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Rozenberg D, Andrawes RR, Wentlandt K. An update of palliative care in lung transplantation with a focus on symptoms, quality of life and functional outcomes. Curr Opin Pulm Med 2024; 30:410-418. [PMID: 38533802 DOI: 10.1097/mcp.0000000000001075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
PURPOSE OF REVIEW Palliative care (PC) in lung transplantation is increasingly acknowledged for its important role in addressing symptoms, enhancing functionality, and facilitating advance care planning for patients, families, and caregivers. The present review provides an update in PC management in lung transplantation. RECENT FINDINGS Research confirms the effectiveness of PC for patients with advanced lung disease who are undergoing transplantation, showing improvements in symptoms and reduced healthcare utilization. Assessment tools and patient-reported outcome measures for PC are commonly used in lung transplant candidates, revealing discrepancies between symptom severity and objective measures such as exercise capacity. The use of opioids to manage dyspnea and cough in the pretransplant period is deemed safe and does not heighten risks posttransplantation. However, the integration of PC support in managing symptoms and chronic allograft dysfunction in the posttransplant period has not been as well described. SUMMARY Palliative care support should be provided in the pretransplant and select peri-operative and posttransplant periods to help support patient quality of life, symptoms, communication and daily function.
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Affiliation(s)
- Dmitry Rozenberg
- Temerty Faculty of Medicine, University of Toronto
- Respirology and Lung Transplantation, University Health Network
- Toronto General Hospital Research Institute, University Health Network
| | - Rogih Riad Andrawes
- Temerty Faculty of Medicine, University of Toronto
- Toronto General Hospital Research Institute, University Health Network
| | - Kirsten Wentlandt
- Department of Supportive Care, Division of Palliative Care, University Health Network, Toronto
- Division of Care, Department of Family and Community Medicine, University of Toronto, Toronto, Canada
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Storaasli S, Nakagawa S, Singer JP, Fedoronko DA, Zhang Y, Tsapepas D, Rincon ME, Scheffert J, Benvenuto L, Arcasoy SM. Quality of Life Outcomes and Associated Symptoms Reported by Lung Transplant Recipients Amidst COVID-19 Pandemic: Applying a Novel Assessment Tool. Transplant Proc 2022; 54:2680-2687. [PMID: 35940947 PMCID: PMC9271457 DOI: 10.1016/j.transproceed.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 07/06/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND There are 2 main aims of lung transplantation for people with end-stage lung disease: (1) to extend life and (2) to improve its quality. Much consideration is given to how to support the longevity and functioning of the allograft, though less robust studies have been done on the quality of the recipients' lives. With an interest in providing compassionate and holistic patient-centered care, it is vital that the treatment providers accurately understand their patients' lived experience. This study aimed to describe the health-related quality of life experiences of lung transplant recipients. An interest was held for where patients may struggle, thus informing where support might be needed to achieve the best possible outcomes. METHODS This single-center study used a validated Lung Transplant Quality of Life questionnaire, which was sent in autumn of 2020 to all of the lung transplant recipients (n = 581) under the care of Columbia University Irving Medical Center (New York, NY). RESULTS "Anxiety/Depression" had the highest concentration of struggle responses, followed closely by "Pulmonary Symptoms" and "Neuromuscular Symptoms." "Neuromuscular Problems" and "Sexual Problems" had the highest percentage of struggle responses. As the struggles increased, the overall quality of life rating dropped proportionately. There was no correlation between the overall quality of life and graft dysfunction, age, or time out from transplant date. All of the domains held an average rating of "Satisfactory," except "Treatment Burden," which was rated as "Favorable." Those ratings dropped for the cohort of patients who died during the study period. CONCLUSIONS With the goal of providing comprehensive care at the forefront of transplant priorities, we found the newly developed questionnaire invaluable in targeting areas for quality improvements, mostly notably respecting recipient mental health.
