The Embedding of a Specialized Nurse Practitioner Palliative Care Clinic within a Multiple Sclerosis Comprehensive...

People with multiple sclerosis (PwMS) face an uncertain future as the nature of the disease can be progressive and unpredictable, leading to chronic serious symptomatology impacting quality of life. Serious illness discussions and symptom management should be part of routine care in all outpatient neurology clinics. Yet few standard clinical approaches to palliative care exist for this population. Providers frequently lack understanding about when to incorporate specialist palliative care. The MS-Support project established a specialized nurse practitioner (NP)-led palliative care clinic embedded in an MS center. A feasibility project evaluated clinician perceptions and referral patterns, as well as the impact on symptom identification and advance care planning/serious illness discussions. Twenty-six patients were referred over 3 months, 77% were seen once; 29% were seen more than twice. The average number of symptoms identified per patient increased from 1.8 to 6.7 postintervention. Seventeen (85%) had serious illness discussions documented compared with zero preintervention. NP productivity increased by 67%. Results indicate that NP provision of embedded palliative care can increase acceptance of palliative care, increase the frequency of serious illness discussions, and improve identification of multidimensional symptoms in patients with progressive MS. An NP-embedded clinic can improve palliative care provided to this vulnerable population.