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DiFiglia S, Georgiopoulos AM, Portenoy R, Seng E, Berdella M, Friedman D, Kier C, Linnemann RW, Middour-Oxler B, Walker P, Wang J, Yonker LM, Buehler B, Chaudhary N, Esposito C, Frantzen T, Henthorne K, Plachta A, Pollinger S, Stables-Carney T, Trentacoste J, Dhingra L. Palliative care needs among outpatient adults with cystic fibrosis: Baseline data from the Improving Life with CF trial. J Cyst Fibros 2024; 23:804-810. [PMID: 37951787 DOI: 10.1016/j.jcf.2023.10.018] [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] [Received: 08/28/2023] [Revised: 10/26/2023] [Accepted: 10/28/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND Little is known about the burden of illness experienced by people with cystic fibrosis (pwCF) since the advent of CF transmembrane conductance regulator (CFTR) modulator therapies. Studies that characterize the nature of illness burden are needed to inform the development and implementation of palliative care programs that can serve this population and address quality of life concerns. METHODS Adults with CF treated at five U.S. CF centers were surveyed to obtain baseline data for the Improving Life with CF primary palliative care implementation trial. Consenting patients completed the Integrated Palliative Care Outcome Scale (IPOS), a multidimensional measure of unmet needs for palliative care. Sociodemographic and clinical information was also obtained. The associations among these variables were examined through bivariate and multivariable analyses. RESULTS Among 256 adults, the most distressing symptoms included not feeling "at peace", communication difficulties with family/friends, anxiety over illness or its treatment, and a lack of energy. In the multivariable analyses, CFTR modulator use was associated with lower IPOS total and physical symptoms scores; female sex and increased hospitalizations were associated with higher scores. Increased age and history of distal intestinal obstructive syndrome were associated with higher IPOS physical symptoms scores. CONCLUSIONS These findings illuminate the nature of illness burden for pwCF in the era of CFTR modulator therapies. Although illness burden is positively affected by modulator therapy, there is a continuing need for palliative care to address physical, emotional, and spiritual distress, and the communication and practical needs experienced by adults with CF.
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Affiliation(s)
- Stephanie DiFiglia
- MJHS Institute for Innovation in Palliative Care, New York, NY, United States.
| | - Anna M Georgiopoulos
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Russell Portenoy
- MJHS Institute for Innovation in Palliative Care, New York, NY, United States; Departments of Family and Social Medicine and Neurology, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Elizabeth Seng
- Ferkauf Graduate School of Psychology, New York, NY, United States; Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Maria Berdella
- Lenox Hill Hospital Northwell Health, New York, NY, United States
| | - Deborah Friedman
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | | | - Rachel W Linnemann
- Emory University School of Medicine, Atlanta, GA, United States; Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Brandi Middour-Oxler
- Emory University School of Medicine, Atlanta, GA, United States; Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Patricia Walker
- Lenox Hill Hospital Northwell Health, New York, NY, United States
| | - Janice Wang
- Feinstein Institute for Medical Research, New Hyde Park, NY, United States
| | - Lael M Yonker
- Pulmonary Division, Massachusetts General Hospital for Children, Boston, MA, United States
| | - Brian Buehler
- Emory University School of Medicine, Atlanta, GA, United States; Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Nivedita Chaudhary
- Department of Pediatrics, Massachusetts General Hospital, Boston, MA, United States
| | - Christine Esposito
- Feinstein Institute for Medical Research, New Hyde Park, NY, United States
| | - Theresa Frantzen
- Feinstein Institute for Medical Research, New Hyde Park, NY, United States
| | | | - Amy Plachta
- Lenox Hill Hospital Northwell Health, New York, NY, United States
| | - Sophie Pollinger
- Department of Pediatrics, Massachusetts General Hospital, Boston, MA, United States
| | | | | | - Lara Dhingra
- MJHS Institute for Innovation in Palliative Care, New York, NY, United States; Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, NY, United States
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Holland AE, Spathis A, Marsaa K, Bausewein C, Ahmadi Z, Burge AT, Pascoe A, Gadowski AM, Collis P, Jelen T, Reilly CC, Reinke LF, Romero L, Russell AM, Saggu R, Solheim J, Vagheggini G, Vandendungen C, Wijsenbeek M, Tonia T, Smallwood N, Ekström M. European Respiratory Society clinical practice guideline on symptom management for adults with serious respiratory illness. Eur Respir J 2024; 63:2400335. [PMID: 38719772 DOI: 10.1183/13993003.00335-2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 03/19/2024] [Indexed: 06/30/2024]
Abstract
Respiratory symptoms are ubiquitous and impair health-related quality of life in people with respiratory disease. This European Respiratory Society (ERS) task force aimed to provide recommendations for symptomatic treatment in people with serious respiratory illness. The ERS task force comprised 16 members, including representatives of people with serious respiratory illness and informal caregivers. Seven questions were formulated, six in the PICO (Population, Intervention, Comparison, Outcome) format, which were addressed with full systematic reviews and evidence assessed using GRADE (Grading of Recommendations Assessment, Development and Evaluation). One question was addressed narratively. An "evidence-to-decision" framework was used to formulate recommendations. To treat symptoms in people with serious respiratory illness, the task force suggests the use of graded exercise therapy (conditional recommendation, low certainty of evidence); and suggests the use of a multicomponent services, handheld fan and breathing techniques (conditional recommendations, very low certainty of evidence). The task force suggests not to use opioids (conditional recommendation, very low certainty of evidence); and suggests either administering or not administering supplemental oxygen therapy (conditional recommendation, low certainty of evidence). The task force suggests that needs assessment tools may be used as part of a comprehensive needs assessment, but do not replace patient-centred care and shared decision making (conditional recommendation, low certainty of evidence). The low certainty of evidence, modest impact of interventions on patient-centred outcomes, and absence of effective strategies to ameliorate cough highlight the need for new approaches to reduce symptoms and enhance wellbeing for individuals who live with serious respiratory illness.
