asian contexts. Understanding illness experience and perceived needs is essential for developing culturally tailored palliative interventions. To explore the lived experience of people with progressive neurological diseases in Hong Kong and their perceptions of palliative care. Qualitative study using an interpretive description approach and thematic analysis. Twenty-five patients (10 Parkinson's disease; 15 multiple sclerosis) were interviewed from August to October 2022. Four themes were identified: (1) struggles with "invisible pain": living with unpredictability and uncontrollability; (2) renegotiating life amid progressive loss of functions; (3) a desire for person-centered holistic care, and (4) dilemmas in future care planning amid limited awareness of palliative care. Participants experienced profound psychospiritual distress, disrupted self-identity, and social disconnection. While seeking acceptance and a positive outlook, they felt their holistic needs were overlooked by a healthcare system focused mainly on physical symptoms. Most were unfamiliar with palliative care, viewing it as irrelevant to progressive neurological diseases, yet desired compassionate, whole-person care, including psychospiritual support. Despite recognizing the need for future care planning before cognitive decline, barriers including emotional burden, family reluctance, and limited information impeded open discussions. Progressive neurological diseases significantly affect psychospiritual and social wellbeing. A person-centered, symptom-based palliative care approach, tailored to the fluctuating trajectory of progressive neurological diseases, is essential to address these multidimensional needs.