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Burdis N, Kapnadak SG, Bartlett LE, McElvaney O, Milinic T, Wai TH, Lange AV, Reid N, Dunitz JM, Billings JL, Pilewski JM, Saavedra M, Goss CH, Hartzler AL, Ramos KJ. Attitudes toward and preparedness for lung transplantation among individuals with cystic fibrosis in the era of highly effective modulators. BMC Pulm Med 2024; 24:348. [PMID: 39026320 PMCID: PMC11256549 DOI: 10.1186/s12890-024-03163-x] [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] [Received: 02/22/2024] [Accepted: 07/11/2024] [Indexed: 07/20/2024] Open
Abstract
BACKGROUND Outcomes for individuals with cystic fibrosis (CF) have improved due to highly effective modulator therapy (HEMT). However, lung transplant (LTx) remains an important treatment for people with advanced lung disease. This study assessed attitudes and knowledge about LTx in the HEMT era. METHODS All patients from the University of Washington CF clinic were surveyed March 25-May 30, 2020. Questions addressed self-rated LTx preparedness and knowledge, as well as barriers and facilitators to discussing LTx. Demographic and clinical data were extracted from the electronic health record. RESULTS There were 159/224 (71%) responses. Respondents had a median forced expiratory volume in one second (FEV1) of 70%, and 142 (89%) were on modulatory therapy. One hundred thirteen (71%) respondents felt that it was moderately or very important to be prepared to make decisions about LTx, though only 56 (35%) felt moderately or very prepared. Only 83 (30%) and 47 (52%) participants correctly answered questions about life expectancy and improved quality of life after LTx, respectively. Respondents with Medicaid insurance less frequently answered questions correctly. The most common barriers to discussing LTx were fear of being a burden on loved ones for 58 respondents (36%) and cost of LTx for 46 (29%). Most participants (94%) trusted their CF doctor, and 75% of participants selected trust as a facilitator for LTx discussions. CONCLUSIONS Many individuals with CF, especially those with lower socioeconomic status, lacked knowledge and did not feel very prepared for decisions about LTx. Earlier education and discussions about LTx represent an area for improvement in CF care.
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Affiliation(s)
- Nora Burdis
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, 1959 NE Pacific St, Box 356522, Seattle, WA, 98195, USA.
| | - Siddhartha G Kapnadak
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, 1959 NE Pacific St, Box 356522, Seattle, WA, 98195, USA
| | - Lauren E Bartlett
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, 1959 NE Pacific St, Box 356522, Seattle, WA, 98195, USA
| | - Oliver McElvaney
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, 1959 NE Pacific St, Box 356522, Seattle, WA, 98195, USA
| | - Tijana Milinic
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, 1959 NE Pacific St, Box 356522, Seattle, WA, 98195, USA
| | - Travis Hee Wai
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, 1959 NE Pacific St, Box 356522, Seattle, WA, 98195, USA
| | - Allison V Lange
- Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Nick Reid
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, WA, USA
| | - Jordan M Dunitz
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Joanne L Billings
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Joseph M Pilewski
- Division of Pulmonary, Allergy & Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Milene Saavedra
- Department of Medicine, National Jewish Health, Denver, CO, USA
| | - Christopher H Goss
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, 1959 NE Pacific St, Box 356522, Seattle, WA, 98195, USA
- Seattle Children's Research Institute, Seattle, WA, USA
| | - Andrea L Hartzler
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, WA, USA
| | - Kathleen J Ramos
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, 1959 NE Pacific St, Box 356522, Seattle, WA, 98195, USA
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2
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Lau N, Ramos KJ, Aitken ML, Goss CH, Barton KS, Kross EK, Engelberg RA. "We'll deal with it as it comes": A Qualitative Analysis of Romantic Partners' Dyadic Coping in Cystic Fibrosis. JOURNAL OF SOCIAL AND PERSONAL RELATIONSHIPS 2024; 41:689-705. [PMID: 38638205 PMCID: PMC11025702 DOI: 10.1177/02654075231190617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Abstract
Background Although cystic fibrosis (CF) is a progressive, life-limiting, genetic disease, recent advances have extended survival, allowing persons with CF the time and physical and mental health to form romantic relationships. Previous studies have shown the importance of dyadic coping to positive psychosocial functioning and relationship satisfaction for people with serious chronic illness and their romantic partners, but little work has been done with persons with CF and their partners. The present study examines dyadic coping processes in persons with CF and their romantic partners. Methods Sixteen adults with moderate to severe CF (Mage=42.3, 43.8% identified as cisgender male, 56.2% identified as cisgender female) and their romantic partners (Mage=43.8, 56.3% identified as cisgender male, 43.7% identified as cisgender female) participated in individual semi-structured interviews focused on topics related to quality of life, communication, and palliative care. We conducted a directed content analysis utilizing Berg and Upchurch's (2007) developmental-contextual theoretical model to examine dyadic coping processes in persons with CF and their romantic partners. Results Consistent with the developmental-contextual model of dyadic coping, couples described adapting to health and functional declines that occurred over time. Dyads were aligned in their appraisals of illness representation, illness ownership, and perspectives of illness as a shared stressor; they used shared coping mechanisms that included supportive and collaborative actions rather than uninvolved or controlling strategies. Conclusions We recommend family-based approaches to medical decision-making and goals of care conversations with persons with CF and their partners, aligning those approaches with supportive and collaborative coping configurations. This may improve psychosocial outcomes for patients and their partners.