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Affiliation(s)
- Anne E Holland
- Departments of Physiotherapy and Respiratory Medicine, Alfred Health, Melbourne, Australia
- School of Translational Medicine, Monash University, Melbourne, Australia
- Institute for Breathing and Sleep, Melbourne, Australia
| | - Anna Spathis
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Kristoffer Marsaa
- Department of Multidisease, North Zealand Hospital, Copenhagen University, Hilleroed, Denmark
| | - Claudia Bausewein
- Department of Palliative Medicine, LMU University Hospital, LMU Munich, Munich, Germany
| | - Zainab Ahmadi
- Respiratory Medicine, Allergology and Palliative Medicine, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Angela T Burge
- School of Translational Medicine, Monash University, Melbourne, Australia
- Department of Physiotherapy, Alfred Health, Melbourne, Australia
| | - Amy Pascoe
- School of Translational Medicine, Monash University, Melbourne, Australia
| | - Adelle M Gadowski
- School of Translational Medicine, Monash University, Melbourne, Australia
| | - Phil Collis
- CPROR Birmingham University, Birmingham, UK
- Patient Advisory Group, European Lung Foundation, Sheffield, UK
| | - Tessa Jelen
- Patient Advisory Group, European Lung Foundation, Sheffield, UK
| | - Charles C Reilly
- Department of Physiotherapy, King's College Hospital, London, UK
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Lynn F Reinke
- College of Nursing, University of Utah, Salt Lake City, UT, USA
| | - Lorena Romero
- The Ian Potter Library, Alfred Health, Melbourne, Australia
| | - Anne-Marie Russell
- Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
- Birmingham Regional NHS Interstitial Lung Disease and Occupational Lung Disease Service, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Ravijyot Saggu
- Pharmacy Medicines Management Team, Central London Community Healthcare Trust, London, UK
| | - John Solheim
- EU-PFF - European Pulmonary Fibrosis Federation, Overijse, Belgium
- LHL-IPF, Jessheim, Norway
| | - Guido Vagheggini
- Department of Internal Medicine and Medical Specialties, Respiratory Failure Pathway, Azienda USL Toscana Nordovest, Pisa, Italy
- Fondazione Volterra Ricerche ONLUS, Volterra, Italy
| | - Chantal Vandendungen
- EU-PFF - European Pulmonary Fibrosis Federation, Overijse, Belgium
- ABFFP - Association Belge Francophone Contre la Fibrose Pulmonaire, Rebecq, Belgium
| | - Marlies Wijsenbeek
- Department of Respiratory Medicine, Erasmus University Medical Center, Center of Excellence for Interstitial Lung Disease, Rotterdam, The Netherlands
| | - Thomy Tonia
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Natasha Smallwood
- School of Translational Medicine, Monash University, Melbourne, Australia
- Department of Respiratory Medicine, Alfred Health, Melbourne, Australia
- Joint last authors
| | - Magnus Ekström
- Respiratory Medicine, Allergology and Palliative Medicine, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Joint last authors
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Burgel PR, Southern KW, Addy C, Battezzati A, Berry C, Bouchara JP, Brokaar E, Brown W, Azevedo P, Durieu I, Ekkelenkamp M, Finlayson F, Forton J, Gardecki J, Hodkova P, Hong G, Lowdon J, Madge S, Martin C, McKone E, Munck A, Ooi CY, Perrem L, Piper A, Prayle A, Ratjen F, Rosenfeld M, Sanders DB, Schwarz C, Taccetti G, Wainwright C, West NE, Wilschanski M, Bevan A, Castellani C, Drevinek P, Gartner S, Gramegna A, Lammertyn E, Landau EEC, Plant BJ, Smyth AR, van Koningsbruggen-Rietschel S, Middleton PG. Standards for the care of people with cystic fibrosis (CF); recognising and addressing CF health issues. J Cyst Fibros 2024; 23:187-202. [PMID: 38233247 DOI: 10.1016/j.jcf.2024.01.005] [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] [Received: 11/06/2023] [Revised: 01/02/2024] [Accepted: 01/09/2024] [Indexed: 01/19/2024]
Abstract
This is the third in a series of four papers updating the European Cystic Fibrosis Society (ECFS) standards for the care of people with CF. This paper focuses on recognising and addressing CF health issues. The guidance was produced with wide stakeholder engagement, including people from the CF community, using an evidence-based framework. Authors contributed sections, and summary statements which were reviewed by a Delphi consultation. Monitoring and treating airway infection, inflammation and pulmonary exacerbations remains important, despite the widespread availability of CFTR modulators and their accompanying health improvements. Extrapulmonary CF-specific health issues persist, such as diabetes, liver disease, bone disease, stones and other renal issues, and intestinal obstruction. These health issues require multidisciplinary care with input from the relevant specialists. Cancer is more common in people with CF compared to the general population, and requires regular screening. The CF life journey requires mental and emotional adaptation to psychosocial and physical challenges, with support from the CF team and the CF psychologist. This is particularly important when life gets challenging, with disease progression requiring increased treatments, breathing support and potentially transplantation. Planning for end of life remains a necessary aspect of care and should be discussed openly, honestly, with sensitivity and compassion for the person with CF and their family. CF teams should proactively recognise and address CF-specific health issues, and support mental and emotional wellbeing while accompanying people with CF and their families on their life journey.
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Affiliation(s)
- Pierre-Régis Burgel
- Respiratory Medicine and Cystic Fibrosis National Reference Center, Cochin Hospital, Assistance Publique Hôpitaux de Paris (AP-HP), Institut Cochin, Inserm U1016, Université Paris-Cité, Paris, France
| | - Kevin W Southern
- Department of Women's and Children's Health, Institute in the Park, Alder Hey Children's Hospital, University of Liverpool, Eaton Road, Liverpool L12 2AP, UK.
| | - Charlotte Addy
- All Wales Adult Cystic Fibrosis Centre, University Hospital Llandough, Cardiff and Vale University Health Board, Cardiff, UK
| | - Alberto Battezzati
- Clinical Nutrition Unit, Department of Endocrine and Metabolic Medicine, IRCCS Istituto Auxologico Italiano, and ICANS-DIS, Department of Food Environmental and Nutritional Sciences, University of Milan, Milan, Italy
| | - Claire Berry
- Department of Nutrition and Dietetics, Alder Hey Children's NHS Trust, Liverpool, UK
| | - Jean-Philippe Bouchara
- University of Brest, Fungal Respiratory Infections Research Unit, SFR ICAT, University of Angers, Angers, France
| | - Edwin Brokaar
- Department of Pharmacy, Haga Teaching Hospital, The Hague, the Netherlands
| | - Whitney Brown
- Cystic Fibrosis Foundation, Inova Fairfax Hospital, Bethesda, Maryland, USA, Falls Church, VA, USA
| | - Pilar Azevedo
- Cystic Fibrosis Reference Centre-Centro, Hospitalar Universitário Lisboa Norte, Portugal
| | - Isabelle Durieu
- Cystic Fibrosis Reference Center (Constitutif), Service de médecine interne et de pathologie vasculaire, Hospices Civils de Lyon, Hôpital Lyon Sud, RESearch on HealthcAre PErformance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1, 8 avenue Rockefeller, 69373 Lyon Cedex 08, France; ERN-Lung Cystic Fibrosis Network, Frankfurt, Germany
| | - Miquel Ekkelenkamp
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Felicity Finlayson
- Department of Respiratory Medicine, The Alfred Hospital, Melbourne, Australia
| | | | - Johanna Gardecki
- CF Centre at Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Pavla Hodkova
- CF Center at University Hospital Motol, Prague, Czech Republic
| | - Gina Hong
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Jacqueline Lowdon
- Clinical Specialist Paediatric Cystic Fibrosis Dietitian, Leeds Children's Hospital, UK
| | - Su Madge
- Royal Brompton Hospital, Part of Guys and StThomas's Hospital, London, UK
| | - Clémence Martin
