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Wells M, Harding S, Dixon G, Buckley K, Russell AM, Barratt SL. Patient and caregiver shared experiences of pulmonary fibrosis (PF): A systematic literature review. Respir Med 2024; 227:107659. [PMID: 38729528 DOI: 10.1016/j.rmed.2024.107659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 04/30/2024] [Accepted: 05/03/2024] [Indexed: 05/12/2024]
Abstract
Pulmonary Fibrosis (PF) describes a group of lung diseases characterised by progressive scarring (fibrosis). Symptoms worsen over time and include breathlessness, tiredness, and cough, giving rise to psychological distress. Significant morbidity accompanies PF, so ensuring patients' care needs are well defined and provided for, represents an important treatment strategy. The purpose of this systematic review was to synthesise what is currently known about the psychosocial morbidity, illness experience and needs of people with pulmonary fibrosis and their informal caregivers. Eight databases (MEDLINE, EMBASE, PUBMED, Cochrane database of Systematic reviews (CDSR), Web of Science Social Sciences Citation Index, PsycINFO, PsycARTICLES and CINAHL) were used to identify studies exploring the supportive needs of adults with PF and/or their caregivers. Methodological quality was assessed using the Mixed Methods Appraisal Tool. 53 studies were included, the majority using qualitative methodology (79 %, 42/53), 6 as part of mixed methodological studies. Supportive care needs were mapped to eight domains using an a priori framework analysis. Findings highlight a lack of psychological support throughout the course of the illness, misconceptions about and barriers to, the provision of palliative care despite its potential positive impacts. Patients and caregivers express a desire for greater disease specific education and information provision throughout the illness. Trials of complex interventions are needed to address the unique set of challenges for patients and carers living with PF.
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Affiliation(s)
- Matthew Wells
- Bristol Interstitial Lung Disease Service, North Bristol NHS Trust, Bristol, UK.
| | - Sam Harding
- Research and Development, North Bristol NHS Trust, Bristol, UK.
| | - Giles Dixon
- Bristol Interstitial Lung Disease Service, North Bristol NHS Trust, Bristol, UK; Department of Clinical and Biomedical Sciences, University of Exeter, Exeter, UK.
| | - Kirsten Buckley
- Library and Knowledge Services, North Bristol NHS Trust, Bristol, UK
| | - Anne-Marie Russell
- Birmingham Regional Interstitial Lung Disease Service, University Hospitals Birmingham NHS Trust, Birmingham, UK; Faculty of Life Sciences, University of Exeter, Exeter, UK.
| | - Shaney L Barratt
- Bristol Interstitial Lung Disease Service, North Bristol NHS Trust, Bristol, UK; Academic Respiratory Unit, Department of Clinical Sciences, University of Bristol, Bristol, UK.
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Althobiani MA, Russell AM, Jacob J, Ranjan Y, Folarin AA, Hurst JR, Porter JC. Interstitial lung disease: a review of classification, etiology, epidemiology, clinical diagnosis, pharmacological and non-pharmacological treatment. Front Med (Lausanne) 2024; 11:1296890. [PMID: 38698783 PMCID: PMC11063378 DOI: 10.3389/fmed.2024.1296890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 03/26/2024] [Indexed: 05/05/2024] Open
Abstract
Interstitial lung diseases (ILDs) refer to a heterogeneous and complex group of conditions characterized by inflammation, fibrosis, or both, in the interstitium of the lungs. This results in impaired gas exchange, leading to a worsening of respiratory symptoms and a decline in lung function. While the etiology of some ILDs is unclear, most cases can be traced back to factors such as genetic predispositions, environmental exposures (including allergens, toxins, and air pollution), underlying autoimmune diseases, or the use of certain medications. There has been an increase in research and evidence aimed at identifying etiology, understanding epidemiology, improving clinical diagnosis, and developing both pharmacological and non-pharmacological treatments. This review provides a comprehensive overview of the current state of knowledge in the field of interstitial lung diseases.
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Affiliation(s)
- Malik A. Althobiani
- Royal Free Campus, UCL Respiratory, University College London, London, United Kingdom
- Department of Respiratory Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Anne-Marie Russell
- School of Health and Care Professions, University of Exeter, Exeter, United Kingdom
- School of Medicine and Health, University of Birmingham, Birmingham, United Kingdom
| | - Joseph Jacob
- UCL Respiratory, University College London, London, United Kingdom
- Satsuma Lab, Centre for Medical Image Computing, University College London Respiratory, University College London, London, United Kingdom
| | - Yatharth Ranjan
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Amos A. Folarin
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust, King's College London, London, United Kingdom
- Institute of Health Informatics, University College London, London, United Kingdom
- NIHR Biomedical Research Centre at University College London Hospitals, NHS Foundation Trust, London, United Kingdom
| | - John R. Hurst
- Royal Free Campus, UCL Respiratory, University College London, London, United Kingdom
| | - Joanna C. Porter
- UCL Respiratory, University College London, London, United Kingdom
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Alamer AA, Ward C, Forrest I, Drinnan M, Patterson J. Eating and drinking experience in patients with idiopathic pulmonary fibrosis: a qualitative study. BMJ Open 2024; 14:e078608. [PMID: 38582536 PMCID: PMC11002418 DOI: 10.1136/bmjopen-2023-078608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 03/11/2024] [Indexed: 04/08/2024] Open
Abstract
OBJECTIVE To explore eating and drinking experiences of patients with idiopathic pulmonary fibrosis (IPF), the impact of any changes associated with their diagnosis and any coping mechanisms developed by patients. SETTING Pulmonary fibrosis support groups around the UK and the regional Interstitial Lung Diseases Clinic, Newcastle upon Tyne. PARTICIPANTS 15 patients with IPF (9 men, 6 women), median age 71 years, range (54-92) years, were interviewed. Inclusion criteria included competent adults (over the age of 18 years) with a secure diagnosis of IPF as defined by international consensus guidelines. Patients were required to have sufficient English language competence to consent and participate in an interview. Exclusion criteria were a history of other lung diseases, a history of pre-existing swallowing problem of other causes that may be associated with dysphagia and individuals with significant communication or other memory difficulties that render them unable to participate in an interview. DESIGN A qualitative study based on semistructured interviews used purpose sampling conducted between February 2021 and November 2021. Interviews were conducted via video videoconferencing call platform or telephone call, transcribed and data coded and analysed using a reflexive thematic analysis. RESULTS Three main themes were identified, along with several subthemes, which were: (1) Eating, as such, is no longer a pleasure. This theme mainly focused on the physical and sensory changes associated with eating and drinking and their effects and the subsequent emotional and social impact of these changes; (2) It is something that happens naturally and just try and get on with it. This theme centred on the self-determined strategies employed to manage changes to eating and drinking; and (3) What is normal. This theme focused on patients seeking information to better understand the changes in their eating and drinking and the patients' beliefs about what has changed their eating and drinking. CONCLUSIONS To our knowledge, this is the first study to report on IPF patients' lived experience of eating and drinking changes associated with their diagnosis. Findings demonstrate that some patients have substantial struggles and challenges with eating and drinking, affecting them physically, emotionally and socially. There is a need to provide better patient information for this area and further study.
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Affiliation(s)
- Amal Ahmad Alamer
- Respiratory Care, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Christopher Ward
- Translational and Clinical Research Institute, School of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Ian Forrest
- Royal Victoria Infirmary, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | | | - Joanne Patterson
- School of Health Sciences, University of Liverpool, Liverpool, UK
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Bramhill C, Langan D, Mulryan H, Eustace-Cook J, Russell AM, Brady AM. A scoping review of the unmet needs of patients diagnosed with idiopathic pulmonary fibrosis (IPF). PLoS One 2024; 19:e0297832. [PMID: 38354191 PMCID: PMC10866483 DOI: 10.1371/journal.pone.0297832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 01/11/2024] [Indexed: 02/16/2024] Open
Abstract
AIMS Patients diagnosed with idiopathic pulmonary fibrosis (IPF) have a high symptom burden and numerous needs that remain largely unaddressed despite advances in available treatment options. There is a need to comprehensively identify patients' needs and create opportunities to address them. This scoping review aimed to synthesise the available evidence and identify gaps in the literature regarding the unmet needs of patients diagnosed with IPF. METHODS The protocol for the review was registered with Open Science Framework (DOI 10.17605/OSF.IO/SY4KM). A systematic search was performed in March 2022, in CINAHL, MEDLINE, Embase, PsychInfo, Web of Science Core Collection and ASSIA Applied Social Science Index. A comprehensive review of grey literature was also completed. Inclusion criteria included patients diagnosed with IPF and date range 2011-2022. A range of review types were included. Data was extracted using a data extraction form. Data was analysed using descriptive and thematic analysis. A total of 884 citations were reviewed. Ethical approval was not required. RESULTS 52 citations were selected for final inclusion. Five themes were identified: 1.) psychological impact of an IPF diagnosis. 2.) adequate information and education: at the right time and in the right way. 3.) high symptom burden support needs. 4.) referral to palliative care and advance care planning (ACP). 5.) health service provision-a systems approach. CONCLUSION This review highlights the myriad of needs patients with IPF have and highlights the urgent need for a systems approach to care, underpinned by an appropriately resourced multi-disciplinary team. The range of needs experienced by patients with IPF are broad and varied and require a holistic approach to care including targeted research, coupled with the continuing development of patient-focused services and establishment of clinical care programmes.
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Affiliation(s)
- Carita Bramhill
- Trinity Centre for Practice & Innovation, School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Donna Langan
- Respiratory Department, Galway University Hospital, Galway, Ireland
| | - Helen Mulryan
- Respiratory Department, Galway University Hospital, Galway, Ireland
| | | | - Anne-Marie Russell
- Institute of Clinical Sciences, College of Medical and Dental Sciences (MDS) University of Birmingham, Birmingham, United Kingdom
| | - Anne-Marie Brady
- Trinity Centre for Practice & Innovation, School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
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Bramhill C, Langan D, Mulryan H, Eustace-Cook J, Russell AM, Brady AM. Exploration of the unmet needs of patients diagnosed with idiopathic pulmonary fibrosis: a scoping review protocol. BMJ Open 2023; 13:e070513. [PMID: 37130693 PMCID: PMC10163457 DOI: 10.1136/bmjopen-2022-070513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/04/2023] Open
Abstract
INTRODUCTION Interstitial lung diseases consist of a range of lung disorders, the most prevalent being idiopathic pulmonary fibrosis (IPF). IPF is a chronic, progressive disease, resulting in loss of lung function and potentially significant impacts on quality of life. There is an increasing need to address unmet needs in this population as there is evidence that unmet needs may impact quality of life and health outcomes. The key objective of this scoping review is to define the unmet needs of patients living with a diagnosis of IPF and to identify gaps in the literature relating to unmet needs. Findings will inform the development of services and the introduction of patient-centred clinical care guidelines for IPF. METHODS AND ANALYSIS This scoping review is guided by the methodological framework for conducting scoping reviews developed by the Joanna Briggs Institute. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist is used for guidance. The following databases will be searched: CINAHL, MEDLINE, PsycINFO, Web of Science, Embase and ASSIA and include a comprehensive grey literature search. The review will report on adult patients >18 with a diagnosis of IPF or pulmonary fibrosis and be limited to publications from 2011 onwards, with no language restrictions applied. Two independent reviewers will screen articles in consecutive stages for relevance against the inclusion and exclusion criteria. Data will be extracted using a predefined data extraction form and analysed using descriptive and thematic analysis. Findings will be presented in tabular form, coupled with a narrative summary of the evidence. ETHICS AND DISSEMINATION Ethics approval is not required for this scoping review protocol. We will disseminate our findings using traditional approaches that include open access peer-reviewed publications and scientific presentations.
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Affiliation(s)
- Carita Bramhill
- Trinity Centre for Practice and Healthcare Innovation, School of Nursing & Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Donna Langan
- Department of Respiratory, Galway University Hospital, Galway, Ireland
| | - Helen Mulryan
- Department of Respiratory, Galway University Hospital, Galway, Ireland
| | | | | | - Anne-Marie Brady
- Trinity Centre for Practice and Healthcare Innovation, School of Nursing & Midwifery, Trinity College Dublin, Dublin, Ireland
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Mann JM, Holland AE, Goh NS, Khor YH. Understanding patient experience of chronic cough in interstitial lung disease. ERJ Open Res 2023; 9:00039-2023. [PMID: 37228271 PMCID: PMC10204822 DOI: 10.1183/23120541.00039-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 04/12/2023] [Indexed: 05/27/2023] Open
Abstract
Rationale Chronic cough is a common symptom in patients with interstitial lung disease (ILD), negatively contributing to health-related quality of life. Despite this, there is limited information and understanding on the experience of this group of patients with chronic cough. This study aimed to explore the symptom experiences for chronic cough in patients with ILD to identify its characteristics and impacts. Methods A qualitative study using semi-structured telephone interviews was undertaken in 16 adults with a diagnosis of ILD of any type and severity. Patients were recruited from a quaternary referral centre in Melbourne, Australia. Interviews were transcribed verbatim and coded by two researchers using thematic analysis. Results Patients (age range: 39-87 years, forced vital capacity: 53-107% predicted and diffusing capacity of the lung for carbon monoxide: 28-89% predicted) experienced a spectrum of cough severity and characteristics, including both dry and productive coughs. The impact of chronic cough included physical symptoms, social and emotional difficulties, and interference with work and vocational participation. Management strategies used to relieve cough included mucolytics, opiates, throat lozenges, warm drinks, pacing, breath control, relaxation exercises, movement, continuous positive airways pressure and supplemental oxygen. Patients expressed a need for further information and education regarding chronic cough, including its triggers and management. Conclusions This study highlights the experience and significance of chronic cough in patients with ILD. The nature and severity of chronic cough in patients with ILD appears to be more heterogeneous than previously described, with physical, social and emotional impacts contributing to symptom burden.