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Affiliation(s)
- Nancy Lau
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA
| | - Kathleen J. Ramos
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washington, Seattle, WA
| | - Moira L. Aitken
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washington, Seattle, WA
| | - Christopher H. Goss
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washington, Seattle, WA
- Division of Pulmonary, Department of Pediatrics, University of Washington, Seattle, WA
| | - Krysta S. Barton
- Biostatistics Epidemiology and Analytics for Research (BEAR) Core, Seattle Children’s Research Institute, Seattle, WA
| | - Erin K. Kross
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washington, Seattle, WA
- Cambia Palliative Care Center of Excellence at UW Medicine, Seattle, WA
| | - Ruth A. Engelberg
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washington, Seattle, WA
- Cambia Palliative Care Center of Excellence at UW Medicine, Seattle, WA
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3
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Brown CE, Steiner JM, Modes M, Lynch Y, Leary PJ, Curtis JR, Engelberg RA. Palliative Care Perspectives of Patients with Pulmonary Arterial Hypertension. Ann Am Thorac Soc 2023; 20:331-334. [PMID: 36416739 PMCID: PMC9989860 DOI: 10.1513/annalsats.202208-721rl] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
| | | | - Matthew Modes
- University of WashingtonSeattle, Washington
- Cedars-Sinai Medical CenterLos Angeles, California
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4
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Bischoff KE, Lin J, Cohen E, O'Riordan DL, Meister S, Zapata C, Sicotte J, Lindenfeld P, Calton B, Pantilat SZ. Outpatient Palliative Care for Noncancer Illnesses: One Program's Experience with Implementation, Impact, and Lessons Learned. J Palliat Med 2022; 25:1468-1475. [PMID: 35442773 DOI: 10.1089/jpm.2022.0019] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Despite substantial palliative care (PC) needs in people with serious illnesses other than cancer, outpatient PC is less available to these populations. Objectives: Describe the experience, impact, and lessons learned from implementing an outpatient PC service (OPCS) for people with noncancer illnesses. Design: Observational cohort study. Setting/Subjects: Patients seen by an OPCS at a United States academic medical center October 2, 2017-March 31, 2021. Measurements: Patient demographics and clinical characteristics, care processes, rates of advance care planning (ACP), and health care utilization. Results: During the study period, 736 patients were seen. Mean age was 66.7 years, 47.7% were women, and 61.4% were White. Nearly half (44.9%) had a neurologic diagnosis, 19.2% pulmonary, and 11.0% cardiovascular. Patients were most often referred for symptoms other than pain (62.2%), ACP (60.2%), and support for patient/family (48.2%). Three-quarters (74.1%) of visits occurred by video. A PC physician, nurse, social worker, and spiritual care provider addressed nonpain symptoms (for 79.2%), family caregiver needs (70.0%), psychosocial distress (69.9%), ACP (68.8%), care coordination (66.8%), pain (38.2%), and spiritual concerns (27.8%). Rates of advance directives increased from 24.6% to 31.8% (p < 0.001) and Physician Orders for Life-Sustaining Treatment forms from 15.6% to 27.3% (p < 0.001). Of 214 patients who died, 61.7% used hospice, with median hospice length-of-stay >30 days. Comparing the six months before initiating PC to the six months after, hospitalizations decreased by 31.3% (p = 0.001) and hospital days decreased by 29.8% (p = 0.02). Conclusions: Outpatient PC for people with noncancer illnesses is feasible, addresses needs in multiple domains, and is associated with increased rates of ACP and decreased health care utilization. Controlled studies are warranted.