- Institut Cochin, Inserm U1016, Université Paris-Cité and National Reference Center for Cystic Fibrosis, Hôpital Cochin AP-HP, ERN-Lung CF Network, Paris 75014, France
| | - Edward McKone
- St.Vincent's University Hospital and University College Dublin School of Medicine, Dublin, Ireland
| | - Anne Munck
- Hospital Necker Enfants-Malades, AP-HP, CF Centre, Université Paris Descartes, Paris, France
| | - Chee Y Ooi
- School of Clinical Medicine, Discipline of Paediatrics and Child Health, Faculty of Medicine & Health, Department of Gastroenterology, Sydney Children's Hospital, University of New South Wales, Sydney, NSW, Australia
| | - Lucy Perrem
- Department of Respiratory Medicine, Children's Health Ireland, Dublin, Ireland
| | - Amanda Piper
- Central Clinical School, Faculty of Medicine, University of Sydney, Sydney, Australia
| | - Andrew Prayle
- Child Health, Lifespan and Population Health & Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Nottingham, UK
| | - Felix Ratjen
- Division of Respiratory Medicine, Department of Pediatrics and Translational Medicine, Research Institute, Hospital for Sick Children, Toronto, Canada
| | - Margaret Rosenfeld
- Department of Pediatrics, Seattle Children's Research Institute, University of Washington School of Medicine, Seattle, WA, USA
| | - Don B Sanders
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Carsten Schwarz
- Division Cystic Fibrosis, CF Center, Clinic Westbrandenburg, HMU-Health and Medical University, Potsdam, Germany
| | - Giovanni Taccetti
- Meyer Children's Hospital IRCCS, Cystic Fibrosis Regional Reference Centre, Italy
| | | | - Natalie E West
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Michael Wilschanski
- Pediatric Gastroenterology Unit, CF Center, Hadassah Medical Center, Jerusalem, Israel
| | - Amanda Bevan
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Carlo Castellani
- IRCCS Istituto Giannina Gaslini, Via Gerolamo Gaslini 5, Genova 16147, Italy
| | - Pavel Drevinek
- Department of Medical Microbiology, Second Faculty of Medicine, Motol University Hospital, Charles University, Prague, Czech Republic
| | - Silvia Gartner
- Cystic Fibrosis Unit and Pediatric Pulmonology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Andrea Gramegna
- Department of Pathophysiology and Transplantation, Respiratory Unit and Adult Cystic Fibrosis Center, Università degli Studi di Milano, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Elise Lammertyn
- Cystic Fibrosis Europe, Brussels, Belgium and the Belgian CF Association, Brussels, Belgium
| | - Eddie Edwina C Landau
- The Graub CF Center, Pulmonary Institute, Schneider Children's Medical Center, Petah Tikva, Israel
| | - Barry J Plant
- Cork Centre for Cystic Fibrosis (3CF), Cork University Hospital, University College Cork, Ireland
| | - Alan R Smyth
- School of Medicine, Dentistry and Biomedical Sciences, Belfast and NIHR Nottingham Biomedical Research Centre, Queens University Belfast, Nottingham, UK
| | | | - Peter G Middleton
- Westmead Clinical School, Department Respiratory & Sleep Medicine, Westmead Hospital, University of Sydney and CITRICA, Westmead, Australia
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Alnajar M, Darawad M, Khater W, Alshahwan R, Mosleh S, Nofal B, Abdalrahim M. Exploring Palliative Care Needs Among Patients With Cancer and Non-Cancer Serious Chronic Diseases: A Comparison Study. Am J Hosp Palliat Care 2024:10499091241235920. [PMID: 38386721 DOI: 10.1177/10499091241235920] [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: 02/24/2024] Open
Abstract
BACKGROUND Palliative care (PC) is integral to improving the quality of life and mitigating suffering for individuals with serious illnesses. This interdisciplinary-led study aims to comprehensively evaluate the prevalence of distressing problems and unmet needs among both cancer and non-cancer chronic disease patients and explore their need for PC. METHODS A cross-sectional, comparative, and multicenter design was conducted, involving 458 patients from eight hospitals, utilizing a self-reported Problems and Needs in Palliative Care-sv questionnaire. RESULTS The study included 276 (60.3%) patients with cancer and 182 (39.7%) with non-cancer chronic diseases. Most were 45-64 years old (n = 216, 47.2%). Patients with cancer reported a higher prevalence of physical symptoms, notably pain (n = 240, 87%) and anorexia (n = 192, 69.6%), while non-cancer patients faced more social challenges, including issues in companion relationships (n = 77, 42.3%) and discussing their disease with life companion (n = 78, 42.9%). Unmet needs were prevalent in both groups, with cancer patients having an average of 75.6% (n = 120) unmet needs, predominantly in the information (n = 145, 91.75%) and spiritual domains (n = 123, 77.8%). Non-cancer patients emphasized financial (n = 71, 66.6%) and autonomy (n = 59, 55.0%) problems. Moreover, patients in both groups with severe Charlson Comorbidity Index scores demonstrated significantly higher PC needs across all health domains. CONCLUSION The study highlights the universal demand for comprehensive PC for patients with both cancer and non-cancer chronic diseases. The findings underscore the need for enhanced PC provision, especially for patients with multiple comorbidities. Further research is needed to comprehensively address psychological, social, and spiritual problems in both patient groups.
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Affiliation(s)
- Malek Alnajar
- College of Nursing, University of Utah, Salt Lake City, Utah, USA
| | - Muhammad Darawad
- School of Nursing, The University of Jordan, Amman, Jordan
- Applied Science Research Center, Applied Science Private University, Amman, Jordan
| | - Wejdan Khater
- Department of Adults Health Nursing, Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | - Rashed Alshahwan
- Department of General Surgery, Jordanian Royal Medical Services (JRMS), Amman, Jordan
| | - Sultan Mosleh
- Faculty of Nursing, Mutah University, Mu'tah, Jordan
| | - Basema Nofal
- Faculty of Nursing, Al-Zaytoonah University of Jordan, Amman, Jordan
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Smirnova N, Lowers J, Magee MJ, Auld SC, Hunt WR, Fitzpatrick A, Lama V, Kavalieratos D. Pulmonary Function and Quality of Life in Adults with Cystic Fibrosis. Lung 2023; 201:635-639. [PMID: 37973684 DOI: 10.1007/s00408-023-00658-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 11/09/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE People living with cystic fibrosis (CF) experience impaired quality of life, but the extent to which pulmonary function is associated with quality of life in CF remains unclear METHODS: Using baseline data from a trial of specialist palliative care in adults with CF, we examined the association between pulmonary obstruction and quality of life (measured with the Functional Assessment of Chronic Illness Therapy Total Score). RESULTS Among 262 participants, median age was 33, and 78% were on modulator therapy. The median quality of life score was higher in those with mild obstruction (135, IQR 110-156) compared to moderate (125, IQR 109-146) and severe obstruction (120, IQR 106-136). In an unadjusted model, we observed a non-significant trend toward lower quality of life with increased obstruction-compared to participants with mild obstruction, those with moderate obstruction had quality of life score 7.46 points lower (95% CI -15.03 to 0.10) and those with severe obstruction had a score 9.98 points lower (95% CI -21.76 to 1.80). However, this association was no longer statistically significant in the adjusted model, which may reflect confounding due to sex, age, BMI, and modulator therapy. Comorbidities (depression and anxiety) and social determinants of health (financial insecurity and education) were also associated with quality of life. CONCLUSION Advancing our understanding of patient-centered markers of quality of life, rather than focusing on pulmonary function alone, may help identify novel interventions to improve quality of life in this patient population.