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Affiliation(s)
- Jennifer M.V. Mann
- Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Australia
- The Institute for Breathing and Sleep, Melbourne, Australia
- Department of Medicine, The University of Melbourne, Melbourne, Australia
| | - Anne E. Holland
- Department of Allergy, Immunology and Respiratory Medicine, Alfred Health, Melbourne, Australia
- Central Clinical School, Monash University, Melbourne, Australia
| | - Nicole S.L. Goh
- Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Australia
- The Institute for Breathing and Sleep, Melbourne, Australia
- Department of Medicine, The University of Melbourne, Melbourne, Australia
| | - Yet H. Khor
- Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Australia
- The Institute for Breathing and Sleep, Melbourne, Australia
- Department of Medicine, The University of Melbourne, Melbourne, Australia
- Central Clinical School, Monash University, Melbourne, Australia
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Pihlaja H, Rantala H, Leivo-Korpela S, Lehtimäki L, Lehto JT, Piili RP. Specialist Palliative Care Consultation for Patients with Nonmalignant Pulmonary Diseases: A Retrospective Study. Palliat Med Rep 2023; 4:108-115. [PMID: 37095866 PMCID: PMC10122226 DOI: 10.1089/pmr.2022.0068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2023] [Indexed: 04/26/2023] Open
Abstract
Background Few patients with chronic nonmalignant pulmonary diseases receive specialist palliative care consultation, despite their high symptom burden in end of life. Objectives To study palliative care decision making, survival, and hospital resource usage in patients with nonmalignant pulmonary diseases with or without a specialist palliative care consultation. Methods A retrospective chart review of all patients with a chronic nonmalignant pulmonary disease and a palliative care decision (palliative goal of therapy), who were treated in Tampere University Hospital, Finland, between January 1, 2018 and December 31, 2020. Results A total of 107 patients were included in the study, 62 (58%) had chronic obstructive pulmonary disease (COPD), and 43 (40%) interstitial lung disease (ILD). Median survival after palliative care decision was shorter in patients with ILD than in patients with COPD (59 vs. 213 days, p = 0.004). Involvement of a palliative care specialist in the decision making was not associated with the survival. Patients with COPD who received palliative care consultation visited less often emergency room (73% vs. 100%, p = 0.019) and spent fewer days in the hospital (7 vs. 18 days, p = 0.007) during the last year of life. When a palliative care specialist attended the decision making, the presence and opinions of the patients were recorded more often, and the patients were more frequently referred to a palliative care pathway. Conclusions Specialist palliative care consultation seems to enable better end-of-life care and supports shared decision making for patients with nonmalignant pulmonary diseases. Therefore, palliative care consultations should be utilized in nonmalignant pulmonary diseases preferably before the last days of life.
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Affiliation(s)
- Hanna Pihlaja
- TUNI Palliative Care Research Group, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Palliative Care Centre, Department of Oncology, Tampere University Hospital, Tampere, Finland
- Address correspondence to: Hanna Pihlaja, MD, TUNI Palliative Care Research Group, Faculty of Medicine and Health Technology, Tampere University, Kauppi Campus, Arvo Building, Arvo Ylpön katu 34, Tampere 33520, Finland.
| | - Heidi Rantala
- TUNI Palliative Care Research Group, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Respiratory Medicine, Tampere University Hospital, Tampere, Finland
| | - Sirpa Leivo-Korpela
- TUNI Palliative Care Research Group, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Palliative Care Centre and Department of Geriatrics, Tampere University Hospital, Tampere, Finland
| | - Lauri Lehtimäki
- TUNI Palliative Care Research Group, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Allergy Centre, Tampere University Hospital, Tampere, Finland
| | - Juho T. Lehto
- TUNI Palliative Care Research Group, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Palliative Care Centre, Department of Oncology, Tampere University Hospital, Tampere, Finland
| | - Reetta P. Piili
- TUNI Palliative Care Research Group, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Palliative Care Centre, Department of Oncology, Tampere University Hospital, Tampere, Finland
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Cottin V, Bonniaud P, Cadranel J, Crestani B, Jouneau S, Marchand-Adam S, Nunes H, Wémeau-Stervinou L, Bergot E, Blanchard E, Borie R, Bourdin A, Chenivesse C, Clément A, Gomez E, Gondouin A, Hirschi S, Lebargy F, Marquette CH, Montani D, Prévot G, Quetant S, Reynaud-Gaubert M, Salaun M, Sanchez O, Trumbic B, Berkani K, Brillet PY, Campana M, Chalabreysse L, Chatté G, Debieuvre D, Ferretti G, Fourrier JM, Just N, Kambouchner M, Legrand B, Le Guillou F, Lhuillier JP, Mehdaoui A, Naccache JM, Paganon C, Rémy-Jardin M, Si-Mohamed S, Terrioux P. [French practical guidelines for the diagnosis and management of IPF - 2021 update, full version]. Rev Mal Respir 2022; 39:e35-e106. [PMID: 35752506 DOI: 10.1016/j.rmr.2022.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Since the previous French guidelines were published in 2017, substantial additional knowledge about idiopathic pulmonary fibrosis has accumulated. METHODS Under the auspices of the French-speaking Learned Society of Pulmonology and at the initiative of the coordinating reference center, practical guidelines for treatment of rare pulmonary diseases have been established. They were elaborated by groups of writers, reviewers and coordinators with the help of the OrphaLung network, as well as pulmonologists with varying practice modalities, radiologists, pathologists, a general practitioner, a head nurse, and a patients' association. The method was developed according to rules entitled "Good clinical practice" in the overall framework of the "Guidelines for clinical practice" of the official French health authority (HAS), taking into account the results of an online vote using a Likert scale. RESULTS After analysis of the literature, 54 recommendations were formulated, improved, and validated by the working groups. The recommendations covered a wide-ranging aspects of the disease and its treatment: epidemiology, diagnostic modalities, quality criteria and interpretation of chest CT, indication and modalities of lung biopsy, etiologic workup, approach to familial disease entailing indications and modalities of genetic testing, evaluation of possible functional impairments and prognosis, indications for and use of antifibrotic therapy, lung transplantation, symptom management, comorbidities and complications, treatment of chronic respiratory failure, diagnosis and management of acute exacerbations of fibrosis. CONCLUSION These evidence-based guidelines are aimed at guiding the diagnosis and the management in clinical practice of idiopathic pulmonary fibrosis.
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Affiliation(s)
- V Cottin
- Centre national coordonnateur de référence des maladies pulmonaires rares, service de pneumologie, hôpital Louis-Pradel, Hospices Civils de Lyon (HCL), Lyon, France; UMR 754, IVPC, INRAE, Université de Lyon, Université Claude-Bernard Lyon 1, Lyon, France; Membre d'OrphaLung, RespiFil, Radico-ILD2, et ERN-LUNG, Lyon, France.
| | - P Bonniaud
- Centre de référence constitutif des maladies pulmonaires rares, service de pneumologie et soins intensifs respiratoires, centre hospitalo-universitaire de Bourgogne et faculté de médecine et pharmacie, université de Bourgogne-Franche Comté, Dijon ; Inserm U123-1, Dijon, France
| | - J Cadranel
- Centre de référence constitutif des maladies pulmonaires rares, service de pneumologie et oncologie thoracique, Assistance publique-Hôpitaux de Paris (AP-HP), hôpital Tenon, Paris ; Sorbonne université GRC 04 Theranoscan, Paris, France
| | - B Crestani
- Centre de référence constitutif des maladies pulmonaires rares, service de pneumologie A, AP-HP, hôpital Bichat, Paris, France
| | - S Jouneau
- Centre de compétence pour les maladies pulmonaires rares de l'adulte, service de pneumologie, hôpital Pontchaillou, Rennes ; IRSET UMR1085, université de Rennes 1, Rennes, France
| | - S Marchand-Adam
- Centre de compétence pour les maladies pulmonaires rares de l'adulte, hôpital Bretonneau, service de pneumologie, CHRU, Tours, France
| | - H Nunes
- Centre de référence constitutif des maladies pulmonaires rares, service de pneumologie, AP-HP, hôpital Avicenne, Bobigny ; université Sorbonne Paris Nord, Bobigny, France
| | - L Wémeau-Stervinou
- Centre de référence constitutif des maladies pulmonaires rares, Institut Cœur-Poumon, service de pneumologie et immuno-allergologie, CHRU de Lille, Lille, France
| | - E Bergot
- Centre de compétence pour les maladies pulmonaires rares de l'adulte, service de pneumologie et oncologie thoracique, hôpital Côte de Nacre, CHU de Caen, Caen, France
| | - E Blanchard
- Centre de compétence pour les maladies pulmonaires rares de l'adulte, service de pneumologie, hôpital Haut Levêque, CHU de Bordeaux, Pessac, France
| | - R Borie
- Centre de référence constitutif des maladies pulmonaires rares, service de pneumologie A, AP-HP, hôpital Bichat, Paris, France
| | - A Bourdin
- Centre de compétence pour les maladies pulmonaires rares de l'adulte, département de pneumologie et addictologie, hôpital Arnaud-de-Villeneuve, CHU de Montpellier, Montpellier ; Inserm U1046, CNRS UMR 921, Montpellier, France
| | - C Chenivesse
- Centre de référence constitutif des maladies pulmonaires rares, service de pneumologie et d'immuno-allergologie, hôpital Albert Calmette ; CHRU de Lille, Lille ; centre d'infection et d'immunité de Lille U1019 - UMR 9017, Université de Lille, CHU Lille, CNRS, Inserm, Institut Pasteur de Lille, Lille, France
| | - A Clément
- Centre de ressources et de compétence de la mucoviscidose pédiatrique, centre de référence des maladies respiratoires rares (RespiRare), service de pneumologie pédiatrique, hôpital d'enfants Armand-Trousseau, CHU Paris Est, Paris ; Sorbonne université, Paris, France
| | - E Gomez
- Centre de compétence pour les maladies pulmonaires rares, département de pneumologie, hôpitaux de Brabois, CHRU de Nancy, Vandoeuvre-les Nancy, France
| | - A Gondouin
- Centre de compétence pour les maladies pulmonaires rares, service de pneumologie, CHU Jean-Minjoz, Besançon, France
| | - S Hirschi
- Centre de compétence pour les maladies pulmonaires rares, service de pneumologie, Nouvel Hôpital civil, Strasbourg, France
| | - F Lebargy
- Centre de compétence pour les maladies pulmonaires rares, service de pneumologie, CHU Maison Blanche, Reims, France
| | - C-H Marquette
- Centre de compétence pour les maladies pulmonaires rares, FHU OncoAge, département de pneumologie et oncologie thoracique, hôpital Pasteur, CHU de Nice, Nice cedex 1 ; Université Côte d'Azur, CNRS, Inserm, Institute of Research on Cancer and Aging (IRCAN), Nice, France
| | - D Montani
- Centre de compétence pour les maladies pulmonaires rares, centre national coordonnateur de référence de l'hypertension pulmonaire, service de pneumologie et soins intensifs pneumologiques, AP-HP, DMU 5 Thorinno, Inserm UMR S999, CHU Paris-Sud, hôpital de Bicêtre, Le Kremlin-Bicêtre ; Université Paris-Saclay, Faculté de médecine, Le Kremlin-Bicêtre, France
| | - G Prévot
- Centre de compétence pour les maladies pulmonaires rares, service de pneumologie, CHU Larrey, Toulouse, France
| | - S Quetant
- Centre de compétence pour les maladies pulmonaires rares, service de pneumologie et physiologie, CHU Grenoble Alpes, Grenoble, France
| | - M Reynaud-Gaubert
- Centre de compétence pour les maladies pulmonaires rares, service de pneumologie, AP-HM, CHU Nord, Marseille ; Aix Marseille Université, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille, France
| | - M Salaun
- Centre de compétence pour les maladies pulmonaires rares, service de pneumologie, oncologie thoracique et soins intensifs respiratoires & CIC 1404, hôpital Charles Nicole, CHU de Rouen, Rouen ; IRIB, laboratoire QuantiIF-LITIS, EA 4108, université de Rouen, Rouen, France
| | - O Sanchez
- Centre de compétence pour les maladies pulmonaires rares, service de pneumologie et soins intensifs, hôpital européen Georges-Pompidou, AP-HP, Paris, France
| | | | - K Berkani
- Clinique Pierre de Soleil, Vetraz Monthoux, France
| | - P-Y Brillet
- Université Paris 13, UPRES EA 2363, Bobigny ; service de radiologie, AP-HP, hôpital Avicenne, Bobigny, France
| | - M Campana
- Service de pneumologie et oncologie thoracique, CHR Orléans, Orléans, France
| | - L Chalabreysse
- Service d'anatomie-pathologique, groupement hospitalier est, HCL, Bron, France
| | - G Chatté
- Cabinet de pneumologie et infirmerie protestante, Caluire, France
| | - D Debieuvre
- Service de pneumologie, GHRMSA, hôpital Emile-Muller, Mulhouse, France
| | - G Ferretti
- Université Grenoble Alpes, Grenoble ; service de radiologie diagnostique et interventionnelle, CHU Grenoble Alpes, Grenoble, France
| | - J-M Fourrier
- Association Pierre-Enjalran Fibrose Pulmonaire Idiopathique (APEFPI), Meyzieu, France
| | - N Just
