1
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Antibiotic use during end-of-life care: A systematic literature review and meta-analysis. Infect Control Hosp Epidemiol 2020; 42:523-529. [PMID: 33172507 DOI: 10.1017/ice.2020.1241] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND We performed a systematic literature review and meta-analysis measuring the burden of antibiotic use during end-of-life (EOL) care. METHODS We searched PubMed, CINAHL (EBSCO platform), and Embase (Elsevier platform), through July 2019 for studies with the following inclusion criteria in the initial analysis: antibiotic use in the EOL care patients (advanced dementia, cancer, organ failure, frailty or multi-morbidity). If the number of patients in palliative care consultation (PCC) was available, antibiotic use data were pooled to compare the proportion of patients who received antibiotics under PCC compared to those not receiving PCC. Random-effect models were used to obtain pooled mean differences, and heterogeneity was assessed using the I2 value. RESULTS Overall, 72 studies met the inclusion criteria and were included in the final review: 22 EOL studies included only patients with cancer; 17 studies included only patients with advanced dementia; and 33 studies included "mixed populations" of EOL patients. Although few studies reported antibiotic using standard metrics (eg, days of therapy), 48 of 72 studies (66.7%) reported antibiotic use in >50% of all patients. When the 3 studies that evaluated antibiotic use in PCC were pooled together, patients under PCC was more likely to receive antibiotics compared to patients not under PCC (pooled odds ratio, 1.73; 95% CI, 1.02-2.93). CONCLUSIONS Future studies are needed to evaluate the benefits and harms of using antibiotics for patients during EOL care in diverse patient populations.
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2
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Patients With Fibrotic Interstitial Lung Disease Receive Supportive and Palliative Care Just Prior to Death. Am J Hosp Palliat Care 2020; 38:154-160. [DOI: 10.1177/1049909120938629] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Background: Fibrotic interstitial lung diseases (f-ILDs) are often progressive and incurable. As patients experience significant symptoms and have a poor prognosis, early palliative care referral is recommended. Objective: To examine the care delivered to patients with f-ILD during the terminal hospital admission and the past 2 years of life. Methods: A retrospective audit was performed for consecutive patients who died from f-ILD at 2 Australian teaching hospitals between January 1, 2012, and December 31, 2016. Results: Of 67 patients, 44 (66%) had idiopathic pulmonary fibrosis. Median age was 78 years. Median respiratory function: forced expiratory volume in 1 second 69.0% predicted (interquartile range [IQR]: 58.0%-77.0%), forced vital capacity 64.0% predicted (IQR = 46.8%-74.3%), and diffusing capacity of carbon monoxide 36.0% predicted (IQR = 31.0%-44.0%). In the 2 years prior to the terminal admission, 38 (57%) patients reported severe breathlessness and 17 (25%) used opioids for symptom relief. Twenty-four (36%) patients received specialist palliative care (SPC) and 11 (16%) completed advance care planning. During the terminal admission, 10 (15%) patients were admitted directly under SPC. A further 33 (49%) patients were referred to SPC, on average 1 day prior to death. Sixty-three (94%) patients received opioids and 49 (73%) received benzodiazepines for symptom management. Median starting and final opioid doses were 10 and 23 mg oral morphine equivalent/24 hours, respectively. Opioids were commenced on average 2 (IQR 1-3) days prior to death. Conclusions: Although most patients were identified as actively dying in the final admission, referral to SPC and use of palliative medications occurred late. Additionally, few patients accessed symptom palliation earlier in their illness.