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Affiliation(s)
- Natalia Smirnova
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Emory University, AllergyAtlanta, GA, USA
| | - Jane Lowers
- Division of Palliative Medicine, Department of Family and Preventive Medicine, Emory University, Atlanta, GA, USA
| | - Matthew J Magee
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Sara C Auld
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Emory University, AllergyAtlanta, GA, USA
| | - William R Hunt
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Emory University, AllergyAtlanta, GA, USA
| | - Anne Fitzpatrick
- Department of Pediatrics, Emory University, Randall Rollins Building, #R544, 1516 Clifton Road, NE, Atlanta, GA, 30322, USA
| | - Vibha Lama
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Emory University, AllergyAtlanta, GA, USA
| | - Dio Kavalieratos
- Division of Palliative Medicine, Department of Family and Preventive Medicine, Emory University, Atlanta, GA, USA.
- Rollins School of Public Health, Emory University, Atlanta, GA, USA.
- Department of Pediatrics, Emory University, Randall Rollins Building, #R544, 1516 Clifton Road, NE, Atlanta, GA, 30322, USA.
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6
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Smirnova N, Trandel ET, Dubin E, Lowers J, Dellon EP, Hempstead S, Faro A, Tallarico E, Kavalieratos D. Clinician perspectives on barriers and solutions to symptom management in cystic fibrosis. J Cyst Fibros 2023; 22:1100-1103. [PMID: 37263825 PMCID: PMC10687299 DOI: 10.1016/j.jcf.2023.05.016] [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: 02/09/2023] [Revised: 05/16/2023] [Accepted: 05/28/2023] [Indexed: 06/03/2023]
Abstract
People living with cystic fibrosis (PLwCF) experience high symptom burden. 146 clinicians completed online surveys regarding barriers and solutions to symptom management between September and October 2020. The surveys contained both closed-ended and free-text entries. The symptom management specialists that CF clinicians most wished to consult included mental health (88, 65%), palliative care (59, 41%), and pain specialists (48, 33%). Barriers to symptom management included concerns about controlled substances prescribed for symptom control causing addiction and precluding transplantation, a lack of trust and collaboration among clinical specialties, a lack of symptom management specialists with CF expertise, and a worry about the affordability of specialist-level symptom management care. Potential solutions included non-pharmacological approaches, expanding access to affordable specialist symptom management care, the creation of clinical care guidelines for symptom management in CF, and having CF clinicians and symptom management specialists work alongside each other in CF clinic to build interdisciplinary trust and education.
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Affiliation(s)
- Natalia Smirnova
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, Emory University, Atlanta, GA, United States.
| | | | - Ethan Dubin
- Rollins School of Public Health, Emory University, Atlanta, GA, United States; Division of Palliative Medicine, Department of Family and Preventive Medicine, Emory University, Atlanta, GA, United States
| | - Jane Lowers
- Division of Palliative Medicine, Department of Family and Preventive Medicine, Emory University, Atlanta, GA, United States
| | - Elisabeth P Dellon
- Department of Pediatrics, UNC Chapel Hill, Chapel Hill, NC, United States
| | | | - Albert Faro
- Cystic Fibrosis Foundation, Bethesda, MD, United States
| | | | - Dio Kavalieratos
- Rollins School of Public Health, Emory University, Atlanta, GA, United States; Division of Palliative Medicine, Department of Family and Preventive Medicine, Emory University, Atlanta, GA, United States; Department of Pediatrics, Emory University, Atlanta, GA, United States
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7
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Wang X, Mo Y, Yuan Y, Zhou Y, Chen Y, Sheng J, Liu J. Exploring the influencing factors of unmet palliative care needs in Chinese patients with end-stage renal disease undergoing maintenance hemodialysis: a cross-sectional study. BMC Palliat Care 2023; 22:113. [PMID: 37543565 PMCID: PMC10403855 DOI: 10.1186/s12904-023-01237-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 07/29/2023] [Indexed: 08/07/2023] Open
Abstract
BACKGROUND The role of palliative care for end-stage renal disease (ESRD) patients have been proven in some developed countries, but it is still unclear in the mainland of China. In fact, patients with ESRD experience many unmet palliative care needs, such as physical, psychological, social and spiritual needs, but the factors influencing these needs have not investigated. METHODS A cross-sectional study was conducted at two hemodialysis centers in the mainland of China from January to September 2022. Convenience sampling was used to collect data on the participants' socio-demographics, clinical characteristics, the Palliative Care Outcome Scale (POS), the Dialysis Symptom Index (DSI), the Karnofsky Performance Status Scale (KPS), the Patient Health Questionnaire-9 item (PHQ-9), and the Social Support Rate Scale (SSRS). Data were analyzed using latent profile analysis, Kruskal-Wallis test, one-way analysis of variance (ANOVA), the chi-square test and multinomial logistic regression analysis. RESULTS Three hundred five participants were included in this study, and divided palliative care needs into three categories: Class 1, mild palliative care needs (n = 154, 50.5%); Class 2, moderate palliative care needs (n = 89, 29.2%); Class 3, severe palliative care needs (n = 62, 20.3%). Based on the analysis of three profiles, the influencing factors of unmet needs were further analyzed. Compared with Class 3, senior high school education, the household per capita monthly income < 2,000, low KPS scores, high PHQ-9 scores, and low SSRS scores were less likely to be in Class 1 (OR = 0.03, P = 0.012; OR = 0.003, P < 0.001; OR = 1.15, P < 0.001; OR = 0.55, P < 0.001; OR = 1.35, P = 0.002; respectively) and Class 2 (OR = 0.03, P = 0.007; OR = 0.05, P = 0.011; OR = 1.10, P = 0.001; OR = 0.60, P = 0.001; OR = 1.32, P = 0.003; respectively), and high symptom severity were less likely to be in Class 1 (OR = 0.82, P = 0.001). Moreover, compared with Class 1, the household per capita monthly income < 2,000 (OR = 16.41, P < 0.001), high symptom severity scores (OR = 1.12, P = 0.002) and low KPS scores (OR = 0.95, P = 0.002) were more likely to be in Class 2. CONCLUSIONS This study showed that almost half of ESRD patients receiving MHD presented moderate to severe palliative care needs, and the unmet needs were mainly affected by education level, financial pressure, functional status, symptom burden and social support. In the future, it is important to identify the populations with the greatest need for palliative care and consider the influencing factors of unmet needs from a comprehensive perspective, so as to help them improve health-related quality of life.