- Service de pneumologie, CH Victor-Provo, Roubaix, France
| | - M Kambouchner
- Service de pathologie, AP-HP, hôpital Avicenne, Bobigny, France
| | - B Legrand
- Cabinet médical de la Bourgogne, Tourcoing ; Université de Lille, CHU Lille, ULR 2694 METRICS, CERIM, Lille, France
| | - F Le Guillou
- Cabinet de pneumologie, pôle santé de l'Esquirol, Le Pradet, France
| | - J-P Lhuillier
- Cabinet de pneumologie, La Varenne Saint-Hilaire, France
| | - A Mehdaoui
- Service de pneumologie et oncologie thoracique, CH Eure-Seine, Évreux, France
| | - J-M Naccache
- Service de pneumologie, allergologie et oncologie thoracique, GH Paris Saint-Joseph, Paris, France
| | - C Paganon
- Centre national coordonnateur de référence des maladies pulmonaires rares, service de pneumologie, hôpital Louis-Pradel, Hospices Civils de Lyon (HCL), Lyon, France
| | - M Rémy-Jardin
- Institut Cœur-Poumon, service de radiologie et d'imagerie thoracique, CHRU de Lille, Lille, France
| | - S Si-Mohamed
- Département d'imagerie cardiovasculaire et thoracique, hôpital Louis-Pradel, HCL, Bron ; Université de Lyon, INSA-Lyon, Université Claude-Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, Villeurbanne, France
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9
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Palmer E, Kavanagh E, Visram S, Bourke AM, Forrest I, Exley C. When should palliative care be introduced for people with progressive fibrotic interstitial lung disease? A meta-ethnography of the experiences of people with end-stage interstitial lung disease and their family carers. Palliat Med 2022; 36:1171-1185. [PMID: 35694777 PMCID: PMC9446428 DOI: 10.1177/02692163221101753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
BACKGROUND Little is currently known about the perspectives of people with interstitial lung disease and their carers in relation to the timing of palliative care conversations. AIM To establish patients' and carers' views on palliative care in interstitial lung disease and identify an optimum time to introduce the concept of palliative care. DESIGN Meta-ethnography of qualitative evidence. The review protocol was prospectively registered with PROSPERO (CRD42021243179). DATA SOURCES Five electronic healthcare databases were searched (Medline, Embase, CINAHL, Scopus and Web of Science) from 1st January 1996 to 31st March 2022. Studies were included that used qualitative methodology and included patients' or carers' perspectives on living with end-stage disease or palliative care. Quality was assessed using the Critical Appraisal Skills Programme checklist. RESULTS About 1779 articles were identified by initial searches. Twelve met the inclusion criteria, providing evidence from 266 individuals across five countries. Three stages were identified in the illness journey of a person with interstitial lung disease: (1) Information seeking, (2) Grief and adjustment, (3) Fear of the future. Palliative care involvement was believed to be most appropriate in the latter two stages and should be prompted by changes in patients' health such as respiratory infections, onset of new symptoms, hospital admission, decline in physical function and initiation of oxygen. CONCLUSIONS Patients and carers prefer referral to palliative care services to be prompted by changes in health status. Future research should focus on supporting timely recognition of changes in patients' health status and how to respond in a community setting.
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Affiliation(s)
- Evelyn Palmer
- Royal Victoria Infirmary, Newcastle upon Tyne, UK.,Marie Curie Hospice Newcastle, Newcastle upon Tyne, UK.,Population Health Sciences, Newcastle University, Newcastle upon Tyne, UK
| | | | - Shelina Visram
- Population Health Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Anne-Marie Bourke
- Royal Victoria Infirmary, Newcastle upon Tyne, UK.,Marie Curie Hospice Newcastle, Newcastle upon Tyne, UK
| | - Ian Forrest
- Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Catherine Exley
- Population Health Sciences, Newcastle University, Newcastle upon Tyne, UK
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10
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French practical guidelines for the diagnosis and management of idiopathic pulmonary fibrosis - 2021 update. Full-length version. Respir Med Res 2022; 83:100948. [PMID: 36630775 DOI: 10.1016/j.resmer.2022.100948] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Since the latest 2017 French guidelines, knowledge about idiopathic pulmonary fibrosis has evolved considerably. METHODS Practical guidelines were drafted on the initiative of the Coordinating Reference Center for Rare Pulmonary Diseases, led by the French Language Pulmonology Society (SPLF), by a coordinating group, a writing group, and a review group, with the involvement of the entire OrphaLung network, pulmonologists practicing in various settings, radiologists, pathologists, a general practitioner, a health manager, and a patient association. The method followed the "Clinical Practice Guidelines" process of the French National Authority for Health (HAS), including an online vote using a Likert scale. RESULTS After a literature review, 54 guidelines were formulated, improved, and then validated by the working groups. These guidelines addressed multiple aspects of the disease: epidemiology, diagnostic procedures, quality criteria and interpretation of chest CT scans, lung biopsy indication and procedures, etiological workup, methods and indications for family screening and genetic testing, assessment of the functional impairment and prognosis, indication and use of antifibrotic agents, lung transplantation, management of symptoms, comorbidities and complications, treatment of chronic respiratory failure, diagnosis and management of acute exacerbations of fibrosis. CONCLUSION These evidence-based guidelines are intended to guide the diagnosis and practical management of idiopathic pulmonary fibrosis.
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11
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Gersten RA, Seth B, Arellano L, Shore J, O'Hare L, Patel N, Safdar Z, Krishna R, Mageto Y, Cochran D, Lindell K, Danoff SK, Patel D, Whelan TP, Adams T, Reichuber J, Russell T, Bachert H, Luckhardt TR, Morrison L, Dematte JE, Gripaldo RE, Henderson M, Thavarajah K, Tomic R. Provider Perspectives on and Access to Palliative Care for Patients With Interstitial Lung Disease. Chest 2022; 162:375-384. [PMID: 35305969 PMCID: PMC9633804 DOI: 10.1016/j.chest.2022.03.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 02/13/2022] [Accepted: 03/06/2022] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND Interstitial lung disease (ILD) results in profound symptom burden and carries high mortality. Palliative care (PC) is dedicated to improving quality of life in patients with serious illness. Early PC provision improves rates of advance care planning and symptom management in patients with ILD. RESEARCH QUESTION What are the current perspectives on PC among ILD providers, and what are the barriers to PC in ILD specialty centers? STUDY DESIGN AND METHODS A 24-question electronic survey was disseminated to providers at the 68 Pulmonary Fibrosis Foundation Care Centers across the United States from October 2020 to December 2020. RESULTS The survey was completed by 128 participants representing all 68 Pulmonary Fibrosis Foundation Care Center Network sites. Most respondents were physicians. Most providers exhibit good knowledge of, feel comfortable assessing a patient's readiness for, and agree with the need for PC for patients with ILD. Providers are most likely to refer to PC at objective disease and/or symptomatic progression rather than at initial diagnosis. In comparison with providers who report referring their patients to PC, providers who report rare referral are more likely to cite lack local PC availability (P < .01) and less likely to feel comfortable discussing prognosis/disease trajectory (P = .03) or feel it is important to address advance directives in ILD clinic (P = .02). There is a lack of standardized measures used to assess specific symptoms, overall symptom burden, or health-related quality of life across institutions. Discordance exists between self-reported and actual access to local inpatient and outpatient PC services. INTERPRETATION Most ILD providers use PC and are comfortable discussing PC. Barriers to PC identified in this survey include the following: perceived lack of local access to PC, lack of systematic tools to assess symptom burden, lack of established optimal timing of PC referral, and unclear need for specialized PC delivery.
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12
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Singer J, Roberts KE, McLean E, Fadalla C, Coats T, Rogers M, Wilson MK, Godwin K, Lichtenthal WG. An examination and proposed definitions of family members' grief prior to the death of individuals with a life-limiting illness: A systematic review. Palliat Med 2022; 36:581-608. [PMID: 35196915 PMCID: PMC10098140 DOI: 10.1177/02692163221074540] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Research has extensively examined family members' grief prior to the death of an individual with a life-limiting illness but several inconsistencies in its conceptualization of related constructs, yet significant conceptualization issues exist. AIM This study aimed to identify and characterize studies published on family members grief before the death of an individual with a life-limiting illness, and propose definitions based on past studies in order to initiate conceptual clarity. DESIGN A mixed-method systematic review utilized six databases and was last conducted July 10, 2021. The search strategy was developed using Medical Subject Headings. This study was prospectively registered on PROSPERO (CRD42020166254). RESULTS One hundred thirty-four full-text articles met inclusion criteria. This review revealed across studies a wide variation in terminology, conceptualization, and characterization of grief before the death. More than 18 terms and 30 definitions have been used. In many cases, the same term (e.g. anticipatory grief) was defined differently across studies. CONCLUSIONS We found grief occurring before the death of a person with a life-limiting illness, which we termed pre-death grief, is comprised of two distinct constructs: anticipatory grief and illness-related grief. Anticipatory grief is future-oriented and is characterized by separation distress and worry about a future without the person with the life-limiting illness being physically present. Illness-related grief is present-oriented and is characterized by grief over current and ongoing losses experienced during the illness trajectory. These definitions provide the field with uniform constructs to advance the study of grief before the death of an individual with a life-limiting illness.
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Affiliation(s)
- Jonathan Singer
- Department of Psychological Science, Texas Tech University, Lubbock, TX, USA
| | - Kailey E Roberts
- Ferkauf Graduate School of Psychology, Yeshiva University, New York, NY, USA
| | - Elisabeth McLean
- Department of Psychological Science, Texas Tech University, Lubbock, TX, USA
| | - Carol Fadalla
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Taylor Coats
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Madeline Rogers
- Center for Research on End-of-Life Care, Weill Cornell Medicine, New York, NY, USA
| | | | - Kendra Godwin
- Medical Library, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Wendy G Lichtenthal
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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13
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Kašiković Lečić S, Javorac J, Živanović D, Lovrenski A, Tegeltija D, Zvekić Svorcan J, Maksimović J. Management of musculoskeletal pain in patients with idiopathic pulmonary fibrosis: a review. Ups J Med Sci 2022; 127:8739. [PMID: 35910492 PMCID: PMC9287761 DOI: 10.48101/ujms.v127.8739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 06/16/2022] [Accepted: 06/16/2022] [Indexed: 11/18/2022] Open
Abstract
Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive, fibrotic, and fatal interstitial lung disease (ILD) of unknown etiology that primarily affects the elderly. Patients with IPF suffer from a heavy symptom burden and usually have a poor quality of life. Dyspnea and dry cough are predominant symptoms of IPF. Although pain is not considered one of the main symptoms of IPF, it can occur for a variety of reasons, such as hypoxia, coughing, muscle and nerve damage, deconditioning, and steroid use. The prevalence of pain in IPF patients varies greatly, ranging from around 30 to 80%, with the prevalence being estimated mostly among patients in the end-of-life period. It manifests itself in the form of muscle pain, joint discomfort, or back and chest pain. Approaches to the treatment of chronic musculoskeletal pain in patients with IPF include pharmacological and non-pharmacological measures that are also important to optimize the treatment of other symptoms (dyspnea and cough) and the optimal treatment of comorbidities. Given the scarcity of data on this symptom in the literature, this article summarizes what is currently known about the etiology and treatment of musculoskeletal pain in IPF.