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Affiliation(s)
- Kara E Bischoff
- Division of Palliative Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Joseph Lin
- Department of Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Eve Cohen
- Division of Palliative Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - David L O'Riordan
- Division of Palliative Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Sarah Meister
- Division of Palliative Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Carly Zapata
- Division of Palliative Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Jeffrey Sicotte
- Division of Palliative Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Paul Lindenfeld
- Division of Palliative Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Brook Calton
- Division of Palliative Medicine and Geriatrics, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Steven Z Pantilat
- Division of Palliative Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
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5
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Chyr LC, DeGroot L, Waldfogel JM, Hannum SM, Sloan DH, Cotter VT, Zhang A, Heughan JA, Wilson RF, Robinson KA, Dy SM. Implementation and Effectiveness of Integrating Palliative Care Into Ambulatory Care of Noncancer Serious Chronic Illness: Mixed Methods Review and Meta-Analysis. Ann Fam Med 2022; 20:77-83. [PMID: 35074772 PMCID: PMC8786411 DOI: 10.1370/afm.2754] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 04/29/2021] [Accepted: 06/03/2021] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To perform a mixed methods review to evaluate the effectiveness and implementation of models for integrating palliative care into ambulatory care for US adults with noncancer serious chronic illness. METHODS We searched 3 electronic databases from January 2000 to May 2020 and included qualitative, mixed methods studies and randomized and nonrandomized controlled trials. For each study, 2 reviewers abstracted data and independently assessed for quality. We conducted meta-analyses as appropriate and graded strength of evidence (SOE) for quantitative outcomes. RESULTS Quantitative analysis included 14 studies of 2,934 patients. Compared to usual care, models evaluated were not more effective for improving patient health-related quality of life (HRQOL) (standardized mean difference [SMD] of 4 of 8 studies, 0.19; 95% CI, ‒0.03 to 0.41) (SOE: moderate) or for patient depressive symptom scores (SMD of 3 of 9 studies, ‒0.09; 95% CI, ‒0.35 to 0.16) (SOE: moderate). Models might have little to no effect on patient satisfaction (SOE: low) but were more effective for increasing advance directive (AD) documentation (relative risk, 1.62; 95% CI, 1.35 to 1.94) (SOE: moderate). Qualitative analysis included 5 studies of 146 patients. Patient preferences for appropriate timing of palliative care varied; costs, additional visits, and travel were considered barriers to implementation. CONCLUSION Models might have little to no effect on decreasing overall symptom burden and were not more effective than usual care for improving HRQOL or depressive symptom scores but were more effective for increasing AD documentation. Additional research should focus on identifying and addressing characteristics and implementation factors critical to integrating models to improve ambulatory, patient-centered outcomes.
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Affiliation(s)
- Linda C Chyr
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Lyndsay DeGroot
- Johns Hopkins University, School of Nursing, Baltimore, Maryland
| | | | - Susan M Hannum
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Danetta H Sloan
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Valerie T Cotter
- Johns Hopkins University, School of Nursing, Baltimore, Maryland
| | - Allen Zhang
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - JaAlah-Ai Heughan
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Renee F Wilson
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Karen A Robinson
- Johns Hopkins University, School of Medicine, Baltimore, Maryland
| | - Sydney M Dy
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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6
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Todd SH, Sonntag EA, Buchanan ML, Jones BW, Dellon EP, Donaldson SH, Goralski JL. Development of an Advance Care Planning Protocol in a Cystic Fibrosis Outpatient Clinic. J Palliat Med 2021; 24:1383-1386. [PMID: 34191614 DOI: 10.1089/jpm.2021.0186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Advance care planning (ACP) is recommended for all patients with cystic fibrosis (CF), yet clear implementation guidelines do not exist. Methods: The University of North Carolina Adult CF Care Team developed a process to implement semistructured multidisciplinary outpatient ACP meetings as routine care for patients with CF. Premeeting and post-meeting surveys were used to elicit patients' attitudes toward ACP. Results: Twenty-seven adults with CF completed a face-to-face ACP meeting, and 13 completed both surveys. Following the multidisciplinary ACP meeting, overall scores for understanding of ACP topics improved by 4.5 points (p = 0.003). Conclusion: We successfully implemented sustainable ACP meetings for adults with CF and found increased comfort with ACP and documentation of wishes after ACP meetings. It is important for CF care providers to meet the needs of this patient population by ensuring that ACP is in place before crisis situations.