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Affiliation(s)
- Xuefei Wang
- Jiangsu Province Official Hospital, Nanjing, Jiangsu, China
| | - Yongzhen Mo
- Jiangsu Province Official Hospital, Nanjing, Jiangsu, China.
| | - Yingying Yuan
- School of Nursing, Department of Medicine, Soochow University, Suzhou, Jiangsu, China
| | - Yi Zhou
- School of Nursing, Department of Medicine, Soochow University, Suzhou, Jiangsu, China
| | - Yan Chen
- Jiangsu Province Official Hospital, Nanjing, Jiangsu, China
| | - Juan Sheng
- Jiangsu Province Official Hospital, Nanjing, Jiangsu, China
| | - Jing Liu
- Nanjing BenQ Medical Center, Nanjing, Jiangsu, China
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8
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DiFiglia S, Dhingra L, Georgiopoulos AM, Papia K, Sullivan E, Plachta A, Boccio C, Portenoy R, Basile M. Addressing Symptom Burden and Palliative Care Needs in Cystic Fibrosis: A Narrative Review of the Literature. Life (Basel) 2023; 13:1620. [PMID: 37629478 PMCID: PMC10455429 DOI: 10.3390/life13081620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 07/06/2023] [Accepted: 07/18/2023] [Indexed: 08/27/2023] Open
Abstract
Among people with cystic fibrosis (CF), illness burden is multifaceted, and symptoms may fluctuate in intensity across a lifespan. Caregivers of people with CF may also experience distressing symptoms. Recent developments in CF care, including the availability of highly effective modulator therapies (HEMTs) and new palliative care guidelines promoting palliative care screening may help alleviate symptoms. The objective of this review was to present a narrative view of the recent literature on symptom burden in CF, new screening approaches informed by the Cystic Fibrosis Foundation (CFF) palliative care guidelines, and early data from studies examining the impact of HEMTs on CF symptom burden. A review of the relevant literature was conducted using Google Scholar and PubMed. Included articles covered approaches to burden assessment in CF and other chronic illnesses, epidemiology of CF symptom burden, the impact of HEMTs on symptom burden, and the CFF palliative care guidelines. A primary palliative care model implementing the CFF guidelines was also described. Results of this review show that while recent developments in CF care have led to a reduction in physical symptoms, mental health symptoms remain prevalent. Ongoing screening and triage can ensure that physical symptoms, psychological symptoms, social needs, practical problems, and communication concerns are addressed by care teams.
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Affiliation(s)
- Stephanie DiFiglia
- MJHS Institute for Innovation in Palliative Care, New York, NY 10006, USA; (S.D.); (L.D.); (R.P.)
| | - Lara Dhingra
- MJHS Institute for Innovation in Palliative Care, New York, NY 10006, USA; (S.D.); (L.D.); (R.P.)
- Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Anna M. Georgiopoulos
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA;
- Harvard Medical School, Boston, MA 02115, USA
| | - Katherine Papia
- Cystic Fibrosis Center, Northwell Health, New Hyde Park, NY 11042, USA; (K.P.); (E.S.); (C.B.)
| | - Erin Sullivan
- Cystic Fibrosis Center, Northwell Health, New Hyde Park, NY 11042, USA; (K.P.); (E.S.); (C.B.)
| | - Amy Plachta
- Cystic Fibrosis Center, Lennox Hill, New York, NY 10021, USA;
| | - Courtney Boccio
- Cystic Fibrosis Center, Northwell Health, New Hyde Park, NY 11042, USA; (K.P.); (E.S.); (C.B.)
| | - Russell Portenoy
- MJHS Institute for Innovation in Palliative Care, New York, NY 10006, USA; (S.D.); (L.D.); (R.P.)
- Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, NY 10461, USA
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Melissa Basile
- Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY 11030, USA
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9
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Kavalieratos D, Lowers J, Moreines LT, Hoydich ZP, Arnold RM, Yabes JG, Richless C, Ikejiani DZ, Teuteberg W, Pilewski JM. Embedded Specialist Palliative Care in Cystic Fibrosis: Results of a Randomized Feasibility Clinical Trial. J Palliat Med 2023; 26:489-496. [PMID: 36350712 PMCID: PMC10066777 DOI: 10.1089/jpm.2022.0349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2012] [Indexed: 11/10/2022] Open
Abstract
Background: Cystic fibrosis (CF) is a progressive genetic disease characterized by multisystem symptom burden. Specialist palliative care (PC), as a model of care, has been shown to be effective in improving quality of life and reducing symptom burden in other conditions, but has not been tested in CF. Objectives: To develop and test the feasibility and acceptability of a specialist PC intervention embedded within an outpatient CF clinic. Design: Single-site, equal-allocation randomized pilot study comparing usual care with addition of four protocolized quarterly visits with a PC nurse practitioner. Participants: Adults with CF age ≥18 years with any of the following: FEV1% predicted ≤50, ≥2 CF-related hospitalizations in the past 12 months, supplemental oxygen use, or noninvasive mechanical ventilation use, and moderate-or-greater severity of any symptoms on the Edmonton Symptom Assessment Scale. Measurements: Randomization rate, intervention visit completion, data completements, participant ratings of intervention acceptability and benefit, and intervention delivery fidelity. Results: We randomized 50 adults with CF of 65 approached (77% randomization rate) to intervention (n = 25) or usual care (n = 25), mean age 38, baseline mean FEV1% predicted 41.8 (usual care), and 41.2 (intervention). No participants withdrew, five were lost to follow-up, and two died (88% retention). In the intervention group, 23 of 25 completed all study visits; 94% stated the intervention was not burdensome, and 97.6% would recommend the intervention to others with CF. More than 90% of study visits addressed topics prescribed by intervention manual. Conclusions: Adding specialist PC to standard clinic visits for adults with CF is feasible and acceptable.
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Affiliation(s)
| | - Jane Lowers
- Emory University School of Medicine, Atlanta, Georgia, USA
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10
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Basile MJ, Dhingra L, DiFiglia S, Polo J, Portenoy R, Wang J, Walker P, Middour-Oxler B, Linnemann RW, Kier C, Friedman D, Berdella M, Abdullah R, Yonker LM, Markovitz M, Hadjiliadis D, Shiffman M, Fischer F, Pollinger S, Hardcastle M, Chaudhary N, Georgiopoulos AM. Development of a Cystic Fibrosis Primary Palliative Care Intervention: Qualitative Analysis of Patient and Family Caregiver Preferences. J Patient Exp 2023; 10:23743735231161486. [PMID: 36936380 PMCID: PMC10021085 DOI: 10.1177/23743735231161486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
To prevent or mitigate chronic illness burden, people with cystic fibrosis (pwCF) and their family caregivers need primary (generalist-level) palliative care from the time of diagnosis forward. We used qualitative methods to explore their preferences about a screening-and-triage model ("Improving Life with CF") developed to standardize this care. We purposively sampled and interviewed 14 pwCF and caregivers from 5 Improving Life with CF study sites. Thematic analysis was guided by a priori codes using the National Consensus Project's Guidelines for Quality Palliative Care. Participants included 7 adults and 2 adolescents with CF (3 with advanced disease), 4 parents, 1 partner (7 women; 5 people of color). Few were familiar with palliative care. Illness burden was described in multiple domains, including physical (e.g., dyspnea, pain), psychological (e.g., anxiety), and social (e.g., family well-being; impact on work/school). Most preferred survey-based screening with care coordination by the CF team. Preferences for screening approaches varied. PwCF and caregivers experience illness burden and are receptive to a CF-team delivered primary palliative care screening-and-triage model with flexible processes.