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Affiliation(s)
- Svetlana Kašiković Lečić
- Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia
- University of Novi Sad, Faculty of Medicine, Department of Internal Medicine, Novi Sad, Serbia
| | - Jovan Javorac
- Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia
- University of Novi Sad, Faculty of Medicine, Department of Internal Medicine, Novi Sad, Serbia
- College of Vocational Studies for the Education of Preschool Teachers and Sports Trainers, Department of Biomedical Sciences, Subotica, Serbia
| | - Dejan Živanović
- College of Vocational Studies for the Education of Preschool Teachers and Sports Trainers, Department of Biomedical Sciences, Subotica, Serbia
| | - Aleksandra Lovrenski
- Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia
- University of Novi Sad, Faculty of Medicine, Department of Pathology, Novi Sad, Serbia
| | - Dragana Tegeltija
- Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia
- University of Novi Sad, Faculty of Medicine, Department of Pathology, Novi Sad, Serbia
| | - Jelena Zvekić Svorcan
- Special Hospital for Rheumatic Diseases, Novi Sad, Serbia
- University of Novi Sad, Faculty of Medicine, Department of Medical Rehabilitation, Novi Sad, Serbia
| | - Jadranka Maksimović
- Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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14
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Scerri D, Borg Xuereb C, Scerri J. Caring for a parent with pulmonary fibrosis in Malta: The lived experiences of daughters in mid-adulthood. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e195-e203. [PMID: 33978275 DOI: 10.1111/hsc.13426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 04/07/2021] [Accepted: 04/18/2021] [Indexed: 06/12/2023]
Abstract
Idiopathic pulmonary fibrosis is a progressive fibrotic lung disease that is on the rise globally. The disease is associated with significant morbidity and hence poses significant challenges for their informal carers, particularly daughters in mid-adulthood, who struggle with their own personal demands and that of their ill parents. Yet there is a dearth of literature on the experiences of these specific carers. Hence, the purpose of this study is to explore the lived experiences of daughters caring for a parent with pulmonary fibrosis within a community setting. This was explored using a phenomenological qualitative framework that was conducted between January and April 2017. Semi-structured audio-recorded interviews were conducted with six adult daughters who provided care to a parent having pulmonary fibrosis. Purposive sampling was used to recruit study participants. Transcribed data were analysed using Interpretative Phenomenological Analysis. Three main themes were extracted which communicate the essence of the daughters' lived experiences: "Walking on tiptoes", "Flooded by emotions" and "Shifts in family dynamics." Participants described experiencing the toll of being constantly vigilant for symptoms. They also expressed a range of emotions that included guilt, helplessness and worry related to their care experience. However, these emotional struggles were suppressed in order to present an external facade of strength and control. A shift in roles was also described where the daughters became the informal carers/support for both their ill and well parent, albeit in different ways. Caring for a person with pulmonary fibrosis is an emotional and life changing experience and hence, there is the need for individualised interventions that target the unique perceptions of these informal carers.
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Affiliation(s)
| | - Christian Borg Xuereb
- Department of Gerontology and Dementia Studies, Faculty for Social Wellbeing, University of Malta, Msida, Malta
| | - Josianne Scerri
- Department of Mental Health, Faculty of Health Sciences, University of Malta, Msida, Malta
- Faculty of Health, Social Care and Education, Kingston University and St George's, University of London, London, UK
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15
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Curtis BR, Rollman BL, Belnap BH, Jeong K, Yu L, Harinstein ME, Kavalieratos D. Perceptions of Need for Palliative Care in Recently Hospitalized Patients With Systolic Heart Failure. J Pain Symptom Manage 2021; 62:1252-1261. [PMID: 34119619 PMCID: PMC8908441 DOI: 10.1016/j.jpainsymman.2021.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 06/01/2021] [Accepted: 06/03/2021] [Indexed: 11/20/2022]
Abstract
CONTEXT The symptom burden associated with heart failure (HF) remains high despite improvements in therapy and calls for the integration of palliative care into traditional HF care. Little is also known about how patients with HF perceive palliative care and patient-level characteristics associated with the need for palliative care, which could influence the utilization of palliative care in HF management. OBJECTIVES To identify characteristics of HF patients associated with perceived need for palliative care. METHODS We analyzed data from the Hopeful Heart Trial, which studied the efficacy of a collaborative care intervention for treating both systolic HF and depression. Palliative care preferences were collected during routine study follow-up. We assessed the association of perceived need for palliative care during study follow-up and baseline data on sociodemographics, clinical measures, and patient-centered outcomes. We then used descriptive statistics and logistic regression to analyze our data. RESULTS Participants were on average 64 years old, male, and reported severe HF symptoms and poor to below average quality of life (. Most had unfavorable impressions of palliative care, but many still perceived a need for palliative care. Factors associated with perceived need for palliative care included depression, non-white race, more severe HF symptoms, and lower mental & physical health-related quality of life. CONCLUSION HF patients' beliefs about palliative care may affect utilization of palliative care. Specific characteristics can help identify patients with HF who may benefit from palliative care involvement. Education targeted towards patients with selected attributes may help incorporate palliative care into HF management.
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Affiliation(s)
- Brett R Curtis
- School of Medicine, University of Pittsburgh (B.R.C., B.L.R.), Pittsburgh, Pennsylvania
| | - Bruce L Rollman
- School of Medicine, University of Pittsburgh (B.R.C., B.L.R.), Pittsburgh, Pennsylvania; Division of General Medicine, University of Pittsburgh School of Medicine (B.L.R., B.H.B., L.Y.), Pittsburgh, Pennsylvania; University of Pittsburgh Center for Behavioral Health, Media and Technology (B.L.R., B.H.B.), Pittsburgh, Pennsylvania
| | - Bea Herbeck Belnap
- Division of General Medicine, University of Pittsburgh School of Medicine (B.L.R., B.H.B., L.Y.), Pittsburgh, Pennsylvania; University of Pittsburgh Center for Behavioral Health, Media and Technology (B.L.R., B.H.B.), Pittsburgh, Pennsylvania
| | - Kwonho Jeong
- Center for Research on Health Care Data Center, University of Pittsburgh (K.J.), Pittsburgh, Pennsylvania
| | - Lan Yu
- Division of General Medicine, University of Pittsburgh School of Medicine (B.L.R., B.H.B., L.Y.), Pittsburgh, Pennsylvania
| | - Matthew E Harinstein
- Division of Cardiology, Heart and Vascular Institute, University of Pittsburgh Medical Center (M.E.H.), Pittsburgh, Pennsylvania
| | - Dio Kavalieratos
- Division of Palliative Medicine, Department of Family and Preventive Medicine, Emory University (D.K.), Atlanta, Georgia; Department of Epidemiology, Rollins School of Public Health, Emory University (D.K.), Atlanta, Georgia.
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16
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Kalluri M, Orenstein S, Archibald N, Pooler C. Advance Care Planning Needs in Idiopathic Pulmonary Fibrosis: A Qualitative Study. Am J Hosp Palliat Care 2021; 39:641-651. [PMID: 34433294 PMCID: PMC9082969 DOI: 10.1177/10499091211041724] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Introduction: Advance care planning is recommended in chronic respiratory diseases, including Idiopathic Pulmonary Fibrosis. In practice, uptake remains low due to patient, physician and system-related factors, including lack of time, training and guidance on timing, components and content of conversations. Our aim was to explore perspectives, experiences and needs to inform a framework. Methods: We conducted a qualitative study in western Canada, using semi-structured interviews and inductive analysis. Patient, caregiver and health care professional participants described advance care planning experiences with Idiopathic Pulmonary Fibrosis. Results: Twenty participants were interviewed individually: 5 patients, 5 caregivers, 5 home care and 5 acute care health care professionals. Two categories, perceptions and recommendations, were identified with themes and subthemes. Participant perceptions were insufficient information and conversations occur late. Recommendations were: have earlier conversations; have open conversations; provide detailed information; and plan for end-of-life. Patients and caregivers wanted honesty, openness and clarity. Professionals related delayed timing to poor end-of-life care and distressing deaths. Home care professionals described comfort with and an engaged approach to advance care planning. Acute care professionals perceived lack of clarity of roles and described personal, patient and caregiver distress. Interpretation: Analysis of diverse experiences provided further understanding of advance care planning in Idiopathic Pulmonary Fibrosis. Advance care planning is desired by patients and caregivers early in their illness experience. Health care professionals described a need to clarify role, scope and responsibility. Practical guidance and training must be available to care providers to improve competency and confidence in these conversations.
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Affiliation(s)
- Meena Kalluri
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.,Alberta Health Services, Edmonton, Alberta, Canada
| | - Sara Orenstein
- Department of Community Health Sciences, University of Calgary, Alberta, Canada
| | - Nathan Archibald
- Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Charlotte Pooler
- Alberta Health Services, Edmonton, Alberta, Canada.,Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
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Chaaban S, McCormick J, Gleason D, McFarlin JM. Palliative Care for the Interstitial Lung Disease Patient a Must and Not Just a Need. Am J Hosp Palliat Care 2021; 39:710-715. [PMID: 34409885 DOI: 10.1177/10499091211040232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Patients with interstitial lung disease (ILD) have many unmet palliative care needs. The majority of patients with chronic ILD have poor access to a specialist in palliative medicine and that is due to several barriers. The mortality for the ILD patient is high and reaches up to 80% if admitted to the ICU with respiratory failure. Palliative care addresses symptoms in diseases where cure is unlikely or impossible. Palliative care consultation also ensures communication among patients, caregivers and providers regarding treatments, prognosis, and end of life planning. Methods: We performed a literature review on palliative care and ILD, accessing articles published since 2002. We found 71 articles related to the topic. We chose 37 that were most relevant and with no redundancy of information to include in this review. Objectives: Summarize the palliative care needs of patients with ILD, discuss the barriers to receiving palliative care, and summarize clinical practice for providing palliative care to this patient population.
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Abstract
Telomere biology disorders (TBD) are a heterogeneous group of diseases arising from germline mutations affecting genes involved in telomere maintenance. Telomeres are DNA-protein structures at chromosome ends that maintain chromosome stability; their length affects cell replicative potential and senescence. A constellation of bone marrow failure, pulmonary fibrosis, liver cirrhosis and premature greying is suggestive, however incomplete penetrance results in highly variable manifestations, with idiopathic pulmonary fibrosis as the most common presentation. Currently, the true extent of TBD burden is unknown as there is no established diagnostic criteria and the disorder often is unrecognised and underdiagnosed. There is no gold standard for measuring telomere length and not all TBD-related mutations have been identified. There is no specific cure and the only treatment is organ transplantation, which has poor outcomes. This review summarises the current literature and discusses gaps in understanding and areas of need in managing TBD.
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Tremayne P, John Clark S. Idiopathic pulmonary fibrosis: a more common condition than you may think. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2021; 30:359-366. [PMID: 33769879 DOI: 10.12968/bjon.2021.30.6.359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive incurable lung disease that affects a significant amount of people in the UK. Many health professionals have a limited understanding of IPF, which can result in a delayed diagnosis and inadequate care for individuals and their families. This article aims to provide an overview of IPF and help to enhance health professionals' understanding of the disease, thus contributing towards improving the care that IPF sufferers receive. This article provides a definition of IPF and explores its pathophysiology. It discusses the causes and risk factors for developing the condition, examines how IPF is diagnosed and details the treatment options available for IPF patients.
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20
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Dean A, Miller B, Hewitt C, Cook M, Nicell C, Spicer K. Caring for carers: exploring the benefits of group support for carers of people with pulmonary fibrosis. PROGRESS IN PALLIATIVE CARE 2021. [DOI: 10.1080/09699260.2020.1826777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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21
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Palliative Care in Interstitial Lung Disease. Respir Med 2021. [DOI: 10.1007/978-3-030-81788-6_11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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22
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Tikellis G, Tong A, Lee JYT, Corte TJ, Hey-Cunningham AJ, Bartlett M, Crawford T, Glaspole I, Price J, Maloney J, Holland AE. Top 10 research priorities for people living with pulmonary fibrosis, their caregivers, healthcare professionals and researchers. Thorax 2020; 76:575-581. [PMID: 33277429 DOI: 10.1136/thoraxjnl-2020-215731] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 09/18/2020] [Accepted: 10/24/2020] [Indexed: 01/30/2023]
Abstract
INTRODUCTION People with pulmonary fibrosis (PF) experience a high symptom burden, reduced quality of life and a shortened lifespan. Treatment options are limited and little is known about what patients, caregivers and healthcare professionals (HCPs)/researchers consider as the most important research priorities. This study aimed to identify the top 10 research priorities for PF across all stakeholders. METHODS Participants included people with PF, caregivers and HCPs/researchers involved with PF. The research priority setting exercise involved three stages: (1) identifying priorities using an open-ended questionnaire and thematic analysis, (2) development of specific research questions at a face-to-face workshop, and (3) online ranking of research questions to identify the top 10 research priorities using nominal group ranking method. RESULTS 196 participants completed stage 1 generating 560 questions and 14 research themes were identified. Stage 2 involved 32 participants and generated 53 indicative questions from which 39 were used for the final ranking. Stage 3 was completed by 270 participants. The top ranked priorities focussed on medications to reverse scarring in the lungs (ranked 1st), improving lung function (ranked 2nd, 6th and 8th), interventions aimed at alleviating symptoms (ranked 5th and 7th), prevention of PF (ranked 3rd and 4th) and the best exercise programme for PF (ranked 10th). There was good consensus among patients/carers and HCPs/researchers on the top 10 priorities, however, causes of acute exacerbations and early diagnosis for improving survival, was ranked higher by HCPs/researchers. CONCLUSION Interventions for preserving lung health and alleviation of symptom burden were top research priorities for PF stakeholders.