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3
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Lange AV, Rueschhoff A, Terauchi S, Cohen L, Reisch J, Jain R, Finklea JD. End-of-Life Care in Cystic Fibrosis: Comparing Provider Practices Based on Lung Transplant Candidacy. J Palliat Med 2020; 23:1606-1612. [PMID: 32380886 DOI: 10.1089/jpm.2019.0304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: The optimal timing to introduce palliative care (PC) and end-of-life (EOL) conversations into the lives of people with cystic fibrosis (CF) has not been established. Objective: Compare EOL care practices for people with CF who died without a lung transplant (LT), are living without an LT, and those who received an LT. Design: Retrospective chart review. Setting/Subjects: People with CF who received care from 2012 to 2017 at the University of Texas Southwestern Medical Center. Measurements: Primary outcomes were (1) EOL discussion with a pulmonologist, (2) time of EOL discussion before death or LT, (3) evaluation by PC, and (4) documentation of advanced directive or medical power of attorney. Results: Twenty-three patients died without LT, 40 patients received an LT, and 222 were living without an LT. Among LT recipients, 10% had EOL conversations compared with 74% of deceased patients and 5% of living patients without LT (p = 0.001). Among deceased patients, 39% had EOL conversations more than six months before death, while 5% of transplanted patients had EOL conversation more than six months before LT (p < 0.001). Deceased patients were more likely to have seen PC (57%) than either patients who received LT (2%) or those living without LT (3%, p = 0.0001). Conclusions: Patients who died without LT were more likely to have seen PC and had an EOL conversation than patients who received LT or who are living without LT. Further research should explore the optimal timing to discuss EOL care and the best timing to involve PC.
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Affiliation(s)
- Allison V Lange
- Department of Internal Medicine, University of Texas Southwestern, Dallas, Texas, USA
| | - Ali Rueschhoff
- Department of Internal Medicine, University of Texas Southwestern, Dallas, Texas, USA
| | - Stephanie Terauchi
- Department of Internal Medicine, University of Texas Southwestern, Dallas, Texas, USA.,Divisions of Palliative Care Medicine and University of Texas Southwestern, Dallas, Texas, USA
| | - Leah Cohen
- Department of Internal Medicine, University of Texas Southwestern, Dallas, Texas, USA.,Divisions of Pulmonary and Critical Care Medicine, University of Texas Southwestern, Dallas, Texas, USA
| | - Joan Reisch
- Department of Population and Data Science, University of Texas Southwestern, Dallas, Texas, USA
| | - Raksha Jain
- Department of Internal Medicine, University of Texas Southwestern, Dallas, Texas, USA.,Divisions of Pulmonary and Critical Care Medicine, University of Texas Southwestern, Dallas, Texas, USA
| | - James D Finklea
- Department of Internal Medicine, University of Texas Southwestern, Dallas, Texas, USA.,Divisions of Pulmonary and Critical Care Medicine, University of Texas Southwestern, Dallas, Texas, USA
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4
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Baumgardner DJ, Chicoine B. Challenges of Pediatric Disease in Adulthood. J Patient Cent Res Rev 2020; 7:142-146. [PMID: 32377547 PMCID: PMC7197890 DOI: 10.17294/2330-0698.1756] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Dennis J. Baumgardner
- Department of Family Medicine, Aurora UW Medical Group, Aurora Health Care, Milwaukee, WI
| | - Brian Chicoine
- Adult Down Syndrome Center, Advocate Medical Group, Park Ridge, IL
- Family Medicine, Advocate Lutheran General Hospital, Park Ridge, IL
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5
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Cross SH, Ely EW, Kavalieratos D, Tulsky JA, Warraich HJ. Place of Death for Individuals With Chronic Lung Disease: Trends and Associated Factors From 2003 to 2017 in the United States. Chest 2020; 158:670-680. [PMID: 32229227 DOI: 10.1016/j.chest.2020.02.062] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 02/09/2020] [Accepted: 02/15/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Although chronic lung disease is a common cause of mortality, little is known about where individuals with chronic lung disease die. RESEARCH QUESTION The aim of this study was to determine the trends and factors associated with place of death among individuals with chronic lung disease. STUDY DESIGN AND METHODS This cross-sectional analysis of natural deaths was conducted by using the Centers for Disease Control and Prevention Wide-ranging OnLine Data for Epidemiologic Research from 2003 to 2017 for which COPD, interstitial lung disease (ILD), or cystic fibrosis (CF) was the underlying cause. Place of death was categorized as hospital, home, nursing facility, hospice facility, and other. RESULTS From 2003 to 2017, more than 2.2. million deaths were primarily attributed to chronic lung disease (51.6% female, 92.4% white). Most were attributed to COPD (88.9%), followed by ILD (10.8.%), and CF (0.3%). Hospital and nursing facility deaths declined from 44.4% (n = 59,470) and 22.6% (n = 30,285) to 28.3% (n = 49,655) and 19.7% (n = 34,495), while home and hospice facility deaths increased from 23.3% (n = 31,296) and 0.1% (n = 192) to 34.7% (n = 60,851) and 9.0% (n = 15,861), respectively. Male sex, being married, and having some college education were associated with increased odds of home death, whereas non-white race and Hispanic ethnicity were associated with increased odds of hospital death. Compared with individuals with COPD, individuals with ILD and CF had increased odds of hospital death and reduced odds of home, nursing facility, or hospice facility death. INTERPRETATION Home deaths are rising among decedents from chronic lung disease, increasing the need for quality end-of-life care in this setting. Further research should explore the end-of-life needs and preferences of these patients and their caregivers, with particular attention paid to patients with ILD and CF who continue to have high rates of hospital death.
