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Amyotrophic lateral sclerosis (ALS) is a disease of low prevalence but high multidisciplinary need. The syndromic nature of ALS, the speed of disease progression and the changing requirements of patients and caregivers represent considerable challenges in ensuring the successful coordination of care. The review paper by Bede et al1 identifies common themes in timing and effective integration of specialist palliative care interventions, reviewing the development of guidelines and variations in service provision across different healthcare …