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Affiliation(s)
- Gabriella Tikellis
- Department of Allergy, Immunology and Respiratory Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Physiotherapy, La Trobe University, Melbourne, Victoria, Australia
- National Health and Medical Research Council Centre of Research Excellence in Pulmonary Fibrosis, The University of Sydney, Sydney, New South Wales, Australia
| | - Allison Tong
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Joanna Y T Lee
- Department of Allergy, Immunology and Respiratory Medicine, Monash University, Melbourne, Victoria, Australia
| | - Tamera J Corte
- National Health and Medical Research Council Centre of Research Excellence in Pulmonary Fibrosis, The University of Sydney, Sydney, New South Wales, Australia
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Department of Respiratory Medicine, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
- School of Medicine (Central Clinical School), The University of Sydney, Sydney, New South Wales, Australia
| | - Alison J Hey-Cunningham
- National Health and Medical Research Council Centre of Research Excellence in Pulmonary Fibrosis, The University of Sydney, Sydney, New South Wales, Australia
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | | | - Tonia Crawford
- Lung Foundation Australia, Milton, Queensland, Australia
| | - Ian Glaspole
- Department of Allergy, Immunology and Respiratory Medicine, Monash University, Melbourne, Victoria, Australia
- National Health and Medical Research Council Centre of Research Excellence in Pulmonary Fibrosis, The University of Sydney, Sydney, New South Wales, Australia
- Department of Respiratory and Sleep Medicine, Alfred Health, Melbourne, Victoria, Australia
| | - John Price
- Institute of Respiratory Health, Perth, Western Australia, Australia
| | - Jamie Maloney
- Lung Foundation Australia, Milton, Queensland, Australia
| | - Anne E Holland
- Department of Allergy, Immunology and Respiratory Medicine, Monash University, Melbourne, Victoria, Australia
- National Health and Medical Research Council Centre of Research Excellence in Pulmonary Fibrosis, The University of Sydney, Sydney, New South Wales, Australia
- Department of Physiotherapy, Alfred Health, Melbourne, Victoria, Australia
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23
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Managing Dyspnea in Individuals With Idiopathic Pulmonary Fibrosis. J Hosp Palliat Nurs 2020; 22:447-455. [PMID: 32956191 DOI: 10.1097/njh.0000000000000687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Idiopathic pulmonary fibrosis is an unrelenting form of interstitial lung disease associated with a high symptom burden and reported low health-related quality of life. Clinicians have access to limited pharmacologic interventions to help slow the disease progression. Nonpharmacologic interventions are vital in managing dyspnea for these individuals, which is one of the most frequently reported factors that negatively impacts health-related quality of life. Common methods of symptom control include integration of pulmonary rehabilitation, supplemental oxygen, and interdisciplinary support, such as support groups, palliative care, and case conferences, into routine medical care. This literature review describes a multidisciplinary approach for managing dyspnea to improve health-related quality of life for those with idiopathic pulmonary fibrosis. Findings demonstrate that structured pulmonary rehabilitation programs, fast-track case conferences, and supplemental oxygen therapy are most effective. Further research is needed to demonstrate a clinically significant benefit of palliative care visits in the long term for these individuals.
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24
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Oliveira EPD, Medeiros Junior P. Palliative care in pulmonary medicine. ACTA ACUST UNITED AC 2020; 46:e20190280. [PMID: 32638839 PMCID: PMC7572288 DOI: 10.36416/1806-3756/e20190280] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 03/08/2020] [Indexed: 01/07/2023]
Abstract
Palliative care was initially developed for patients with advanced cancer. The concept has evolved and now encompasses any life-threatening chronic disease. Studies carried out to compare end-of-life symptoms have shown that although symptoms such as pain and dyspnea are as prevalent in patients with lung disease as in patients with cancer, the former receive less palliative treatment than do the latter. There is a need to refute the idea that palliative care should be adopted only when curative treatment is no longer possible. Palliative care should be provided in conjunction with curative treatment at the time of diagnosis, by means of a joint decision-making process; that is, the patient and the physician should work together to plan the therapy, seeking to improve quality of life while reducing physical, psychological, and spiritual suffering.
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25
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Kalluri M, Bendstrup E, Lindell KO, Ferrara G. Early referral to palliative care in IPF - pitfalls and opportunities in clinical trials. Respir Res 2020; 21:174. [PMID: 32641138 PMCID: PMC7341662 DOI: 10.1186/s12931-020-01418-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 06/08/2020] [Indexed: 01/11/2023] Open
Affiliation(s)
- Meena Kalluri
- Division of Pulmonary Medicine, Department of Medicine, University of Alberta, Alberta Health Services, Edmonton, Canada.
| | - Elisabeth Bendstrup
- Center for Rare Lung Diseases, Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | - Kathleen O Lindell
- University of Pittsburgh Dorothy P. & Richard P. Simmons Center for Interstitial Lung Disease at UPMC, Pittsburgh, PA, Division of Pulmonary, Allergy, and Critical Care Medicine, Pittsburgh, PA, USA
| | - Giovanni Ferrara
- Division of Pulmonary Medicine, Department of Medicine, University of Alberta, Alberta health Services, Edmonton, AB, Canada
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26
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Rozenberg D, Sitzer N, Porter S, Weiss A, Colman R, Reid WD, Shapera S, Fisher J, Wentlandt K. Idiopathic Pulmonary Fibrosis: A Review of Disease, Pharmacological, and Nonpharmacological Strategies With a Focus on Symptoms, Function, and Health-Related Quality of Life. J Pain Symptom Manage 2020; 59:1362-1378. [PMID: 31887400 DOI: 10.1016/j.jpainsymman.2019.12.364] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 12/16/2019] [Accepted: 12/18/2019] [Indexed: 01/13/2023]
Abstract
Despite several advances in treatment, idiopathic pulmonary fibrosis (IPF) remains a progressive, symptomatic, and terminal disease in patients not suitable for lung transplantation. With disease progression, IPF often leads to a constellation of symptoms, including dyspnea, cough, anxiety, and depression. Palliative care is appropriate to support these patients. However, traditional curriculum in palliative care has often focused on supporting patients with malignant disease, and clinicians are not universally trained to manage patients with progressive nonmalignant diseases such as IPF. Current antifibrotic therapies aim to slow disease progression but are not able to reduce symptoms or improve daily function and health-related quality of life (HRQL). Palliative care in this patient group requires an understanding of the clinical characteristics of IPF, comorbidities, common medications used, and nonpharmacological strategies that can be undertaken to improve daily function and HRQL. This review focuses on IPF management strategies and their effects on symptoms, exercise tolerance, HRQL, and survival. Pharmacological interactions and considerations related to commonly used palliative care medications are also reviewed. This review highlights the needs of patients with IPF and caregivers, psychosocial function, patient-reported assessment tools, and topics related to advance care planning.
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Affiliation(s)
- Dmitry Rozenberg
- Division of Respirology, Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada; Toronto Lung Transplant Program, University Health Network, Toronto, Ontario, Canada; Toronto General Hospital Research Institute, Toronto, Ontario, Canada
| | - Nicole Sitzer
- Division of Respirology, Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Sandra Porter
- Department of Pharmacy, University Health Network, Toronto, Ontario, Canada
| | - Andrea Weiss
- Division of Palliative Care, Department of Supportive Care, University Health Network, Toronto, Ontario, Canada; Division of Palliative Care, Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Rebecca Colman
- Division of Respirology, Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada; Toronto Lung Transplant Program, University Health Network, Toronto, Ontario, Canada
| | - W Darlene Reid
- Interdepartmental Division of Critical Care, Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada; Interdepartmental Division of Critical Care Medicine, Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Shane Shapera
- Division of Respirology, Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada; Toronto Lung Transplant Program, University Health Network, Toronto, Ontario, Canada
| | - Jolene Fisher
- Division of Respirology, Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Kirsten Wentlandt
- Division of Palliative Care, Department of Supportive Care, University Health Network, Toronto, Ontario, Canada; Division of Palliative Care, Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.
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27
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Zou RH, Kass DJ, Gibson KF, Lindell KO. The Role of Palliative Care in Reducing Symptoms and Improving Quality of Life for Patients with Idiopathic Pulmonary Fibrosis: A Review. Pulm Ther 2020; 6:35-46. [PMID: 32048243 PMCID: PMC7229085 DOI: 10.1007/s41030-019-00108-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Indexed: 01/06/2023] Open
Abstract
Idiopathic pulmonary fibrosis (IPF) is a progressive fibrotic lung disease with a median survival of 3-4 years from time of initial diagnosis, similar to the time course of many malignancies. A hallmark of IPF is its unpredictable disease course, ranging from long periods of clinical stability to acute exacerbations with rapid decompensation. As the disease progresses, patients with chronic cough and progressive exertional dyspnea become oxygen dependent. They may experience significant distress due to concurrent depression, anxiety, and fatigue, which often lead to increased symptom burden and decreased quality of life. Despite these complications, palliative care is an underutilized, and often underappreciated, resource before end-of-life care in this population. While there is growing recognition about early palliative care in IPF, current data suggest referral patterns vary widely based on institutional practices. In addition to focusing on symptom management, there is emphasis on supplemental oxygen use, pulmonary rehabilitation, quality of life, and end-of-life care. Importantly, increased use of support groups and national foundation forums have served as venues for further disease education, communication, and advanced care planning outside of the hospital settings. The purpose of this review article is to discuss the clinical features of IPF, the role of palliative care in chronic disease management, current data supporting benefits of palliative care in IPF, its role in symptom management, and practices to help patients and their caregivers achieve their best quality of life.
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Affiliation(s)
- Richard H Zou
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Daniel J Kass
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
- Dorothy P. and Richard P. Simmons Center for Interstitial Lung Disease at UPMC, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kevin F Gibson
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
- Dorothy P. and Richard P. Simmons Center for Interstitial Lung Disease at UPMC, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kathleen O Lindell
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
- Dorothy P. and Richard P. Simmons Center for Interstitial Lung Disease at UPMC, University of Pittsburgh, Pittsburgh, PA, USA.
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28
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Takahashi Y, Akiho M, Aono H, Tsugitomi R, Tamura T. Evaluation of factors associated with the timing of pulmonary rehabilitation during hospitalisation in patients with interstitial lung disease: a two-centre retrospective study. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2020. [DOI: 10.1080/21679169.2019.1578826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Yuta Takahashi
- Department of Rehabilitation, St. Luke’s International Hospital, Tokyo, Japan
| | - Mitsutoshi Akiho
- Department of Rehabilitation, Mitsui Memorial Hospital, Tokyo, Japan
| | - Hiromi Aono
- Department of Pulmonary Medicine, Mitsui Memorial Hospital, Tokyo, Japan
| | - Ryosuke Tsugitomi
- Department of Pulmonary Medicine, St. Luke’s International Hospital, Tokyo, Japan
| | - Tomohide Tamura
- Department of Pulmonary Medicine, St. Luke’s International Hospital, Tokyo, Japan
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29
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Lee JYT, Tikellis G, Corte TJ, Goh NS, Keir GJ, Spencer L, Sandford D, Khor YH, Glaspole I, Price J, Hey-Cunningham AJ, Maloney J, Teoh AKY, Watson AL, Holland AE. The supportive care needs of people living with pulmonary fibrosis and their caregivers: a systematic review. Eur Respir Rev 2020; 29:29/156/190125. [PMID: 32350085 DOI: 10.1183/16000617.0125-2019] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 01/03/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND People with pulmonary fibrosis often experience a protracted time to diagnosis, high symptom burden and limited disease information. This review aimed to identify the supportive care needs reported by people with pulmonary fibrosis and their caregivers. METHODS A systematic review was conducted according to PRISMA guidelines. Studies that investigated the supportive care needs of people with pulmonary fibrosis or their caregivers were included. Supportive care needs were extracted and mapped to eight pre-specified domains using a framework synthesis method. RESULTS A total of 35 studies were included. The most frequently reported needs were in the domain of information/education, including information on supplemental oxygen, disease progression and prognosis, pharmacological treatments and end-of-life planning. Psychosocial/emotional needs were also frequently reported, including management of anxiety, anger, sadness and fear. An additional domain of "access to care" was identified that had not been specified a priori; this included access to peer support, psychological support, specialist centres and support for families of people with pulmonary fibrosis. CONCLUSION People with pulmonary fibrosis report many unmet needs for supportive care, particularly related to insufficient information and lack of psychosocial support. These data can inform the development of comprehensive care models for people with pulmonary fibrosis and their loved ones.