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Affiliation(s)
- Sasha Storaasli
- Department of Social Work, New York-Presbyterian Hospital, Columbia University Irving Medical Center, New York, NY.
| | - Shunichi Nakagawa
- Adult Palliative Care Service, Department of Medicine, Columbia University Medical Center, New York, NY
| | - Jonathan P Singer
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, University of California San Francisco, San Francisco, CA
| | - David A Fedoronko
- Department of Psychiatry, Columbia University Medical Center, New York, NY
| | - Yuan Zhang
- Department of Biostatistics, Mailman School of Public Health, Columbia University Medical Center, New York, NY
| | - Demetra Tsapepas
- Department of Quality and Research-Transplantation, New York-Presbyterian Hospital, New York, NY
| | - Maylin E Rincon
- Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University Irving Medical Center, New York, NY
| | - Jenna Scheffert
- Department of Transplant Pharmacy, New York-Presbyterian Hospital, New York, NY
| | - Luke Benvenuto
- Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University Irving Medical Center, New York, NY
| | - Selim M Arcasoy
- Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University Irving Medical Center, New York, NY
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Baumann T, Das S, Jarrell JA, Nakashima-Paniagua Y, Benitez EA, Gazzaneo MC, Villafranco N. Palliative Care in Pediatric Pulmonology. CHILDREN 2021; 8:children8090802. [PMID: 34572234 PMCID: PMC8466481 DOI: 10.3390/children8090802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 09/02/2021] [Accepted: 09/08/2021] [Indexed: 11/16/2022]
Abstract
Children with End Stage Lung Disease (ESLD) are part of the growing population of individuals with life-limiting conditions of childhood. These patients present with a diverse set of pulmonary, cardiovascular, neuromuscular, and developmental conditions. This paper first examines five cases of children with cystic fibrosis, bronchopulmonary dysplasia, neuromuscular disease, pulmonary hypertension, and lung transplantation from Texas Children’s Hospital. We discuss the expected clinical course of each condition, then review the integration of primary and specialized palliative care into the management of each diagnosis. This paper then reviews the management of two children with end staged lung disease at Hospital Civil de Guadalajara, providing an additional perspective for approaching palliative care in low-income countries.
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Affiliation(s)
- Taylor Baumann
- Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX 77030, USA;
| | - Shailendra Das
- Section of Pediatric Pulmonary Medicine, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX 77030, USA; (S.D.); (M.C.G.)
| | - Jill Ann Jarrell
- Section of Palliative Care, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX 77030, USA;
| | - Yuriko Nakashima-Paniagua
- Section of Palliative Care, Department of Pediatrics, Hospital Civil de Guadalajara, Guadalajara 44280, Mexico; (Y.N.-P.); (E.A.B.)
| | - Edith Adriana Benitez
- Section of Palliative Care, Department of Pediatrics, Hospital Civil de Guadalajara, Guadalajara 44280, Mexico; (Y.N.-P.); (E.A.B.)
| | - Maria Carolina Gazzaneo
- Section of Pediatric Pulmonary Medicine, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX 77030, USA; (S.D.); (M.C.G.)
| | - Natalie Villafranco
- Section of Pediatric Pulmonary Medicine, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX 77030, USA; (S.D.); (M.C.G.)
- Correspondence:
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Gustafson C, Song MK. State of the Science of Palliative Care in Solid Organ Transplantation. Prog Transplant 2020; 30:382-395. [PMID: 32930042 DOI: 10.1177/1526924820958156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Both solid organ transplant candidates and recipients and their family caregivers have complex care needs and may benefit from palliative care. But palliative care is not often considered as part of transplant care despite palliative care being promoted as an important component of transplant care both before and after solid organ transplantation. Further, the current state of the science of palliative care in solid organ transplantation has not been well-documented. OBJECTIVE To describe the state of the science of palliative care in solid organ transplant and identify gaps in the literature. METHODS Four electronic databases were searched using controlled vocabulary words and synonymous free text to find articles on palliative care and solid organ transplant. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and checklist were also used. RESULTS Twenty articles were included in the final review for synthesis, 18 of which involved transplants for adults only. Twelve articles described palliative care for patients before transplant, four articles examined palliative care for patients after transplant, primarily at the end-of-life, and four articles described transplant provider perspectives on palliative care. The reviewed evidence suggested that patients could be benefited by palliative care both pre and posttransplant, particularly for symptom management and advance care planning and that transplant providers faced many barriers to implementing palliative care in practice. DISCUSSION There is limited research on palliative care following solid organ transplantation, particularly outside of hospice care. Much of the prior research on this topic has described adult patients.