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Affiliation(s)
- Sarah H Cross
- Sanford School of Public Policy, Duke University, Durham, NC
| | - E Wesley Ely
- Critical Illness, Brain Dysfunction, and Survivorship Center, Vanderbilt University Medical Center, Nashville, TN; VA Tennessee Valley Geriatric Research Education Clinical Center, Nashville, TN; Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University, Nashville, TN
| | - Dio Kavalieratos
- Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - James A Tulsky
- Division of Palliative Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA
| | - Haider J Warraich
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Cardiology Section, Department of Medicine, Boston VA Healthcare System, Boston, MA.
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6
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Marmor M, Jonas A, Mirza A, Rad E, Wong H, Aslakson RA. Opportunities to Improve Utilization of Palliative Care Among Adults With Cystic Fibrosis: A Systematic Review. J Pain Symptom Manage 2019; 58:1100-1112.e1. [PMID: 31437475 DOI: 10.1016/j.jpainsymman.2019.08.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 08/07/2019] [Accepted: 08/09/2019] [Indexed: 10/26/2022]
Abstract
CONTEXT Individuals with cystic fibrosis (CF) frequently survive into adulthood, and many have multifaceted symptoms that impair quality of life. OBJECTIVE We conducted a systematic review to investigate opportunities to improve utilization of palliative care among adults with CF. METHODS We searched PubMed, Embase, Scopus, Web of Science, and CINAHL databases from inception until September 27, 2018, and reviewed references manually. Eligible articles were published in English, involved adults aged 18 years and older with CF, and contained original data regarding patient outcomes related to presence of advance care planning (ACP), symptom experience, and preferred and/or received end-of-life (EOL) care. RESULTS We screened 652 article abstracts and 32 full-text articles; 12 studies met inclusion criteria. All studies were published between 2000 and 2018. Pertinent findings include that although 43% to 65% of adults with CF had contemplated completing ACP, the majority only completed ACP during their terminal hospital admission. Patients also reported high prevalence of untreated symptoms, with adequate symptom control reported in 45% among those with dyspnea, 22% among those with pain, and 51% among those with anxiety and/or depression. Prevalence of in-hospital death ranged from 62% to 100%, with a third dying in the intensive care unit. The majority received antibiotics and preventative treatments during their terminal hospitalization. Finally, treatment from a palliative care specialist was associated with a higher prevalence of patient completion of advanced directives, decreased likelihood of death in intensive care unit, and decreased use of mechanical ventilation at EOL. CONCLUSION Adults with CF often have untreated symptoms, and many opportunities exist for palliative care specialists to improve ACP completion and quality of EOL care.
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Affiliation(s)
- Meghan Marmor
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University, Stanford, California, USA.