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Affiliation(s)
- Sarah H Todd
- Departments of Medicine and Pediatrics, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Elizabeth A Sonntag
- Division of Pulmonary and Critical Care Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Marianne L Buchanan
- UNC Hospitals Department of Social Work, and The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Brooke W Jones
- UNC Hospitals Department of Social Work, and The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Elisabeth P Dellon
- Division of Pediatric Pulmonology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Scott H Donaldson
- Division of Pulmonary and Critical Care Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jennifer L Goralski
- Division of Pulmonary and Critical Care Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Division of Pediatric Pulmonology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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7
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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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8
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Waldman E, Quinn M. Palliative care and cystic fibrosis: Opportunities for growth. Pediatr Pulmonol 2020; 55:2179-2180. [PMID: 32678474 DOI: 10.1002/ppul.24953] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 06/22/2020] [Accepted: 06/23/2020] [Indexed: 11/09/2022]
Affiliation(s)
- Elisha Waldman
- Division of Palliative Care, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Megan Quinn
- Division of Palliative Care, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
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9
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Trandel ET, Kavalieratos D, Basile M, Hobler MR, Georgiopoulos AM, Chen E, Goggin JL, Goss CH, Hempstead SE, Faro A, Dellon EP. Palliative care skills in CF: Perspectives of adults with CF, caregivers, and CF care team members. Pediatr Pulmonol 2020; 55:2017-2024. [PMID: 32384215 PMCID: PMC8597706 DOI: 10.1002/ppul.24806] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 04/23/2020] [Accepted: 04/26/2020] [Indexed: 11/11/2022]
Abstract
BACKGROUND The role of cystic fibrosis (CF) care team members in delivering palliative care (PC) remains undefined. We aimed to understand the PC skills of CF care teams. METHODS CF care team members ("clinicians"), adults with CF ("patients"), and family caregivers ("caregivers") rated the ability of CF clinicians to provide aspects of PC using a five-point scale ("poor" to "excellent"). Median ratings were compared between groups. RESULTS A total of 70 patients, 100 caregivers, and 350 clinicians participated. Clinicians consistently rated their PC skills higher than patients or caregivers rated them, particularly for advanced PC skills. While clinicians, patients, and caregivers rated clinicians as "very good" at basic pain assessment and "good" at discussing prognostic uncertainty, clinicians rated themselves more highly at providing most skills, including simultaneous PC and standard CF care (P < .0001), basic depression assessment (P < .001), and discussing transplant, advance directives, end of life, code status, and hospice (all P < .0001). Respondents affiliated with adult CF care teams rated clinicians more highly than respondents affiliated with pediatric CF care teams at discussing lung transplant (P < .001), end of life (P = .006), advance directives (P < .001), code status (P = .012), and hospice (P = .016). Most patients (69%) and caregivers (60%) felt CF clinicians should receive more PC training. CONCLUSIONS Discrepancies exist among patient/caregiver and clinician perceptions of PC skills in CF, and skills of adult and pediatric teams may differ. Patients and caregivers feel clinicians' more advanced PC skills are lacking. CF clinicians may benefit from PC training to enhance skills and to understand how and when to utilize specialty PC services.