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Affiliation(s)
- Joanna Y T Lee
- Physiotherapy, La Trobe University, Melbourne, Australia.,Allergy, Immunology and Respiratory Medicine, Monash University, Melbourne, Australia.,NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Sydney, Australia
| | - Gabriella Tikellis
- Physiotherapy, La Trobe University, Melbourne, Australia.,Allergy, Immunology and Respiratory Medicine, Monash University, Melbourne, Australia.,NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Sydney, Australia
| | - Tamera J Corte
- NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Sydney, Australia.,The University of Sydney, Sydney, Australia.,Respiratory Medicine, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Nicole S Goh
- Austin Health, Heidelberg, Australia.,Institute for Breathing and Sleep, Melbourne, Australia.,Alfred Health, Melbourne, Australia
| | | | - Lissa Spencer
- The University of Sydney, Sydney, Australia.,Royal Prince Alfred Hospital, Camperdown, Australia
| | - Debra Sandford
- Royal Adelaide Hospital, Adelaide, Australia.,The University of Adelaide, Adelaide, Australia
| | - Yet H Khor
- Austin Health, Heidelberg, Australia.,Institute for Breathing and Sleep, Melbourne, Australia.,Alfred Health, Melbourne, Australia.,University of Melbourne, Melbourne, Australia
| | - Ian Glaspole
- Allergy, Immunology and Respiratory Medicine, Monash University, Melbourne, Australia.,NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Sydney, Australia.,Alfred Health, Melbourne, Australia
| | - John Price
- Institute for Respiratory Health, Nedlands, Australia
| | - Alison J Hey-Cunningham
- NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Sydney, Australia.,The University of Sydney, Sydney, Australia
| | | | - Alan K Y Teoh
- NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Sydney, Australia.,The University of Sydney, Sydney, Australia.,Respiratory Medicine, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Alice L Watson
- Physiotherapy, La Trobe University, Melbourne, Australia
| | - Anne E Holland
- Physiotherapy, La Trobe University, Melbourne, Australia .,Allergy, Immunology and Respiratory Medicine, Monash University, Melbourne, Australia.,NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Sydney, Australia.,Institute for Breathing and Sleep, Melbourne, Australia.,Alfred Health, Melbourne, Australia
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30
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Antin-Ozerkis D, Hinchcliff M. Connective Tissue Disease-Associated Interstitial Lung Disease: Evaluation and Management. Clin Chest Med 2020; 40:617-636. [PMID: 31376896 DOI: 10.1016/j.ccm.2019.05.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Interstitial lung disease is common among patients with connective tissue disease and is an important contributor to morbidity and mortality. Infection and drug toxicity must always be excluded as the cause of radiographic findings. Immunosuppression remains a mainstay of therapy despite few controlled trials supporting its use. When a decision regarding therapy initiation is made, considerations include an assessment of disease severity as well as a determination of the rate of progression. Because patients may have extrathoracic disease activity, a multidisciplinary approach is crucial and should include supportive and nonpharmacologic management strategies.
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Affiliation(s)
- Danielle Antin-Ozerkis
- Section of Pulmonary and Critical Care Medicine, Yale School of Medicine, PO Box 208057, New Haven, CT 06520-8057, USA.
| | - Monique Hinchcliff
- Section of Rheumatology, Allergy and Immunology, Yale School of Medicine, PO Box 208031, New Haven, CT 06520-8031, USA
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31
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Tikellis G, Lee JYT, Corte TJ, Maloney J, Bartlett M, Crawford T, Glaspole IN, Goh N, Herrmann K, Hey-Cunningham AJ, Keir G, Khor YH, Price J, Sandford DG, Spencer L, Teoh A, Walsh J, Webster S, Holland AE. Peer Connect Service for people with pulmonary fibrosis in Australia: Participants' experiences and process evaluation. Respirology 2020; 25:1053-1059. [PMID: 32207225 DOI: 10.1111/resp.13807] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 02/11/2020] [Accepted: 02/26/2020] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND OBJECTIVE People living with pulmonary fibrosis (PF) report unmet needs for information and support. Lung Foundation Australia (LFA) have developed the Peer Connect Service to facilitate telephone support for people with PF across Australia. This project documented the experiences of participants and the resources required to support the service. METHODS Consenting participants took part in semi-structured interviews by telephone. Primary peers (peers who agreed to initiate contact) and secondary peers (eligible patients who sought a peer match) were interviewed. Thematic analysis was undertaken by two independent researchers. Data were collected on the number of matches and contacts required to establish each match. RESULTS Interviews were conducted with 32 participants (16 primary peers, 15 secondary peers and 1 who was both), aged from 53 to 89 years with 56% being male. Major themes included the value of shared experiences, providing mutual support and the importance of shared personal characteristics (e.g. gender and hobbies) in allowing information and emotional support needs to be met. Participants saw face-to-face contact with peers as highly desirable whilst acknowledging the practical difficulties. Primary peers were cognizant that their role was not to provide medical advice but to listen and share experiences. In the 12-month period, 60 peer matches were made, each match requiring a minimum of seven staff contacts. CONCLUSION The Peer Connect Service provides a unique opportunity for people with PF to share experiences and offer mutual support. This telephone matching model may be useful in providing peer support for individuals with rare diseases who are geographically dispersed.
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Affiliation(s)
- Gabriella Tikellis
- Department of Allergy, Immunology and Respiratory Medicine, Monash University, Melbourne, VIC, Australia.,Department of Physiotherapy, La Trobe University, Melbourne, VIC, Australia.,NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Australia
| | - Joanna Y T Lee
- Department of Allergy, Immunology and Respiratory Medicine, Monash University, Melbourne, VIC, Australia
| | - Tamera J Corte
- NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Australia.,The University of Sydney Central Clinical School, Sydney, NSW, Australia.,Department of Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | | | | | | | - Ian N Glaspole
- Department of Allergy, Immunology and Respiratory Medicine, Monash University, Melbourne, VIC, Australia.,NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Australia.,Department of Respiratory and Sleep Medicine, Alfred Health, Melbourne, VIC, Australia
| | - Nicole Goh
- Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, VIC, Australia.,Institute for Breathing and Sleep, Melbourne, VIC, Australia.,Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia
| | | | - Alison J Hey-Cunningham
- NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Australia.,The University of Sydney Central Clinical School, Sydney, NSW, Australia
| | - Greg Keir
- Department of Respiratory Medicine, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Yet H Khor
- NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Australia.,Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, VIC, Australia.,Institute for Breathing and Sleep, Melbourne, VIC, Australia.,Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia
| | - John Price
- Institute for Respiratory Health, Perth, WA, Australia
| | - Debra G Sandford
- NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Australia.,Department of Thoracic Medicine, Royal Adelaide Hospital, Adelaide, SA, Australia.,Discipline of Psychiatry, School of Medicine, The University of Adelaide, Adelaide, SA, Australia
| | - Lissa Spencer
- Physiotherapy Department, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Faculty of Health Sciences, The University of Sydney, Sydney, NSW, Australia
| | - Alan Teoh
- NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Australia.,The University of Sydney Central Clinical School, Sydney, NSW, Australia.,Department of Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Jennifer Walsh
- NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Australia.,The University of Sydney Central Clinical School, Sydney, NSW, Australia
| | - Susanne Webster
- NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Australia.,Department of Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Anne E Holland
- Department of Allergy, Immunology and Respiratory Medicine, Monash University, Melbourne, VIC, Australia.,NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Australia.,Department of Physiotherapy, Alfred Health, Melbourne, VIC, Australia
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32
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Kalluri M, Luppi F, Ferrara G. What Patients With Idiopathic Pulmonary Fibrosis and Caregivers Want: Filling the Gaps With Patient Reported Outcomes and Experience Measures. Am J Med 2020; 133:281-289. [PMID: 31520625 DOI: 10.1016/j.amjmed.2019.08.032] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 08/20/2019] [Accepted: 08/22/2019] [Indexed: 01/11/2023]
Abstract
Idiopathic pulmonary fibrosis is a progressive disease, with a high mortality within the first 3-5 years from diagnosis and a poor quality of life mainly because of the burden of symptoms, such as dyspnea and cough, occurring usually many months before the diagnosis. Although available antifibrotic therapies slow down disease progression, they have no impact on quality of life. Moreover, health care around idiopathic pulmonary fibrosis patients is often "disease-centered" and relies on clinical surrogate outcomes that are poorly related to patients' quality of life and disease experience. Therefore, patients with idiopathic pulmonary fibrosis have several unmet needs in all domains of health that they wish to see recognized and addressed in the context of the treatment of their disease and its complications. In this review, we summarize the care pathway from the patients' perspective, identifying current gaps in care, education, support, and communication among patients with IPF, their caregivers, and care teams during the patient journey. The role of patient-reported outcomes (PROs), PRO measures (PROMs), and patient-reported experience measures (PREMs) in their care is discussed, as well as the need of disease-specific PROs, PROMs, and PREMs.
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Affiliation(s)
- Meena Kalluri
- Division of Pulmonary Medicine, Department of Medicine, University of Alberta and Alberta Health Services, Edmonton, Calgary, Canada
| | - Fabrizio Luppi
- Respiratory Unit, University of Milano Bicocca, S. Gerardo Hospital, ASST Monza, Italy
| | - Giovanni Ferrara
- Division of Pulmonary Medicine, Department of Medicine, University of Alberta and Alberta Health Services, Edmonton, Calgary, Canada.
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33
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Janssen K, Rosielle D, Wang Q, Kim HJ. The impact of palliative care on quality of life, anxiety, and depression in idiopathic pulmonary fibrosis: a randomized controlled pilot study. Respir Res 2020; 21:2. [PMID: 31900187 PMCID: PMC6942318 DOI: 10.1186/s12931-019-1266-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 12/19/2019] [Indexed: 01/11/2023] Open
Abstract
Background Idiopathic pulmonary fibrosis (IPF) is a fatal disease that results in poor quality of life due to progressive respiratory symptoms, anxiety, and depression. Palliative care improves quality of life and survival in other progressive diseases. No randomized controlled trials have investigated the impact of palliative care on quality of life, anxiety, or depression in IPF. Methods We conducted a randomized, controlled, pilot study to assess the feasibility of measuring the effect of a palliative care clinic referral on quality of life, anxiety, and depression in IPF. Patients were randomized to usual care (UC) or usual care + palliative care (UC + PC) with routine pulmonary follow up at 3 and 6 months. The UC + PC group received a minimum of one PC clinic visit. Primary outcome was change from baseline in quality of life, anxiety, and depression as measured by the St. George’s Respiratory Questionnaire (SGRQ), the Hospital Anxiety and Depression Index (HADS), and the Patient Health Questionnaire (PHQ-9) at 6 months. Results Twenty-two patients were randomized between September 2017 through July 2018; 11 to UC and 11 to UC + PC. There was no difference in the change in SGRQ score at 3 months or 6 months, however, the symptom score trended towards a significant worsening for UC + PC at both 3 and 6 months (mean change at 3 months for UC and UC + PC was − 7.8 and + 10.7, respectively, p = 0.066; mean change at 6 months for UC and UC + PC was − 6.0 and + 4.6, respectively, p = 0.055). There was no difference in the change in HADS anxiety or depression scores. There was a significant transient worsening in PHQ-9 scores for UC + PC at 3 months (UC: -1.6, UC + PC: + 0.9, p = 0.008); this effect did not persist at 6 months. Conclusion This pilot study demonstrated that a randomized controlled trial of palliative care in idiopathic pulmonary fibrosis patients is feasible. Receiving palliative care did not lead to improved quality of life, anxiety, or depression compared to usual care after 6 months. Patients in the UC + PC group trended towards worsening symptoms and a small but statistically significant transient worsening in depression. These findings should be interpreted with caution, and need to be evaluated in adequately powered clinical trials. NCT03981406, June 10, 2019, retrospectively registered.
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Affiliation(s)
- Katherine Janssen
- University of Minnesota Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, MMC 276, 420 Delaware Street SE, Minneapolis, MN, 55455, USA.
| | - Drew Rosielle
- University of Minnesota Palliative Care, MMC 603 Mayo, 8603A, 420 Delaware Street SE, Minneapolis, MN, 55455, USA
| | - Qi Wang
- University of Minnesota Biostatistical Design and Support Center, Clinical Translational Science Institute, Room 223, 1932D, 717 Delaware St SE, Minneapolis, MN, 55414, USA
| | - Hyun Joo Kim
- University of Minnesota Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, MMC 276, 420 Delaware Street SE, Minneapolis, MN, 55455, USA
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34
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Moor CC, Wijsenbeek MS, Balestro E, Biondini D, Bondue B, Cottin V, Flewett R, Galvin L, Jones S, Molina-Molina M, Planas-Cerezales L, Prasse A, Prosch H, Russell AM, Viegas M, Wanke G, Wuyts W, Kreuter M, Bonella F. Gaps in care of patients living with pulmonary fibrosis: a joint patient and expert statement on the results of a Europe-wide survey. ERJ Open Res 2019; 5:00124-2019. [PMID: 31649949 PMCID: PMC6801215 DOI: 10.1183/23120541.00124-2019] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 07/20/2019] [Indexed: 12/26/2022] Open
Abstract
Introduction Pulmonary fibrosis (PF) and its most common form, idiopathic pulmonary fibrosis (IPF), are chronic, progressive diseases resulting in increasing loss of lung function and impaired quality of life and survival. The aim of this joint expert and patient statement was to highlight the most pressing common unmet needs of patients with PF/IPF, putting forward recommendations to improve the quality of life and health outcomes throughout the patient journey. Methods Two online surveys for patients and healthcare professionals (HCPs) were conducted by the European Idiopathic Pulmonary Fibrosis and Related Disorders Federation (EU-IPFF) in 14 European countries. Results The surveys were answered by 286 patients and 69 HCPs, including physicians and nurses. Delays in diagnosis and timely access to interstitial lung disease specialists and pharmacological treatment have been identified as important gaps in care. Additionally, patients and HCPs reported that a greater focus on symptom-centred management, adequate information, trial information and increasing awareness of PF/IPF is required. Conclusions The surveys offer important insights into the current unmet needs of PF/IPF patients. Interventions at different points of the care pathway are needed to improve patient experience.