| | - Andrea Jonas
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University, Stanford, California, USA
| | - Alicia Mirza
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University, Stanford, California, USA
| | - Elika Rad
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University, Stanford, California, USA
| | - Hongnei Wong
- Lane Medical Library & Knowledge Management Center, Stanford University School of Medicine, Stanford, California, USA
| | - Rebecca A Aslakson
- Department of Medicine, Stanford University, Stanford, California, USA; Department of Anesthesiology, Stanford University, Stanford, California, USA
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7
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Friedman D, Linnemann RW, Altstein LL, Georgiopoulos AM, Islam S, Bach KT, St John A, Fracchia MS, Neuringer I, Lapey A, Sicilian L, Moskowitz SM, Yonker LM. Effects of a primary palliative care intervention on quality of life and mental health in cystic fibrosis. Pediatr Pulmonol 2019; 54:984-992. [PMID: 30854795 DOI: 10.1002/ppul.24311] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 01/16/2019] [Accepted: 02/06/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Despite the significant impact of chronic symptoms on quality of life with cystic fibrosis (CF), the role of palliative care in management of this disease is not well defined. The coping, goal assessment, and relief from evolving CF symptoms (CF-CARES) model is a primary palliative care intervention designed to provide chronic symptom management at all stages of the disease. The goal of this pilot study was to estimate the effectiveness of the CF-CARES intervention on improving chronic symptoms and quality of life for people living with CF. METHODS A structured assessment was used to guide referral to supportive services intended to address burdensome symptoms. Follow-up assessments were performed approximately 3 and 6 months later. Longitudinal regression analyses of changes in symptoms and quality of life were performed for all participants regardless of utilization of supportive services. Subgroup analyses were performed for subjects participating in mental health and alternative health services. RESULTS Forty-one subjects completed assessment and referral processes. The mean number of CF-associated symptoms decreased over time, as did respiratory symptom-related distress and depressive symptoms. Subjects utilizing alternative health services reported less psychological distress at follow-up. Among subjects with severe disease, mental health, and quality of life improved, especially for those using mental health services. CONCLUSIONS The CF-CARES model resulted in significant mental health and quality-of-life benefits, suggesting the value of integrating symptom management interventions into routine CF care. Moreover, mental health services can play a key role in CF-specific primary palliative care, especially for those with advanced disease.
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Affiliation(s)
- Deborah Friedman
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Rachel W Linnemann
- Department. of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Lily L Altstein
- Department of Biostatistics, Massachusetts General Hospital, Boston, Massachusetts
| | - Anna M Georgiopoulos
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Suhayla Islam
- Department. of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts
| | - Kieu-Tram Bach
- Department. of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts
| | - Anita St John
- Department. of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts
| | - M Shannon Fracchia
- Department. of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Isabel Neuringer
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts.,Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Allen Lapey
- Department. of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Leonard Sicilian
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts.,Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Samuel M Moskowitz
- Department. of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Lael M Yonker
- Department. of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
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8
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Smallwood N, Ross L, Taverner J, John J, Baisch A, Irving L, Philip J. A Palliative Approach is Adopted for Many Patients Dying in Hospital with Chronic Obstructive Pulmonary Disease. COPD 2019; 15:503-511. [DOI: 10.1080/15412555.2018.1549210] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Natasha Smallwood
- Department of Respiratory and Sleep Medicine, The Royal Melbourne Hospital, Parkville, Victoria Australia
- Department of Medicine (Royal Melbourne Hospital), University of Melbourne, Parkville, Victoria Australia
| | - Lauren Ross
- Department of Respiratory and Sleep Medicine, The Royal Melbourne Hospital, Parkville, Victoria Australia
| | - John Taverner
- Department of Respiratory and Sleep Medicine, The Royal Melbourne Hospital, Parkville, Victoria Australia
| | - Jenny John
- Department of Rural Health, University of Melbourne, Northeast Health Wangaratta, Wangaratta, Victoria, Australia
| | - Andreas Baisch
- Department of Rural Health, University of Melbourne, Northeast Health Wangaratta, Wangaratta, Victoria, Australia
- Department of Medicine, Northeast Health Wangaratta, Wangaratta, Victoria, Australia
| | - Louis Irving
- Department of Respiratory and Sleep Medicine, The Royal Melbourne Hospital, Parkville, Victoria Australia
| | - Jennifer Philip
- St Vincent’s Hospital and Victorian Comprehensive Cancer Centre, University of Melbourne, Melbourne, Victoria, Australia
- St Vincent’s Hospital, Victoria Parade, Fitzroy, Victoria, Australia
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9
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Hobler MR, Engelberg RA, Curtis JR, Ramos KJ, Zander MI, Howard SS, Goss CH, Aitken ML. Exploring Opportunities for Primary Outpatient Palliative Care for Adults with Cystic Fibrosis: A Mixed-Methods Study of Patients' Needs. J Palliat Med 2018; 21:513-521. [PMID: 29298400 DOI: 10.1089/jpm.2017.0259] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Persons with cystic fibrosis (CF) experience high morbidity and mortality, yet little is known about their palliative care needs and how clinicians may address these needs. OBJECTIVES (1) To identify palliative care and advance care planning needs of patients with CF and their families; and (2) to identify clinicians' potential roles in meeting these needs. METHODS A mixed-methods study of adult patients (age ≥18 years) with moderate-to-severe CF [forced expiratory volume in the first second (FEV1) <65% predicted] were recruited from a CF Center. Semi-structured interviews (30-60 minutes) and questionnaires were administered in person or by phone. Grounded theory was used to analyze the interviews. Questionnaires were analyzed descriptively. RESULTS Forty-nine patients (FEV1 % range = 19%-63%) participated; the participation rate was 80% for eligible patients. Three main domains of palliative care needs were identified: (1) to be listened to, feel heard, and be "seen"; (2) understanding the context around CF and its trajectory, with the goal of preparing for the future; and (3) information about, and potential solutions to, practical and current circumstances that cause stress. In questionnaires, few patients (4.3%) reported talking with their clinician about their wishes for care if they were to become sicker, but mixed-methods data demonstrated that more than half of participants were willing to receive palliative care services provided those services were adapted to CF. CONCLUSION Patients expressed a need for and openness to palliative care services, as well as some reluctance. They appreciated clinician communication that was open, forthcoming, and attuned to individualized concerns.