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Affiliation(s)
- Carolina Gustafson
- Nell Hodgson Woodruff School of Nursing, 15792Emory University, Atlanta, GA, USA
| | - Mi-Kyung Song
- Nell Hodgson Woodruff School of Nursing, 15792Emory University, Atlanta, GA, USA
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Butler CR, Reese PP, Perkins JD, Hall YN, Curtis JR, Kurella Tamura M, O'Hare AM. End-of-Life Care among US Adults with ESKD Who Were Waitlisted or Received a Kidney Transplant, 2005-2014. J Am Soc Nephrol 2020; 31:2424-2433. [PMID: 32908000 DOI: 10.1681/asn.2020030342] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 06/22/2020] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND The care of patients in the United States who have ESKD is often shaped by their hopes and prognostic expectations related to kidney transplant. Little is known about how patients' engagement in the transplant process might relate to patterns of end-of-life care. METHODS We compared six measures of intensity of end-of-life care among adults in the United States with ESKD who died between 2005 and 2014 after experiencing differing exposure to the kidney transplant process. RESULTS Of 567,832 decedents with ESKD, 27,633 (5%) had a functioning kidney transplant at the time of death, 14,653 (3%) had a failed transplant, 16,490 (3%) had been removed from the deceased donor waitlist, 17,010 (3%) were inactive on the waitlist, 11,529 (2%) were active on the waitlist, and 480,517 (85%) had never been waitlisted for or received a transplant (reference group). In adjusted analyses, compared with the reference group, patients exposed to the transplant process were significantly more likely to have been admitted to an intensive care unit and to have received an intensive procedure in the last 30 days of life; they were also significantly more likely to have died in the hospital. Those who died on the transplant waitlist were also less likely than those in the reference group to have been enrolled in hospice and to have discontinued dialysis before death. CONCLUSIONS Patients who had engaged in the kidney transplant process received more intensive patterns of end-of-life care than other patients with ESKD. These findings support the relevance of advance care planning, even for this relatively healthy segment of the ESKD population.
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Affiliation(s)
- Catherine R Butler
- Division of Nephrology, Department of Medicine and the Kidney Research Institute, University of Washington, Seattle, Washington
| | - Peter P Reese
- Renal-Electrolyte and Hypertension Division, Department of Medicine and Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania.,Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - James D Perkins
- Division of Transplant Surgery, Department of Surgery, University of Washington, Seattle, Washington
| | - Yoshio N Hall
- Division of Nephrology, Department of Medicine and the Kidney Research Institute, University of Washington, Seattle, Washington
| | - J Randall Curtis
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine and the Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington
| | - Manjula Kurella Tamura
- Division of Nephrology, Geriatric Research, Education, and Clinical Center, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Ann M O'Hare
- Division of Nephrology, Department of Medicine and the Kidney Research Institute, University of Washington, Seattle, Washington.,Division of Nephrology, Department of Medicine, Veterans Affairs Puget Sound Heath Care System, Seattle, Washington
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Pawlow PC, Doherty CL, Blumenthal NP, Matura LA, Christie JD, Ersek M. An Integrative Review of the Role of Palliative Care in Lung Transplantation. Prog Transplant 2020; 30:147-154. [DOI: 10.1177/1526924820913512] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Lung transplant patients experience significant physical symptoms and psychological stress that affect their quality of life. Palliative care is an interdisciplinary specialty associated with improved symptom management and enhanced quality of life. Little, however, is known about the palliative care needs of lung transplant patients and the role it plays in their care. Aim: The aim of this integrative review was to synthesize the literature describing the palliative care needs, the current role, and factors influencing the integration of palliative care in the care of lung transplant patients. Design/Data Sources: We searched PubMed, Scopus, CINAHL, and Embase to identify English-language, primary studies focused on palliative care in adult lung transplantation. Study quality was evaluated using Strengthening the Report of Observational studies in Epidemiology and Consolidated Criteria for Reporting Qualitative Research criteria. Results: Seven articles were included in the review. Most were single-center, descriptive studies. Two studies used qualitative and 5 used quantitative methodologies. Collectively, these studies suggest that palliative care is typically consulted for physical and psychological symptom management, although consultation is uncommon and often occurs late in the lung transplant process. We found no studies that systematically assessed palliative needs. Misperceptions about palliative care, communication challenges, and unrealistic patient/family expectations are identified barriers to the integration. While limited, evidence suggests that palliative care can be successfully integrated into lung transplant patient management. Conclusions: Empirical literature about palliative care in lung transplantation is sparse. Further research is needed to define the needs and opportunities for integration into the care of these patients.
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Affiliation(s)
| | | | | | - Lea Ann Matura
- University of Pennsylvania School of Nursing Philadelphia, PA, USA
| | - Jason D. Christie
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Mary Ersek
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Veterans Affairs, Corporal Michael J. Crescenz VA Medical Center, PA, USA
- School of Nursing, Perelman School of Medicine, University of Pennsylvania, PA, USA
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