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Affiliation(s)
- Melissa J Basile
- Feinstein Institutes for Medical Research, Northwell Health, New
York, NY, USA
- Melissa J Basile, Center for Health
Innovations and Outcomes Research, Feinstein Institutes for Medical Research,
Northwell Health, New York, NY, USA.
| | - Lara Dhingra
- MJHS Institute for Innovation in Palliative Care, New York, NY,
USA
- Department of Family and Social Medicine,
Albert Einstein
College of Medicine, Bronx, NY, USA
| | | | - Jennifer Polo
- Feinstein Institutes for Medical Research, Northwell Health, New
York, NY, USA
| | - Russell Portenoy
- MJHS Institute for Innovation in Palliative Care, New York, NY,
USA
- Department of Family and Social Medicine, Department of Neurology,
Albert Einstein
College of Medicine, Bronx, NY, USA
| | - Janice Wang
- Division of Pulmonary, Critical Care and Sleep Medicine,
Donald and
Barbara Zucker School of Medicine at
Hofstra/Northwell, New Hyde Park, NY, USA
| | - Patricia Walker
- Department of Pulmonary Medicine, Icahn School of Medicine at Mount
Sinai, New York, NY, USA
| | - Brandi Middour-Oxler
- Division of Pulmonary, Asthma, Cystic Fibrosis and Sleep, Department
of Pediatrics, Emory
University, Atlanta, GA, USA
- Department of Pediatrics, Children's Healthcare of Atlanta, Atlanta,
GA, USA
| | - Rachel W Linnemann
- Division of Pulmonary, Asthma, Cystic Fibrosis and Sleep, Department
of Pediatrics, Emory
University, Atlanta, GA, USA
- Department of Pediatrics, Children's Healthcare of Atlanta, Atlanta,
GA, USA
| | - Catherine Kier
- Department of Pediatrics, Stony Brook University Medical
Center, Stony Brook, NY, USA
| | - Deborah Friedman
- Department of Psychiatry, Massachusetts General
Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical
School, Boston, MA, USA
| | - Maria Berdella
- Department of Pulmonary Medicine, Icahn School of Medicine at Mount
Sinai, New York, NY, USA
| | - Robert Abdullah
- Department of Pediatrics, Stony Brook University Medical
Center, Stony Brook, NY, USA
| | - Lael M Yonker
- Department of Psychiatry, Massachusetts General
Hospital, Boston, MA, USA
- Pulmonary Division, Massachusetts General Hospital for Children,
Boston, MA, USA
| | - Martha Markovitz
- Keck Medicine of University of Southern California, Los Angeles,
California, USA (retired)
| | - Denis Hadjiliadis
- Division of Pulmonary and Critical Care Medicine, Department of
Medicine, Hospital of
the University of Pennsylvania,
Philadelphia, PA, USA
| | | | | | - Sophie Pollinger
- Department of Pediatrics, Massachusetts General
Hospital, Boston, MA, USA
| | - Margot Hardcastle
- Department of Pediatrics, Massachusetts General
Hospital, Boston, MA, USA
| | - Nivedita Chaudhary
- Department of Pediatrics, Massachusetts General
Hospital, Boston, MA, USA
| | - Anna M Georgiopoulos
- Department of Psychiatry, Massachusetts General
Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical
School, Boston, MA, USA
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11
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Lowers J, Dellon EP, Stephenson A, Arnold R, Althouse A, Jeong K, Dubin E, Soodalter J, Hovater C, Bakitas M, Goggin J, Hunt W, Ladores S, Curseen K, Winter G, Solomon G, Ailon J, Conrad D, Kavalieratos D. Integrating specialist palliative care to improve care and reduce suffering: cystic fibrosis (InSPIRe:CF) - study protocol for a multicentre randomised clinical trial. BMJ Open Respir Res 2022; 9:9/1/e001381. [PMID: 36126995 PMCID: PMC9490626 DOI: 10.1136/bmjresp-2022-001381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 09/11/2022] [Indexed: 11/20/2022] Open
Abstract
Introduction Cystic fibrosis (CF) is a life-limiting genetic disorder estimated to affect more than 160 000 individuals and their families worldwide. People living with CF commonly experience significant physical and emotional symptom burdens, disruptions to social roles and complex treatment decision making. While palliative care (PC) interventions have been shown to relieve many such burdens in other serious illnesses, no rigorous evidence exists for palliative care in CF. Thus, this study aims to compare the effect of specialist palliative care plus usual CF care vs usual CF care alone on patient quality of life. Methods and analysis This is a five-site, two-arm, partially masked, randomised superiority clinical trial. 264 adults with CF will be randomly assigned to usual CF care or usual CF care plus a longitudinal palliative care intervention delivered by a palliative care specialist. The trial’s primary outcome is patient quality of life (measured with the Functional Assessment of Chronic Illness Therapy-Palliative care instrument). Secondary outcomes include symptom burden, satisfaction with care and healthcare utilisation. Outcomes will be measured at 12 months (primary endpoint) and 15 months (secondary endpoint). In addition, we will conduct qualitative interviews with patient participants, caregivers, and palliative care and CF care team members to explore perceptions of the intervention’s impact and barriers and facilitators to dissemination. Ethics and dissemination Human subjects research ethics approval was obtained from all participating sites, and all study participants gave informed consent. We will publish the results of this trial in a peer-reviewed journal. Trial registration number ISRCTN53323164.
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Affiliation(s)
- Jane Lowers
- Family and Preventive Medicine, Emory University, Atlanta, Georgia, USA
| | - Elisabeth P Dellon
- Pediatrics, The University of North Carolina, School of Medicine, Chapel Hill, North Carolina, USA
| | | | - Robert Arnold
- General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Andrew Althouse
- General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Kwonho Jeong
- General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ethan Dubin
- Family and Preventive Medicine, Emory University, Atlanta, Georgia, USA
| | - Jesse Soodalter
- Family and Preventive Medicine, Emory University, Atlanta, Georgia, USA
| | - Cade Hovater
- Family and Preventive Medicine, Emory University, Atlanta, Georgia, USA
| | - Marie Bakitas
- School of Nursing, The University of Alabama, Birmingham, Alabama, USA
| | - Jessica Goggin
- Medicine, University of California, La Jolla, California, USA
| | | | - Sigrid Ladores
- School of Nursing, The University of Alabama, Birmingham, Alabama, USA
| | - Kimberly Curseen
- Family and Preventive Medicine, Emory University, Atlanta, Georgia, USA
| | | | - George Solomon
- Medicine, The University of Alabama, Birmingham, AL, USA
| | - Jonathan Ailon
- Medicine, St Michael's Hospital, Toronto, Ontario, Canada
| | - Douglas Conrad
- Medicine, University of California, La Jolla, California, USA
| | - Dio Kavalieratos
- Family and Preventive Medicine, Emory University, Atlanta, Georgia, USA
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12
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Dubin E, Lowers J, Dellon EP, Hempstead S, Faro A, Tallarico E, Fitzpatrick A, Hunt WR, Kavalieratos D. Prevalence of unmet pain and symptom management needs in adults with cystic fibrosis. J Cyst Fibros 2022; 22:352-355. [PMID: 35973901 DOI: 10.1016/j.jcf.2022.08.006] [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] [Received: 05/10/2022] [Revised: 08/05/2022] [Accepted: 08/09/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Although people living with CF (PLwCF) commonly report pain and other symptoms, little is known regarding their experiences of living with and accessing treatment for burdensome symptoms. METHODS PLwCF completed online questionnaires assessing symptom prevalence and distress and were also asked about experiences accessing pain and symptom treatment, using both closed-ended and free-text entries. RESULTS Pain was the most prevalent symptom experienced among the 55 participants (76%) and the symptom that most commonly caused distress (64%). PLwCF not on CFTR modulator therapy were likelier to endorse pain as distressing (p = 0.007). Respondents expressed that their pain was commonly underrecognized and undermanaged, they desired a multi-modal approach to treatment, and noted concerns about disease progression affecting their symptom management options. CONCLUSIONS Our study suggests that PLwCF often have unmet symptom management needs that may impair quality of life.