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Affiliation(s)
- Mara R Hobler
- 1 Cambia Palliative Care Center of Excellence, University of Washington , Seattle, Washington.,2 Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington , Seattle, Washington
| | - Ruth A Engelberg
- 1 Cambia Palliative Care Center of Excellence, University of Washington , Seattle, Washington.,2 Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington , Seattle, Washington
| | - J Randall Curtis
- 1 Cambia Palliative Care Center of Excellence, University of Washington , Seattle, Washington.,2 Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington , Seattle, Washington
| | - Kathleen J Ramos
- 2 Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington , Seattle, Washington
| | - Miriam I Zander
- 3 Touro College of Osteopathic Medicine , New York, New York
| | - Shacole S Howard
- 4 Sports Medicine Center, University of Washington Medical Center , Seattle, Washington
| | - Christopher H Goss
- 2 Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington , Seattle, Washington.,5 Seattle Children's Hospital , Seattle, Washington.,6 Pediatric Pulmonology, Department of Pediatrics, University of Washington , Seattle, Washington
| | - Moira L Aitken
- 2 Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington , Seattle, Washington
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10
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Friedman D, Linnemann RW, Altstein LL, Islam S, Bach KT, Lamb C, Volpe J, Doolittle C, St. John A, O'Malley PJ, Sawicki GS, Georgiopoulos AM, Yonker LM, Moskowitz SM. The CF-CARES primary palliative care model: A CF-specific structured assessment of symptoms, distress, and coping. J Cyst Fibros 2018; 17:71-77. [DOI: 10.1016/j.jcf.2017.02.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 02/12/2017] [Accepted: 02/23/2017] [Indexed: 11/27/2022]
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11
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Chen E, Homa K, Goggin J, Sabadosa KA, Hempstead S, Marshall BC, Faro A, Dellon EP. End-of-life practice patterns at U.S. adult cystic fibrosis care centers: A national retrospective chart review. J Cyst Fibros 2017; 17:S1569-1993(17)30873-1. [PMID: 28917611 DOI: 10.1016/j.jcf.2017.08.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 08/09/2017] [Accepted: 08/14/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND There are many challenges to providing end-of-life care (EOLC) to people with cystic fibrosis (CF). METHODS Chart abstraction was used to examine EOLC in adults with CF who died between 2011 and 2013. RESULTS We reviewed 248 deaths from 71 CF care centers. Median age at death was 29years (range 18-73). While median FEV1 was in the severe lung disease category (FEV1<40%), 38% had mild or moderate lung disease in the year preceding death. The most common location of death was the intensive care unit (ICU, 39%), and 12% of decedents were listed for lung transplant. Fewer of those dying in the ICU personally participated in advance care planning or utilized hospice or Palliative Care Services (p<0.05). CONCLUSIONS Adults dying with CF in the United States most commonly die in an ICU, with limited and variable use of hospice and Palliative Care Services. Palliative care and advance care planning are recommended as a routine part of CF care.