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Affiliation(s)
- Catharina C Moor
- Dept of Respiratory Medicine, Erasmus MC, Rotterdam, The Netherlands.,These authors share first authorship
| | - Marlies S Wijsenbeek
- Dept of Respiratory Medicine, Erasmus MC, Rotterdam, The Netherlands.,These authors share first authorship
| | - Elisabetta Balestro
- Dept of Cardiac, Thoracic, Vascular Sciences and Public Health, Azienda Ospedaliera di Padova, Università degli Studi di Padova, Padua, Italy
| | - Davide Biondini
- Dept of Cardiac, Thoracic, Vascular Sciences and Public Health, Azienda Ospedaliera di Padova, Università degli Studi di Padova, Padua, Italy
| | - Benjamin Bondue
- Dept of Respiratory Medicine, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Vincent Cottin
- Dept of Respiratory Diseases, Centre Hospitalier Universitaire de Lyon, Lyon, France
| | - Ron Flewett
- Pulmonary Fibrosis Trust, Lichfield, UK.,These authors represent the patient's perspective
| | - Liam Galvin
- Irish Lung Fibrosis Association, Blackrock, Ireland.,These authors represent the patient's perspective
| | - Steve Jones
- Action for Pulmonary Fibrosis, Lichfield, UK.,These authors represent the patient's perspective
| | | | | | - Antje Prasse
- Dept of Pneumology, Hannover Medical School, Hannover, Germany
| | - Helmut Prosch
- Dept of Biomedical Imaging and Image Guided Interventions, Medical University Vienna, Vienna. Austria
| | | | - Michel Viegas
- Association Belge contre la Fibrose Pulmonaire Idiopathique, Waterloo, Belgium.,These authors represent the patient's perspective
| | - Guenther Wanke
- Dept of Respiratory Medicine, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium.,These authors represent the patient's perspective
| | - Wim Wuyts
- Dept of Respiratory Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Michael Kreuter
- Dept of Pneumology and Critical Care Medicine, Universitätsklinikum Heidelberg, Heidelberg, Germany.,These authors share senior authorship
| | - Francesco Bonella
- Dept of Pneumology and Allergy, Ruhrlandklinik Medical Faculty, University of Duisburg-Essen, Essen, Germany.,These authors share senior authorship
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A systematic review of literature to evaluate the burden of physical and psychological symptoms and palliative care in patients diagnosed with idiopathic pulmonary fibrosis. Afr J Thorac Crit Care Med 2019; 25. [PMID: 34286243 PMCID: PMC8278994 DOI: 10.7196/ajtccm.2019.v25i1.231] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2019] [Indexed: 11/08/2022] Open
Abstract
Background Palliative care improves quality of life in patients with life-threatening illnesses, such as idiopathic pulmonary fibrosis (IPF), in a holistic manner and should be integrated early into the management of these patients. Objective To evaluate the degree of physical and psychological symptoms in patients with IPF and the extent to which palliative care is used in patient management. Methods Several databases were searched for studies reporting on symptom burden, quality of life or palliative interventions in patients with IPF. Results A total of 46 articles were included in this review. Studies showed that many patients experienced dyspnoea, which improved with pulmonary rehabilitation in some cases. Fatigue and poor quality of sleep had a notable negative impact on daily life activities. Instruments evaluating anxiety and depression showed that many patients with IPF experienced mild to moderate depression and anxiety. Quality of life was shown to be negatively affected across all domains. Two studies indicated poor referral to palliative care units and one study reported positively on the use of morphine for managing breathlessness in advanced IPF. Conclusion Patients with IPF generally experience poor quality of life. Patients are seldom referred to palliative care, even in developed countries. No data were available on the use of palliative care in developing countries. Furthermore, research on the burden of symptoms and management of these symptoms appears to be limited. Increased awareness of and research on the palliative care needs of patients with IPF are recommended, particularly in resource-limited settings such as South Africa.
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Spruit MA, Rochester CL, Pitta F, Kenn K, Schols AMWJ, Hart N, Wouters EFM, Nava S, Dreher M, Janssen DJA, Johnson MJ, Curtis RJ, Sastry M, Franssen FME. Pulmonary rehabilitation, physical activity, respiratory failure and palliative respiratory care. Thorax 2019; 74:693-699. [PMID: 30872364 DOI: 10.1136/thoraxjnl-2018-212044] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 02/07/2019] [Accepted: 02/11/2019] [Indexed: 12/13/2022]
Abstract
The CIRO Academy in Horn (the Netherlands) organised a 2-day meeting to present and discuss the studies published in 2017 pertaining to key priority areas of respiratory and critical care medicine. This review summarises studies focussing on pulmonary rehabilitation and exercise training, physical activity, chronic respiratory failure and palliative respiratory care published in 2017.
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Affiliation(s)
- Martijn A Spruit
- REVAL - Rehabilitation Research Center, BIOMED - Biomedical Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium .,Department of Research and Education, CIRO, Horn, The Netherlands.,Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), NUTRIMSchool of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands
| | - Carolyn L Rochester
- Section of Pulmonary and Critical Care, Yale University School of Medicine, New Haven, Connecticut, USA.,VA Connecticut Healthcare System, West Haven, CT, United States
| | - Fabio Pitta
- Department of Physiotherapy, Laboratory of Research in Respiratory Physiotherapy, Londrina, Brazil
| | - Klaus Kenn
- Department of Respiratory Medicine and Pulmonary Rehabilitation, Schoen Klinik Berchtesgadener Land, Schoenau am Koenigssee, Germany.,Department of Pulmonary Rehabilitation, University of Marburg, Marburg, Germany
| | - Annemie M W J Schols
- Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), NUTRIMSchool of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands
| | - Nicholas Hart
- Lane Fox Respiratory Service, Guy's & St Thomas' NHS Foundation Trust, London, UK.,Lane-Fox Clinical Respiratory Physiology Research Centre, Guy's and St Thomas' NHS Trust, St Thomas' Hospital, London, United Kingdom
| | - Emiel F M Wouters
- Department of Research and Education, CIRO, Horn, The Netherlands.,Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), NUTRIMSchool of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands
| | - Stefano Nava
- Alma Mater University, Dept. of Clinical, Integrated and Experimental Medicine (DIMES), Respiratory and Critical Care Unit, S. Orsola-Malpighi Hospital Bologna, Bologna, Italy
| | - Michael Dreher
- Pneumology, Universitatsklinikum Aachen, Aachen, Germany
| | - Daisy J A Janssen
- Department of Research and Education, CIRO, Horn, The Netherlands.,Centre of Expertise for Palliative Care, MUMC+, Maastricht, The Netherlands
| | - Miriam J Johnson
- Wolfson Palliative Care Research Centre, Hull York Medical School, The University of Hull, Hull, UK
| | - Randall J Curtis
- Pulmonary and Critical Care Medicine, University of Washington, Seattle, Washington, USA.,Cambia Palliative Care Center of Excellence, University of Washington, Seattle, United States
| | | | - Frits M E Franssen
- Department of Research and Education, CIRO, Horn, The Netherlands.,Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), NUTRIMSchool of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands
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Lindell KO. The patients have spoken; now it is time for us to listen and move the needle forward. Respirology 2019; 24:197-198. [DOI: 10.1111/resp.13476] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Accepted: 12/10/2018] [Indexed: 01/13/2023]
Affiliation(s)
- Kathleen O. Lindell
- University of Pittsburgh PACCMDorothy P. & Richard P. Simmons Center for Interstitial Lung Disease at UPMC Pittsburgh PA USA
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Zou RH, Nouraie M, Chen X, Saul MI, Kaminski N, Gibson KF, Kass DJ, Lindell KO. Assessing Patterns of Palliative Care Referral and Location of Death in Patients with Idiopathic Pulmonary Fibrosis: A Sixteen-Year Single-Center Retrospective Cohort Study. J Palliat Med 2019; 22:538-544. [PMID: 30615545 DOI: 10.1089/jpm.2018.0400] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Background: Idiopathic pulmonary fibrosis (IPF) is a progressive and fatal lung disease with an unpredictable course and a median survival of three to four years. This timeline challenges providers to approach diagnosis, oxygen therapy, rehabilitation, transplantation, and end-of-life discussions in limited encounters. There is currently no widely accepted guideline for determining when IPF patients should be referred to palliative care (PC). Objective: We sought to describe the patient and clinical factors associated with PC referral, as well as its impact on mortality and location of death. We also aimed to examine temporal trends in PC referral in this population. Materials and Methods: Patient data were retrospectively extracted from the health system repository of our specialty referral center for all new IPF patients evaluated between 2000 and 2016 (n = 828). Exclusion criteria included transplant recipients and patients who did not have IPF. Results: One hundred twelve (13.5%) IPF patients received formal PC referral. Recipients were older at diagnosis (72 years vs. 69 years, p < 0.001), had higher frequency of Charlson Comorbidity Index ≥1 (55% vs. 42%, p = 0.011), resided closer to our institution (16 miles vs. 54 miles, p < 0.001), and had a higher number of total outpatient visits (7 vs. 4, p < 0.001). PC was associated with less in-hospital death (44% vs. 60%, p = 0.006) and more in-home and hospice death (56% vs. 40%, p = 0.006). Conclusions: IPF patients referred to PC were older with more severe comorbidities, resided closer to our specialty referral center, and had more outpatient follow-up. This was associated with more in-home and hospice deaths. The patient-provider relationship and frequency of follow-up visits likely play important roles in the introduction of end-of-life discussions.
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Affiliation(s)
- Richard H Zou
- 1 Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Mehdi Nouraie
- 2 Dorothy P. and Richard P. Simmons Center for Interstitial Lung Disease at the University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, Pennsylvania.,3 Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Xiaoping Chen
- 3 Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Melissa I Saul
- 1 Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Naftali Kaminski
- 4 Section of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Kevin F Gibson
- 2 Dorothy P. and Richard P. Simmons Center for Interstitial Lung Disease at the University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, Pennsylvania.,3 Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Daniel J Kass
- 2 Dorothy P. and Richard P. Simmons Center for Interstitial Lung Disease at the University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, Pennsylvania.,3 Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Kathleen O Lindell
- 2 Dorothy P. and Richard P. Simmons Center for Interstitial Lung Disease at the University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, Pennsylvania.,3 Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
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Kim JW, Atkins C, Wilson AM. Barriers to specialist palliative care in interstitial lung disease: a systematic review. BMJ Support Palliat Care 2018; 9:130-138. [DOI: 10.1136/bmjspcare-2018-001575] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 10/23/2018] [Accepted: 11/07/2018] [Indexed: 12/14/2022]
Abstract
BackgroundCurrent guidelines recommend palliative care based on individual needs for patients with idiopathic pulmonary fibrosis. However, patients with interstitial lung disease (ILD) are less likely to receive specialist palliative care services compared with patients with malignant disease. The aim of this review is to summarise recent studies addressing barriers to referring patients to specialist palliative care services.MethodsPubMed, Embase, Medline and Web of Science were reviewed to identify relevant publications. Studies were selected if they examined the frequency of specialist palliative care referral and/or addressed issues surrounding access to palliative care services for patients with ILD.ResultsTen studies with a total of 4073 people with ILD, 27 caregivers and 18 healthcare professionals were selected and analysed. Frequency of palliative care referrals ranged from 0% to 38%. Delay in palliative care referrals and end-of-life decisions, patients’ fear of talking about the future, prognostic uncertainty and confusion about the roles of palliative care were identified as barriers to accessing palliative care services.ConclusionFurther research should concentrate on the early identification of patients who need specialist palliative care possibly with establishment of criteria to trigger referral ensuring that referrals are also based on patient’s needs.
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40
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Burnett K, Glaspole I, Holland AE. Understanding the patient's experience of care in idiopathic pulmonary fibrosis. Respirology 2018; 24:270-277. [PMID: 30282111 DOI: 10.1111/resp.13414] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 08/02/2018] [Accepted: 09/05/2018] [Indexed: 12/27/2022]
Affiliation(s)
- Kimberley Burnett
- Department of Allergy, Immunology and Respiratory Medicine, Alfred Health, Melbourne, VIC, Australia
| | - Ian Glaspole
- Department of Allergy, Immunology and Respiratory Medicine, Alfred Health, Melbourne, VIC, Australia.,Department of Medicine, Monash University, Melbourne, VIC, Australia
| | - Anne E Holland
- Department of Physiotherapy, Alfred Health, Melbourne, VIC, Australia.,Discipline of Physiotherapy, La Trobe University, Melbourne, VIC, Australia.,Institute for Breathing and Sleep, Melbourne, VIC, Australia
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41
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Igai Y. A narrative literature review of palliative care regarding patients with idiopathic pulmonary fibrosis. Nurs Open 2018; 5:536-545. [PMID: 30338099 PMCID: PMC6177544 DOI: 10.1002/nop2.163] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 03/27/2018] [Accepted: 04/21/2018] [Indexed: 11/25/2022] Open
Abstract
AIM The aim of this study was to examine the reported characteristics of extant studies on palliative care for patients with idiopathic pulmonary fibrosis. DESIGN Narrative review. METHODS A comprehensive search of the following electronic databases in English and Japanese commenced from 2002 - December 2017. Eligibility criteria was determined by the inclusion and exclusion criteria. RESULTS Nineteen articles were eligible. The characteristics of palliative care for patients with idiopathic pulmonary fibrosis were symptoms relief, start time of palliative care and palliative care needs of patients and care partners. Also, patients' education of disease management including advanced care planning and developing a palliative care system by the healthcare provider including multidisciplinary professional teams was identified. The care provided was a "care conference" and integrated palliative care was carried out in the patient's home. The majority of the studies were qualitative and retrospective in design. The palliative care system and the development of palliative care were limited.