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Affiliation(s)
- Ethan Dubin
- Rollins School of Public Health, Emory University, Atlanta, GA, United States; Division of Palliative Medicine, Department of Family and Preventive Medicine, Emory University, Atlanta, GA, United States
| | - Jane Lowers
- Division of Palliative Medicine, Department of Family and Preventive Medicine, Emory University, Atlanta, GA, United States
| | - Elisabeth P Dellon
- Department of Pediatrics, UNC Chapel Hill, Chapel Hill, NC, United States
| | | | - Albert Faro
- Cystic Fibrosis Foundation, Bethesda, MD, United States
| | | | - Anne Fitzpatrick
- Department of Pediatrics, Emory University, Atlanta, GA, United States
| | - William R Hunt
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, Emory University, Atlanta, GA, United States
| | - Dio Kavalieratos
- Rollins School of Public Health, Emory University, Atlanta, GA, United States; Division of Palliative Medicine, Department of Family and Preventive Medicine, Emory University, Atlanta, GA, United States; Department of Pediatrics, Emory University, Atlanta, GA, United States.
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13
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Waller A, Hobden B, Fakes K, Clark K. A Systematic Review of the Development and Implementation of Needs-Based Palliative Care Tools in Heart Failure and Chronic Respiratory Disease. Front Cardiovasc Med 2022; 9:878428. [PMID: 35498028 PMCID: PMC9043454 DOI: 10.3389/fcvm.2022.878428] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 03/25/2022] [Indexed: 11/19/2022] Open
Abstract
Background The impetus to develop and implement tools for non-malignant patient groups is reflected in the increasing number of instruments being developed for heart failure and chronic respiratory diseases. Evidence syntheses of psychometric quality and clinical utility of these tools is required to inform research and clinical practice. Aims This systematic review examined palliative care needs tools for people diagnosed with advanced heart failure or chronic respiratory diseases, to determine their: (1) psychometric quality; and (2) acceptability, feasibility and clinical utility when implemented in clinical practice. Methods Systematic searches of MEDLINE, CINAHL, Embase, Cochrane and PsycINFO from database inception until June 2021 were undertaken. Additionally, the reference lists of included studies were searched for relevant articles. Psychometric properties of identified measures were evaluated against pre-determined and standard criteria. Results Eighteen tools met inclusion criteria: 11 were developed to assess unmet patient palliative care needs. Of those, 6 were generic, 4 were developed for heart failure and 1 was developed for interstitial lung disease. Seven tools identified those who may benefit from palliative care and include general and disease-specific indicators. The psychometric qualities of the tools varied. None met all of the accepted criteria for psychometric rigor in heart failure or respiratory disease populations. There is limited implementation of needs assessment tools in practice. Conclusion Several tools were identified, however further validation studies in heart failure and respiratory disease populations are required. Rigorous evaluation to determine the impact of adopting a systematic needs-based approach for heart failure and lung disease on the physical and psychosocial outcomes of patients and carers, as well as the economic costs and benefits to the healthcare system, is required.
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Affiliation(s)
- Amy Waller
- Health Behaviour Research Collaborative, College of Health Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- *Correspondence: Amy Waller
| | - Breanne Hobden
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Kristy Fakes
- Health Behaviour Research Collaborative, College of Health Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Katherine Clark
- Northern Sydney Local Health District (NSLHD) Supportive and Palliative Care Network, St Leonards, NSW, Australia
- Northern Clinical School, The University of Sydney, Darlington, NSW, Australia
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW, Australia
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14
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Nolley E, Morrell M. The role of palliative care in lung transplantation. J Thorac Dis 2021; 13:6737-6746. [PMID: 34992849 PMCID: PMC8662469 DOI: 10.21037/jtd-2021-27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 07/15/2021] [Indexed: 11/18/2022]
Abstract
Lung transplantation confers meaningful benefit for patients by extending life and improving quality of life. Palliative care is a medical specialty that likewise aims to improve the quality of life of patients enduring serious illness and their caregivers. Yet, while transplant candidates and recipients face serious illness they rarely receive palliative care, even at end of life. While limited palliative care utilization is likely multifactorial, one key reason is a limited understanding of the specialty of palliative care and evidence for palliative interventions. In this review, we address this key barrier by discussing in depth what the specialty of palliative care is and provides to patients and their caregivers. We then discuss the growing evidence for palliative care interventions to improve quality of life and reduce symptom burdens in patients with malignancy including those undergoing bone marrow transplantation and patients with chronic organ failure. We then consider what palliative care needs exist across pre and post transplantation based on studies of palliative care needs of patients with end stage lung disease, studies of quality of life after lung transplantation, and limited studies of palliative care utilization pre and post lung transplantation. Finally, we consider different models of palliative care and discuss how palliative care might optimally be incorporated in lung transplantation using a longitudinal, integrated approach to palliative care.
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Affiliation(s)
- Eric Nolley
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, John’s Hopkins University, Baltimore, MD, USA
| | - Matt Morrell
- Division of Pulmonary Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
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15
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Sharma PB, Sathe M, Savant AP. Year in Review 2020: Multisystemic impact of cystic fibrosis. Pediatr Pulmonol 2021; 56:3110-3119. [PMID: 34324789 DOI: 10.1002/ppul.25584] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 07/13/2021] [Accepted: 07/14/2021] [Indexed: 12/13/2022]
Abstract
Clinical care in cystic fibrosis (CF) has continued to advance over the last several years, particularly with the widespread eligibility and use of highly effective modulator therapy. Improved outcomes and longevity of persons with CF (PwCF) have increased recognition of the multisystem impact of the disease on the daily lives of PwCF. This review will cover a broad array of topics, from diagnosis to multisystem effects related to mental health, endocrine, palliative care, reproductive health, otolaryngology, and cardiac issues. Additionally, worldwide care delivery will be reviewed, demonstrating variation in outcomes based on resources and populations served. This review is part of the CF Year in Review 2020 series, focusing on the multi-system effects of CF. This review focuses on articles from Pediatric Pulmonology but also includes articles published in 2020 from other journals that are of particular interest to clinicians.