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Affiliation(s)
- Elaine Chen
- Rush University Medical Center, Chicago, IL, United States.
| | - Karen Homa
- Independent Consultant, Orford, NH, United States
| | | | - Kathryn A Sabadosa
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
| | | | | | - Albert Faro
- Cystic Fibrosis Foundation, Bethesda, MD, United States
| | - Elisabeth P Dellon
- University of North Carolina School of Medicine, Chapel Hill, NC, United States
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12
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Pisaturo M, Deppen A, Rochat I, Robinson WM, Hafen GM. Death after cessation of treatment by cystic fibrosis patients: An international survey of clinicians. Palliat Med 2017; 31:82-88. [PMID: 26979669 DOI: 10.1177/0269216316637773] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Little is known about cystic fibrosis patients, who are not considered to be terminally ill, and who die after voluntary cessation of treatment. AIM This study was undertaken to provide an international snapshot of this issue. DESIGN An online survey was distributed across three continents. SETTING Distribution to the medical directors of the cystic fibrosis centres affiliated with the US Cystic Fibrosis Foundation, Cystic Fibrosis Australia (inclusion of New Zealand) and to every clinician member of the European Cystic Fibrosis Society. RESULTS More than 200 cystic fibrosis patients not considered to be terminally ill and, who voluntarily ceased treatment, were reported by the clinicians surveyed. Detailed data were reported in 102 patients (4 children, 25 adolescents and 73 adults). Only one child, six adolescents and one adult were judged by clinicians not to be competent to make the decision to stop treatment. Time-consuming and low immediate-impact therapies, such as respiratory physiotherapy, were most frequently discontinued. Resignation was the main reported reason for discontinuing treatment, followed by reactive depression and lack of familial support. A total of 69% of the patients received palliative care and 72% died in the 6 months following cessation of treatment. CONCLUSION Death of cystic fibrosis patients, not considered to be terminally ill, is reported in Europe, the United States and Australia due to voluntary cessation of treatment.
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Affiliation(s)
- Marisa Pisaturo
- 1 Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Alain Deppen
- 2 Child and Adolescent Psychiatry Service, Lausanne University Hospital, Lausanne, Switzerland
| | - Isabelle Rochat
- 1 Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland.,3 Respiratory Unit, Department of Paediatrics, CHUV Lausanne University Hospital, Lausanne, Switzerland
| | | | - Gaudenz M Hafen
- 1 Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland.,3 Respiratory Unit, Department of Paediatrics, CHUV Lausanne University Hospital, Lausanne, Switzerland
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13
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Goggin J, Cohen RI. CF healthcare workers feel unprepared in providing suitable end of life care and desire more education: Results of a nationwide survey. J Cyst Fibros 2016; 15:85-9. [DOI: 10.1016/j.jcf.2015.08.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 08/23/2015] [Accepted: 08/24/2015] [Indexed: 11/24/2022]
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14
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Development and evaluation of a palliative care curriculum for cystic fibrosis healthcare providers. J Cyst Fibros 2016; 15:90-5. [DOI: 10.1016/j.jcf.2015.03.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2014] [Revised: 03/06/2015] [Accepted: 03/09/2015] [Indexed: 11/20/2022]
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15
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Isaac M, Curtis JR. Improving quality of life for patients with terminal respiratory disease. Expert Rev Respir Med 2014; 3:597-605. [DOI: 10.1586/ers.09.47] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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16
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Clark JK, Fasciano K. Young adult palliative care: challenges and opportunities. Am J Hosp Palliat Care 2013; 32:101-11. [PMID: 24198063 DOI: 10.1177/1049909113510394] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Young adulthood is a time of immense growth and possibilities. As a result, it is also a time when serious illness can have profound effects. This review examines the current data pertinent to young adult palliative care and discusses the challenges and opportunities where palliative medicine can enhance the care provided to this growing and vulnerable population. From the data, 2 primary themes emerged (1) ongoing young adult development not only generates unique biologic disease burdens and clinical treatment options but also requires frequent assessment and promotion and (2) binary health care systems often leave young adults without access to developmentally appropriate health care. Given its interdisciplinary approach, palliative care is uniquely poised to address the challenges known to caring for the seriously ill young adult.