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Affiliation(s)
| | - Dio Kavalieratos
- Department of Family and Preventive Medicine, Division of Palliative Medicine, Emory University, Atlanta, Georgia
| | - Melissa Basile
- Center for Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York
| | - Mara R Hobler
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, Washington
| | | | - Elaine Chen
- Department of Internal Medicine, Pulmonary, Critical Care, and Palliative Medicine, Rush University Medical Center, Chicago, Illinois
| | - Jessica L Goggin
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of California San Diego, San Diego, California
| | - Christopher H Goss
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, Washington
| | | | - Albert Faro
- Cystic Fibrosis Foundation, Bethesda, Maryland
| | - Elisabeth P Dellon
- Department of Pediatrics, Division of Pulmonology, University of North Carolina, Chapel Hill, North Carolina
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10
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Kapnadak SG, Dimango E, Hadjiliadis D, Hempstead SE, Tallarico E, Pilewski JM, Faro A, Albright J, Benden C, Blair S, Dellon EP, Gochenour D, Michelson P, Moshiree B, Neuringer I, Riedy C, Schindler T, Singer LG, Young D, Vignola L, Zukosky J, Simon RH. Cystic Fibrosis Foundation consensus guidelines for the care of individuals with advanced cystic fibrosis lung disease. J Cyst Fibros 2020; 19:344-354. [DOI: 10.1016/j.jcf.2020.02.015] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 02/14/2020] [Accepted: 02/19/2020] [Indexed: 12/25/2022]
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11
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Dellon EP, Basile M, Hobler MR, Georgiopoulos AM, Chen E, Goggin J, Goss CH, Hempstead SE, Faro A, Kavalieratos D. Palliative Care Needs of Individuals with Cystic Fibrosis: Perspectives of Multiple Stakeholders. J Palliat Med 2020; 23:957-963. [PMID: 32023421 DOI: 10.1089/jpm.2019.0464] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Studies suggest palliative care may be different in cystic fibrosis (CF) than in other conditions. To provide quality palliative care to individuals with CF, unique needs must be understood. Objective: To examine perceptions of how palliative care may be different in CF, top palliative needs of individuals with CF, and barriers to palliative care in CF. Methods: Online surveys with closed- and open-ended questions about palliative care needs were administered to multiple stakeholders in CF care, including adults with CF, caregivers of individuals with CF, and CF care team members from U.S. centers. We used descriptive statistics to report survey findings. Results: A total of 70 adults with CF, 100 caregivers, and 350 care team members completed surveys. While care team members reported they introduce palliative care to patients a majority of the time, adults with CF and caregivers rarely recalled learning about it. Very few reported having seen a palliative care specialist. A majority of participants reported that palliative care is valuable in CF care. Over 80% of participants felt palliative care is different in CF, most often citing the unpredictable disease course. Top palliative care needs identified include emotional support, emotional symptom management, and communication about treatment decisions. Major barriers to palliative care identified include perception that it is for dying people and lack of CF care team knowledge and training in palliative care. Conclusions: Participants felt palliative care is valuable in CF and identified many palliative care needs, and also barriers that can be addressed with education and training. Our findings will be used to develop interventions targeting specific needs and inform guidelines to enhance provision of palliative care in CF.
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Affiliation(s)
- Elisabeth P Dellon
- Department of Pediatrics, University of North Carolina Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Melissa Basile
- Institute of Health Innovations and Outcomes Research, Northwell Health, Manhasset, New York, USA
| | - Mara R Hobler
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, Washington, USA
| | - Anna M Georgiopoulos
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Elaine Chen
- Department of Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Jessica Goggin
- UCSD Health, University of California San Diego, La Jolla, California, USA
| | - Christopher H Goss
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, Washington, USA
| | | | - Albert Faro
- Cystic Fibrosis Foundation, Bethesda, Maryland, USA
| | - Dio Kavalieratos
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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12
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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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13
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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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14
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Steiner JM, Stout K, Soine L, Kirkpatrick JN, Curtis JR. Perspectives on advance care planning and palliative care among adults with congenital heart disease. CONGENIT HEART DIS 2019; 14:403-409. [PMID: 30575286 PMCID: PMC6561330 DOI: 10.1111/chd.12735] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Revised: 11/02/2018] [Accepted: 11/28/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Patients with adult congenital heart disease (ACHD) report that advance care planning (ACP) is important, and that they want information about prognosis. However, recognizing importance and being willing to participate are different constructs, and how and when to begin ACP and palliative care discussions remains ill-defined. METHODS We conducted a cross-sectional survey of 150 consecutive outpatients to assess willingness to participate in ACP, with whom, and important barriers and facilitators to these discussions. RESULTS The majority of participants (69%) reported being willing to participate in ACP; 79% to have a meeting to discuss goals and care preferences; and 91% to speak to a clinician who specializes in palliative care. Being married and anticipating a shorter lifespan were associated with increased reported willingness to participate in ACP. The health care provider with whom most participants preferred to have these discussions was their ACHD clinician. Participants identified important barriers and facilitators to these discussions. CONCLUSION Patients with ACHD report being willing to participate in ACP and palliative care discussions. Patients prefer to have these discussions with their ACHD clinicians, thus ACHD clinicians need to be prepared to address these issues as part of routine care.