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Affiliation(s)
- Preeti B Sharma
- Department of Pediatrics, Division of Pulmonary and Sleep Medicine, University of Texas Southwestern and Children's Health, Dallas, Texas, USA
| | - Meghana Sathe
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, University of Texas Southwestern and Children's Health, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Adrienne P Savant
- Department of Pediatrics, Division of Pulmonary Medicine, Tulane University School of Medicine, Children's Hospital of New Orleans, New Orleans, Louisiana, USA
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16
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Mingora CM, Flume PA. Pulmonary Complications in Cystic Fibrosis: Past, Present, and Future. Chest 2021; 160:1232-1240. [PMID: 34147501 DOI: 10.1016/j.chest.2021.06.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 03/14/2021] [Accepted: 06/14/2021] [Indexed: 12/22/2022] Open
Abstract
Cystic fibrosis (CF) is an autosomal recessive genetic condition with multisystemic disease manifestations, the most prominent of which occur in the respiratory system. Despite significant developments in disease understanding and therapeutics, each contributing to improved lung function and survival in patients with CF, several pulmonary complications, including pneumothorax, massive hemoptysis, and respiratory failure, continue to occur. In this review, we briefly describe each of these complications and their management and discuss how they impact the care and disease trajectory of individuals in whom they occur. Finally, we discuss the evolving role that palliative care and CF transmembrane conductance regular modulator therapies play in the natural disease course and care of patients with CF.
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Affiliation(s)
- Christina M Mingora
- Department of Medicine, Medical University of South Carolina, Charleston, SC.
| | - Patrick A Flume
- Department of Medicine, Medical University of South Carolina, Charleston, SC
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17
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Basile M, Jojan L, Hobler MR, Dellon EP, Georgiopoulos AM, Goggin JL, Chen E, Goss CH, Hempstead SE, Faro A, Kavalieratos D. Assessing Practices, Beliefs, and Attitudes about Palliative Care among People with Cystic Fibrosis, Their Caregivers, and Clinicians: Results of a Content Analysis. J Palliat Med 2021; 24:1650-1656. [PMID: 33885355 DOI: 10.1089/jpm.2020.0725] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Individuals with cystic fibrosis (CF) experience symptoms affecting quality of life and may benefit from palliative care (PC). Objectives: To present results of content analysis from open-ended survey questions assessing knowledge and experiences with PC among CF stakeholders. Design, Setting, Subjects: Online surveys were sent to CF stakeholders through CF-specific listservs predominantly in the United States. Measurements: Responses to five open-ended questions about CF PC-delivery, health care provider training, and lung transplant-underwent content analysis. Responses were coded using NVivo12 Software™. Results: Forty-eight CF adults, 59 caregivers, and 229 providers responded to the open-ended survey questions. Analysis showed 5 primary categories related to CF PC: (1) stakeholder perceptions of PC for CF, (2) delivering PC to people with CF, (3) conversations about PC for CF, (4) perceptions that PC services are underutilized for people with CF, and (5) beliefs that PC services are critical for people with CF considering or pursuing lung transplant. Analysis showed variation among and within groups in defining PC for CF, when, and how to deliver it. Many respondents felt PC was underutilized in CF. Most saw PC as particularly important when considering lung transplant, managing anxiety around transplant, and for goals of care discussions. Some believed PC and lung transplant were mutually exclusive. Conclusion: Respondents felt PC is underutilized for CF, and that people with CF may miss out on the benefits of PC. Among stakeholders, respondents felt people with CF would benefit from access to primary and secondary PC services.
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Affiliation(s)
| | - Lincy Jojan
- Molloy College, Rockville Centre, New York, USA
| | | | | | | | | | - Elaine Chen
- Rush University Medical Center, Chicago, Illinois, USA
| | | | | | - Albert Faro
- Cystic Fibrosis Foundation, Bethesda, Maryland, USA
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Kapnadak SG, Ramos KJ, Dellon EP. Enhancing care for individuals with advanced cystic fibrosis lung disease. Pediatr Pulmonol 2021; 56 Suppl 1:S69-S78. [PMID: 32609949 DOI: 10.1002/ppul.24937] [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] [Received: 04/20/2020] [Revised: 06/12/2020] [Accepted: 06/12/2020] [Indexed: 11/09/2022]
Abstract
While remarkable advances in cystic fibrosis (CF) care have led to improvements in survival and quality of life, many individuals with CF are living with advanced cystic fibrosis lung disease (ACFLD) and others will face continued disease progression and its associated complex treatments and choices. This review will provide a summary of recently published guidelines for ACFLD care and lung transplant referral and highlight ongoing work to enhance the care of those with ACFLD through improvements in medical and psychosocial care, palliative care, and care around lung transplantation.
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Affiliation(s)
- Siddhartha G Kapnadak
- Division of Pulmonary, Department of Medicine, Critical Care, and Sleep Medicine, University of Washington, Seattle, Washington
| | - Kathleen J Ramos
- Division of Pulmonary, Department of Medicine, Critical Care, and Sleep Medicine, University of Washington, Seattle, Washington
| | - Elisabeth P Dellon
- Division of Pulmonology, Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina
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19
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Kavalieratos D, Georgiopoulos AM, Dhingra L, Basile MJ, Rabinowitz E, Hempstead SE, Faro A, Dellon EP. Models of Palliative Care Delivery for Individuals with Cystic Fibrosis: Cystic Fibrosis Foundation Evidence-Informed Consensus Guidelines. J Palliat Med 2020; 24:18-30. [PMID: 32936045 PMCID: PMC7757696 DOI: 10.1089/jpm.2020.0311] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Cystic fibrosis (CF) affects more than 70,000 individuals and their families worldwide. Although outcomes for individuals with CF continue to improve, it remains a life-limiting condition with no cure. Individuals with CF manage extensive symptom and treatment burdens and face complex medical decisions throughout the illness course. Although palliative care has been shown to reduce suffering by alleviating illness-related burdens for people with serious illness and their families, little is known regarding the components and structure of various delivery models of palliative care needed to improve outcomes for people affected by CF. The Cystic Fibrosis Foundation (CFF) assembled an expert panel of clinicians, researchers, individuals with CF, and family caregivers, to develop consensus recommendations for models of best practices for palliative care in CF. Eleven statements were developed based on a systematic literature review and expert opinion, and address primary palliative care, specialty palliative care, and screening for palliative needs. These recommendations are intended to comprehensively address palliative care needs and improve quality of life for individuals with CF at all stages of illness and development, and their caregivers.
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Affiliation(s)
- Dio Kavalieratos
- Division of Palliative Medicine, Department of Family and Preventive Medicine, Emory University, Atlanta, Georgia, USA
| | - Anna M Georgiopoulos
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Lara Dhingra
- MJHS Institute for Innovation in Palliative Care, New York, New York, USA.,Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Melissa J Basile
- Department of Medicine, Northwell Health, Manhasset, New York, USA
| | | | | | - Albert Faro
- Cystic Fibrosis Foundation, Bethesda, Maryland, USA
| | - Elisabeth P Dellon
- Department of Pediatrics, University of North Carolina, Chapel Hill, North Carolina, USA
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