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Affiliation(s)
- Jennifer K Clark
- Departments of Internal Medicine and Pediatrics, University of Oklahoma, School of Community Medicine-Tulsa, OU Center for Palliative Care, Tulsa, OK, USA
| | - Karen Fasciano
- Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, MA, USA
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Abstract
As a testimony to advances in patient care, more individuals with cystic fibrosis are surviving into their adult years than ever before. The clinical epidemiology of this complex multi-organ disease is evolving and has changed dramatically over the past two to three decades. This article discusses the emergence of chronic disease-related co-morbidities such as CF-related diabetes, chronic kidney disease, bone disease, arthropathy, and depression. It also provides an overview of the many challenges confronted by adult CF care providers.
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Affiliation(s)
- Bradley S Quon
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Washington Medical Center, 1959 NE Pacific St., Campus Box 356522, Seattle, Washington, USA, 98195
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18
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Abstract
Cystic fibrosis (CF) is a multisystemic life-limiting genetic disorder, primarily affecting respiratory functioning. Most patients with CF are diagnosed by 2 years of age, and the current median predicted survival rate is 37.4 years old, with 95% of patients dying from complications related to pulmonary infection. Given the chronic, progressive, and disabling nature of CF, multiple treatments are prescribed, most on a daily basis. Thus, this illness requires children, with the aid of their families, to adopt multiple health-related behaviors in addition to managing more typical developmental demands. The morbidity and mortality factors pose cognitive, emotional, and behavioral challenges for many children with CF and their families. This article applies a developmental perspective to describing the psychosocial factors affecting psychological adjustment and health-related behaviors relevant to infants, preschool and school-age children, and adolescents with CF. Topics particularly pertinent to developmental periods and medical milestones are noted, with clinical implications highlighted.
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Affiliation(s)
- Michelle M Ernst
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue, Cincinnati, OH 45229-3039, USA.
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19
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Braithwaite M, Philip J, Tranberg H, Finlayson F, Gold M, Kotsimbos T, Wilson J. End of life care in CF: Patients, families and staff experiences and unmet needs. J Cyst Fibros 2011; 10:253-7. [DOI: 10.1016/j.jcf.2011.03.002] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2010] [Revised: 02/10/2011] [Accepted: 03/02/2011] [Indexed: 11/17/2022]
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20
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Sands D, Repetto T, Dupont LJ, Korzeniewska-Eksterowicz A, Catastini P, Madge S. End of life care for patients with cystic fibrosis. J Cyst Fibros 2011; 10 Suppl 2:S37-44. [DOI: 10.1016/s1569-1993(11)60007-6] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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21
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Ketchell I. Patients with cystic fibrosis should be intubated and ventilated. J R Soc Med 2010; 103 Suppl 1:S20-4. [PMID: 20573664 DOI: 10.1258/jrsm.2010.s11005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Ian Ketchell
- All Wales Adult Cystic Fibrosis Centre, University Hospital Llandough, Penlan Road, Penarth CF64 2XX, UK.
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22
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Abstract
Cystic fibrosis (CF) is a multisystemic life-limiting genetic disorder, primarily affecting respiratory functioning. Most patients with CF are diagnosed by 2 years of age, and the current median predicted survival rate is 37.4 years old, with 95% of patients dying from complications related to pulmonary infection. Given the chronic, progressive, and disabling nature of CF, multiple treatments are prescribed, most on a daily basis. Thus, this illness requires children, with the aid of their families, to adopt multiple health-related behaviors in addition to managing more typical developmental demands. The morbidity and mortality factors pose cognitive, emotional, and behavioral challenges for many children with CF and their families. This article applies a developmental perspective to describing the psychosocial factors affecting psychological adjustment and health-related behaviors relevant to infants, preschool and school-age children, and adolescents with CF. Topics particularly pertinent to developmental periods and medical milestones are noted, with clinical implications highlighted.