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Affiliation(s)
- Jill M. Steiner
- Division of Cardiology, School of Medicine, University of
Washington, Seattle, Washington
| | - Karen Stout
- Division of Cardiology, School of Medicine, University of
Washington, Seattle, Washington
| | - Laurie Soine
- Division of Cardiology, School of Medicine, University of
Washington, Seattle, Washington
| | - James N. Kirkpatrick
- Division of Cardiology, School of Medicine, University of
Washington, Seattle, Washington
| | - J. Randall Curtis
- Cambia Palliative Care Center of Excellence, University of
Washington, Seattle, Washington
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15
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Ramos KJ, Hobler MR, Engelberg RA, Curtis JR, Zander MI, Howard SS, Goss CH, Aitken ML. Addressing lung transplant with adults with cystic fibrosis: A qualitative analysis of patients' perspectives and experiences. J Cyst Fibros 2019; 18:416-419. [PMID: 31003953 DOI: 10.1016/j.jcf.2019.04.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 03/29/2019] [Accepted: 04/05/2019] [Indexed: 12/21/2022]
Abstract
Referral for lung transplantation is a complex process that typically begins with a discussion in cystic fibrosis (CF) clinic. We performed a secondary analysis of interviews conducted at the University of Washington CF Clinic as part of a study of unmet palliative care needs, June 2015 - January 2016, among adults with moderate-to-severe CF-related lung disease. Content analysis methods were used to identify themes related to discussion of lung transplant in CF clinic. Thirty-two of 48 interviews (67%) addressed transplant. An individual's willingness to discuss transplant was not necessarily related to the degree of lung function impairment. Patients reported reliance on CF physicians as a source of accurate information about transplant. Individuals with CF sometimes reported feeling too old or not worthy of transplant. Many had apprehensive or ambivalent feelings towards transplant. Patient-identified barriers and facilitators to lung transplant discussions can inform physicians as they discuss transplant in CF clinic.
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Affiliation(s)
- Kathleen J Ramos
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, WA, USA.
| | - Mara R Hobler
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, WA, USA; Cambia Palliative Care Center of Excellence, University of Washington, Seattle, WA, USA
| | - Ruth A Engelberg
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, WA, USA; Cambia Palliative Care Center of Excellence, University of Washington, Seattle, WA, USA
| | - J Randall Curtis
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, WA, USA; Cambia Palliative Care Center of Excellence, University of Washington, Seattle, WA, USA
| | - Miriam I Zander
- Department of Internal Medicine, Cooper University Hospital, Camden, NJ, USA
| | - Shacole S Howard
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, WA, USA
| | - Christopher H Goss
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, WA, USA; Department of Pediatrics, Division of Pulmonary and Sleep Medicine, University of Washington, Seattle, WA, USA; Seattle Children's Hospital, Seattle, WA, USA
| | - Moira L Aitken
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, WA, USA
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16
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Linnemann RW, Friedman D, Altstein LL, Islam S, Bach KT, Georgiopoulos AM, Moskowitz SM, Yonker LM. Advance Care Planning Experiences and Preferences among People with Cystic Fibrosis. J Palliat Med 2019; 22:138-144. [DOI: 10.1089/jpm.2018.0262] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Affiliation(s)
- Rachel W. Linnemann
- Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Deborah Friedman
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Lily L. Altstein
- Department of Biostatistics, Massachusetts General Hospital, Boston, Massachusetts
| | - Suhayla Islam
- Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts
| | - Kieu-Tram Bach
- Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts
| | - Anna M. Georgiopoulos
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
- Department of Psychiatry, 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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17
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Costello J. Research roundup. Int J Palliat Nurs 2018; 24:48-49. [PMID: 29368555 DOI: 10.12968/ijpn.2018.24.1.48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Synopses of a selection of recently published research articles of relevance to palliative care.
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Affiliation(s)
- John Costello
- Senior Lecturer, University of Manchester Division of Nursing, Midwifery and Social Work
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