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Affiliation(s)
- Yasuko Igai
- St. Luke's International UniversityTokyoJapan
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42
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Abstract
PURPOSE OF REVIEW The palliative care needs of people with interstitial lung disease (ILD) have recently been highlighted by the National Institute for Health and Care Excellence. All people with progressive ILD should receive best supportive care to improve symptom control and quality of life and where possible this should be evidence based. RECENT FINDINGS Deaths from ILD are increasing and deaths in hospital are more common compared to home. People with ILD experience a wide range of symptoms including breathlessness and cough. People living with ILD often suffer unmet physical and psychological needs throughout the disease journey. Few appropriately validated outcome measures exist for ILD which has hampered research on the longitudinal experience of symptoms and quality of life and the evaluation of interventions. Recent recommendations from the National Institute of Clinical Excellence promote the use of a new palliative care needs assessment tool. Use of a tool in busy respiratory clinics may help to highlight those requiring specialist input. SUMMARY Further research into the role of opioids, oxygen and neuromodulatory agents in symptom management are needed. In addition, exploration of breathlessness and case conference interventions in transitioning patients from the hospital to community settings is a priority. Further work is needed to identify a core set of validated ILD-specific patient-reported outcome measures for the robust evaluation of interventions.
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Lindell KO, Nouraie M, Klesen MJ, Klein S, Gibson KF, Kass DJ, Rosenzweig MQ. Randomised clinical trial of an early palliative care intervention (SUPPORT) for patients with idiopathic pulmonary fibrosis (IPF) and their caregivers: protocol and key design considerations. BMJ Open Respir Res 2018; 5:e000272. [PMID: 29531748 PMCID: PMC5844378 DOI: 10.1136/bmjresp-2017-000272] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 01/22/2018] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Idiopathic pulmonary fibrosis (IPF), a progressive life-limiting lung disease affects approximately 128 000 newly diagnosed individuals in the USA annually. IPF, a disease of ageing associated with intense medical and financial burden, is expected to grow in incidence globally. Median survival from diagnosis is 3.8 years, and many of these patients succumb to a rapid death within 6 months. Despite the fatal prognosis, we have found that patients and caregivers often fail to understand the poor prognosis as the disease relentlessly progresses. Based on feedback from patients and families living with IPF, we developed the S-Symptom Management, U-Understanding the Disease, P-Pulmonary Rehabilitation, P-Palliative Care, O-Oxygen Therapy, R-Research Considerations and T-Transplantation ('SUPPORT') intervention to increase knowledge of the disease, teach self-management strategies and facilitate preparedness with end of life (EOL) planning. METHODS This study is a randomised trial to test the efficacy of SUPPORT intervention compared with routine care in patients with IPF and their caregivers delivered after three clinical visits. We are recruiting a cohort of 64 new IPF patient/caregiver dyads (32 for each dyad). RESULTS The trial will evaluate whether the SUPPORT intervention decreases stress, improves symptom burden, quality of life, preparedness and advance care planning for patients and caregivers, quality of dying and death for caregivers if the patient dies during the course of the study, as well as assess the impact of primary palliative care on healthcare resource use near the EOL. CONCLUSION By increasing knowledge of the disease, teaching self-management strategies and facilitating preparedness with EOL planning, we will address a critical gap in the care of patients with IPF. TRIAL REGISTRATION NUMBER NCT02929017; Pre-results.
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Affiliation(s)
- Kathleen Oare Lindell
- Department of Medicine, PACCM, Dorothy P. and Richard P. Simmons, Center for Interstitial Lung Disease, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Mehdi Nouraie
- Department of Medicine/PACCM, University of Pittsburgh, Pitttsburgh, Pennsylvania, USA
| | - Melinda J Klesen
- Department of Medicine, PACCM, Dorothy P. and Richard P. Simmons, Center for Interstitial Lung Disease, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Sara Klein
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Kevin F Gibson
- Department of Medicine, PACCM, Dorothy P. and Richard P. Simmons, Center for Interstitial Lung Disease, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Daniel J Kass
- Department of Medicine, PACCM, Dorothy P. and Richard P. Simmons, Center for Interstitial Lung Disease, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Ramadurai D, Corder S, Churney T, Graney B, Harshman A, Meadows S, Swigris JJ. Understanding the informational needs of patients with IPF and their caregivers: 'You get diagnosed, and you ask this question right away, what does this mean?'. BMJ Open Qual 2018; 7:e000207. [PMID: 29464212 PMCID: PMC5812387 DOI: 10.1136/bmjoq-2017-000207] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 12/19/2017] [Accepted: 12/30/2017] [Indexed: 11/17/2022] Open
Abstract
Background Idiopathic pulmonary fibrosis (IPF) is a progressive, incurable lung disease whose intrusive symptoms rob patients of their quality of life. Patients with IPF rely on their caregivers for support and assistance in amounts that vary according to patients’ individual circumstances and disease severity. Knowledgeable and well-informed patients and caregivers are best suited to deal with life-altering conditions like IPF. Methods We conducted two hour-long focus groups with 13 patients with IPF and 4 caregivers of patients with IPF to better understand their informational needs and in what format such information should be delivered. Results Patients discussed the challenges IPF creates in their daily lives. They wanted information on how to live well despite having IPF, practical information on how they could remain active and travel and how they could preserve their quality of life despite living with a life-threatening disease like IPF. Caregivers wanted information on the general aspects of IPF, because it would help them understand what patients were going through. They also wanted specific information on how to give care to a patient with IPF, even when physical care may not be needed (as in earlier phases of the disease). Patients and caregivers both needed efficient information delivery from trustworthy sources, including the healthcare team involved in their care. They considered both spoken and written information valuable, and ease of access was critical. Conclusion This study provides valuable insight regarding the informational needs of IPF patients and their caregivers. It is hoped that identifying or creating sources of this information, and insuring that patients and caregivers have access to it, will improve well-being for patients with IPF and their caregivers.
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Affiliation(s)
- Deepa Ramadurai
- Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Stephanie Corder
- Office of Professional Education, National Jewish Health, Denver, Colorado, USA
| | - Tara Churney
- Interstitial Lung Disease Program, National Jewish Health, Denver, Colorado, USA
| | - Bridget Graney
- Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Andrea Harshman
- Office of Professional Education, National Jewish Health, Denver, Colorado, USA
| | - Sarah Meadows
- Administration, Denver Health, Denver, Colorado, USA
| | - Jeffrey J Swigris
- Interstitial Lung Disease Program, National Jewish Health, Denver, Colorado, USA
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Abstract
Idiopathic pulmonary fibrosis (IPF) is a rare pulmonary disease with a poor prognosis and severe impact on quality of life. Early diagnosis is still challenging and important delays are registered before final diagnosis can be reached. Available tools fail to predict the variable course of the disease and to evaluate response to antifibrotic drugs. Despite the recent approval of pirfenidone and nintedanib, significant challenges remain to improve prognosis and quality of life. It is hoped that the new insights gained in pathobiology in the last few years will lead to further advances in the diagnosis and management of IPF. Currently, early diagnosis and prompt initiation of treatments reducing lung function loss offer the best hope for improved outcomes. This article aims at providing an overview of recent advances in managing patients with IPF and has a particular focus on how to reach a diagnosis, manage comorbidities and lung transplantation, care for the non-pharmacological needs of patients, and address palliative care.
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Affiliation(s)
- Chiara Scelfo
- Unità Operativa di Pneumologia e Terapia Semi-Intensiva Respiratoria, Servizio di Fisiopatologia Respiratoria ed Emodinamica Polmonare, Ospedale San Giuseppe, Multimedica IRCCS, Milan, Italy
| | - Antonella Caminati
- Unità Operativa di Pneumologia e Terapia Semi-Intensiva Respiratoria, Servizio di Fisiopatologia Respiratoria ed Emodinamica Polmonare, Ospedale San Giuseppe, Multimedica IRCCS, Milan, Italy
| | - Sergio Harari
- Unità Operativa di Pneumologia e Terapia Semi-Intensiva Respiratoria, Servizio di Fisiopatologia Respiratoria ed Emodinamica Polmonare, Ospedale San Giuseppe, Multimedica IRCCS, Milan, Italy
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Kreuter M, Bendstrup E, Russell AM, Bajwah S, Lindell K, Adir Y, Brown CE, Calligaro G, Cassidy N, Corte TJ, Geissler K, Hassan AA, Johannson KA, Kairalla R, Kolb M, Kondoh Y, Quadrelli S, Swigris J, Udwadia Z, Wells A, Wijsenbeek M. Palliative care in interstitial lung disease: living well. THE LANCET RESPIRATORY MEDICINE 2017; 5:968-980. [PMID: 29033267 DOI: 10.1016/s2213-2600(17)30383-1] [Citation(s) in RCA: 146] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 09/28/2017] [Accepted: 09/28/2017] [Indexed: 12/25/2022]
Abstract
Progressive fibrotic interstitial lung diseases (ILDs) are characterised by major reductions in quality of life and survival and have similarities to certain malignancies. However, palliative care expertise is conspicuously inaccessible to many patients with ILD. Unmet patient and caregiver needs include effective pharmacological and psychosocial interventions to improve quality of life throughout the disease course, sensitive advanced care planning, and timely patient-centred end-of-life care. The incorrect perception that palliative care is synonymous with end-of-life care, with no role earlier in the course of ILD, has created a culture of neglect. Interventions that aim to improve life expectancy are often prioritised without rigorous assessment of the individual's health and psychosocial needs, thereby inadvertently reducing quality of life. As in malignant disorders, radical interventions to slow disease progression and palliative measures to improve quality of life should both be prioritised. Efficient patient-centred models of palliative care must be validated, taking into account religious and cultural differences, as well as variability of resources. Effective implementation of palliative care for ILD will require multidisciplinary participation from clinicians, specialist nurses, psychologists, social workers, and, in some countries, non-governmental faith and community-based organisations with access to palliative care expertise.
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Affiliation(s)
- Michael Kreuter
- Center for Interstitial and Rare Lung Diseases, Pneumology and Respiratory Critical Care Medicine, Thoraxklinik, University of Heidelberg, Heidelberg, Germany.
| | - Elisabeth Bendstrup
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | - Anne-Marie Russell
- National Heart & Lung Institute, Royal Brompton Hospital and Imperial College London, London, UK
| | - Sabrina Bajwah
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, UK
| | - Kathleen Lindell
- Dorothy P & Richard P Simmons Center for Interstitial Lung Disease at UPMC, University of Pittsburgh, Pittsburgh, PA, USA
| | - Yochai Adir
- Pulmonary Division, Lady Davis Carmel Medical Center, Faculty of Medicine, The Technion-Israel Institute of Technology, Haifa, Israel
| | - Crystal E Brown
- Division of Pulmonary and Critical Care Medicine, Harborview Medical Center, Seattle, WA, USA; University of Washington Medical Center, Seattle, WA, USA
| | - Greg Calligaro
- Division of Pulmonology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | | | - Tamera J Corte
- Royal Prince Alfred Hospital, University of Sydney, Sydney, NSW, Australia
| | | | - Azza Adel Hassan
- Hamad Medical Corporation, Supportive and Palliative Section, Oncology Department, Doha, Qatar; Medical Research Institute, Clinical Oncology Department, Alexandria University, Alexandria, Egypt
| | | | - Ronaldo Kairalla
- Pulmonary Division, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | - Martin Kolb
- Firestone Institute for Respiratory Health, Department of Medicine, Pathology & Molecular Medicine, McMaster University, Hamilton, ON, Canada
| | - Yasuhiro Kondoh
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, Nagoya University School of Medicine, Nagoya, Japan
| | | | - Jeff Swigris
- Interstitial Lung Disease Program, National Jewish Health, Denver, CO, USA
| | - Zarir Udwadia
- Department of Respiratory Medicine, P D Hinduja National Hospital and Medical Research Center, Mumbai, India
| | - Athol Wells
- NIHR Biomedical Research Unit, Royal Brompton Hospital, Sydney Street, London, UK; Fibrosis Research Group, National Heart and Lung Institute, Imperial College London, London, UK
| | - Marlies Wijsenbeek
- Department of Respiratory Medicine, Erasmus University Medical Centre, Rotterdam, Netherlands
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47
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Costello J. Research roundup. Int J Palliat Nurs 2017; 23:256-257. [PMID: 28548911 DOI: 10.12968/ijpn.2017.23.5.256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Synopses of a selection of recently published research articles of relevance to palliative care.
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Affiliation(s)
- John Costello
- Senior Lecturer, University of Manchester School of Nursing, Midwifery and Social Work
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