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Affiliation(s)
- Michelle M. Ernst
- Assistant Professor, Division of Behavioral Medicine and Clinical Psychology,Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Mark C. Johnson
- Assistant Professor, Division of Child and Adolescent Psychiatry,Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Lori J. Stark
- Professor, Division of Behavioral Medicine and Clinical Psychology,Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
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23
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End-of-life experience of children undergoing stem cell transplantation for malignancy: parent and provider perspectives and patterns of care. Blood 2010; 115:3879-85. [PMID: 20228275 DOI: 10.1182/blood-2009-10-250225] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The end-of-life (EOL) experience of children who undergo stem cell transplantation (SCT) may differ from that of other children with cancer. To evaluate perspectives and patterns of EOL care after SCT, we surveyed 141 parents of children who died of cancer (response rate, 64%) and their physicians. Chart review provided additional information. Children for whom SCT was the last cancer therapy (n = 31) were compared with those for whom it was not (n = 110). SCT parents and physicians recognized no realistic chance for cure later than non-SCT peers (both P < .001) and were more likely to have a primary goal of cure at death (parents, P < .001; physicians, P = .02). SCT children were more likely to suffer highly from their last cancer therapy and die in the intensive care unit (both P < .001), with less opportunity for EOL preparation. SCT parents who recognized no realistic chance for cure more than 7 days before death along with the physician were more likely to prepare for EOL, and if their primary goal was to reduce suffering, to achieve this (P < .001). SCT is associated with significant suffering and less opportunity to prepare for EOL. Children and families undergoing SCT may benefit from ongoing discussions regarding prognosis, goals, and opportunities to maximize quality of life.
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Palliative and end-of-life care in cystic fibrosis: what we know and what we need to know. Curr Opin Pulm Med 2009; 15:621-5. [DOI: 10.1097/mcp.0b013e3283304c29] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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25
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Current World Literature. Curr Opin Pulm Med 2009; 15:638-44. [DOI: 10.1097/mcp.0b013e3283328a80] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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26
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Braithwaite M, Philip J, Finlayson F, Tranberg H, Gold M, Kotsimbos T, Wilson J. Adverse events arising from a palliative care survey. Palliat Med 2009; 23:665-9. [PMID: 19648221 DOI: 10.1177/0269216309106894] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Development of evidence-based practice requires investigation of the attitudes and needs of patients, families and healthcare professionals, particularly for sensitive subject areas. Cystic fibrosis (CF) is a recessively inherited life-limiting disorder resulting in early death. Patients with this condition generally expect that lung transplantation will be an available treatment option; however, this is uncertain. A dual approach to care that involves both preparing patients for transplant assessment, while simultaneously exploring acceptable palliative care options is needed. A survey amongst patients with CF, their families and health carers was conducted to understand their attitudes and needs in relation to end-of-life care. The survey encompassed five separate domains, with a total of 60 questions requiring approximately 20 min to complete. Of the 200 surveys sent to patients, 82 (41%) completed responses were received. The Institutional Ethics Committee received six complaints from families of seven patients (3.5% of those surveyed). This article explores the nature of the adverse responses to the survey. The majority of complaints were received from family members rather than from patients. Complaints described dissatisfaction with the topic, little warning about the study and felt it to be inappropriate for their family member's level of health. Survey instruments used to determine attitudes and needs in relation to end-of-life patient care are likely to elicit adverse responses that should be reported in a similar way to other investigational studies. Also arising from adverse responses and the complaint process, is the impact of criticism on study researchers.
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Affiliation(s)
- M Braithwaite
- Department of Allergy, Immunology and Respiratory Medicine, Alfred Hospital, Melbourne, Australia
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Hoping for a miracle: supporting patients in transplantation and cardiac assist programs. Curr Opin Support Palliat Care 2009; 2:252-5. [PMID: 19069309 DOI: 10.1097/spc.0b013e32831a7280] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
PURPOSE OF REVIEW Palliative medicine is often viewed as a medical specialty reserved for end of life care. This review focuses on the role that palliative care can play in transplant and cardiac assist device programs, along the continuum of a patient's disease course. RECENT FINDINGS In general, transplant and cardiac assist programs do not incorporate palliative medicine during the treatment course, but rather reserve it for when the patient is approaching death and is no longer a candidate for transplant or device therapy. There is a new shift, however, to viewing the practice of aggressive medicine and palliative medicine as 'shared care' so as to optimize the patient's quality of life throughout his or her illness. CONCLUSION Transplant and cardiac assist device programs should not exclude the practice of palliative care in their daily work. Palliative care is not 'giving up' rather it is optimizing the quality of a patient's life irrespective of the level of disease severity and prognosis.
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Current World Literature. Curr Opin Support Palliat Care 2009; 3:79-82. [DOI: 10.1097/spc.0b013e3283277013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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