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Georgiopoulos AM, DiFiglia S, Seng EK, Portenoy R, Chaudhary N, Wei R, Berdella MN, Friedman D, Kier C, Linnemann RW, Middour-Oxler B, Stables-Carney T, Walker P, Wang J, Yonker LM, Dhingra L. Validation of the Integrated Palliative Care Outcome Scale (IPOS) in adults with cystic fibrosis. Pediatr Pulmonol 2024. [PMID: 38934771 DOI: 10.1002/ppul.27143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 05/22/2024] [Accepted: 06/11/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND A primary palliative care model for cystic fibrosis (CF) recommends using the Integrated Palliative Care Outcome Scale (IPOS) for screening. Validation of the IPOS is needed. METHODS This secondary analysis utilized baseline data from a multisite trial of the palliative care model, Improving Life with CF. Adults with CF completed the IPOS, the Memorial Symptom Assessment Scale-CF (MSAS-CF), the CF Questionnaire-Revised (CFQ-R), the Patient Health Questionnaire (PHQ-8), the Generalized Anxiety Disorder (GAD-7), and the Perceived Stress Scale (PSS). IPOS structure was assessed using Cronbach α coefficients and a factor analysis. Construct validity was evaluated through bivariate relationships between IPOS scores and other questionnaire scores, and linear regressions assessing the extent to which the IPOS explains variance in quality-of-life domains. RESULTS The sample comprised 256 adults with complete IPOS data. α coefficients were .86 for the IPOS total score, .81 for the Physical Symptoms subscale, .79 for the Emotional Symptoms subscale, and .63 for the Communication/Practical Issues subscale. A two-component factor structure best aligned with the current subscales. IPOS scores were significantly associated with other measures; associations with MSAS-CF and CFQ-R subscales differentiated the IPOS Physical and Emotional subscales. The IPOS total score provided unique information about the variance in the CFQ-R Physical Functioning and Respiratory Symptoms domain scores. CONCLUSIONS In adults with CF, the IPOS has acceptable internal consistency and there is evidence of construct validity. These findings support adoption of the IPOS in the primary palliative care model for CF.
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Affiliation(s)
- Anna M Georgiopoulos
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Stephanie DiFiglia
- MJHS Institute for Innovation in Palliative Care, New York, New York, USA
| | - Elizabeth K Seng
- Ferkauf Graduate School of Psychology, New York, New York, USA
- Albert Einstein College of Medicine, Bronx, New York, USA
| | - Russell Portenoy
- MJHS Institute for Innovation in Palliative Care, New York, New York, USA
- Departments of Family and Social Medicine and Neurology, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Nivedita Chaudhary
- Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Ruobin Wei
- Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Deborah Friedman
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Rachel W Linnemann
- Emory University School of Medicine, Atlanta, Georgia, USA
- Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Brandi Middour-Oxler
- Emory University School of Medicine, Atlanta, Georgia, USA
- Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | | | - Patricia Walker
- Lenox Hill Hospital Northwell Health, New York, New York, USA
| | - Janice Wang
- Long Island Jewish Medical Center, Northwell Health, New Hyde Park, New York, USA
| | - Lael M Yonker
- Pulmonary Division, Massachusetts General for Children, 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
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2
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Kates J, Stricker CT, Rising KL, Gentsch AT, Solomon E, Powers V, Salcedo VJ, Worster B. Perspectives from patients with chronic lung disease on a telehealth-facilitated integrated palliative care model: a qualitative content analysis study. BMC Palliat Care 2024; 23:103. [PMID: 38637806 PMCID: PMC11027367 DOI: 10.1186/s12904-024-01433-3] [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: 08/04/2023] [Accepted: 04/11/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Chronic lung disease affects nearly 37 million Americans and often results in significant quality of life impairment and healthcare burden. Despite guidelines calling for palliative care (PC) integration into pulmonary care as a vital part of chronic lung disease management, existing PC models have limited access and lack scalability. Use of telehealth to provide PC offers a potential solution to these barriers. This study explored perceptions of patients with chronic lung disease regarding a telehealth integrated palliative care (TIPC) model, with plans to use findings to inform development of an intervention protocol for future testing. METHODS For this qualitative study, we conducted semi-structured interviews between June 2021- December 2021 with patients with advanced chronic lung disease. Interviews explored experiences with chronic lung disease, understanding of PC, and perceived acceptability of the proposed model along with anticipated facilitators and barriers of the TIPC model. We analyzed findings with a content analysis approach. RESULTS We completed 20 interviews, with two that included both a patient and caregiver together due to patient preference. Perceptions were primarily related to three categories: burden of chronic lung disease, pre-conceived understanding of PC, and perspective on the proposed TIPC model. Analysis revealed a high level of disease burden related to chronic lung disease and its impact on day-to-day functioning. Although PC was not well understood, the TIPC model using a shared care planning approach via telehealth was seen by most as an acceptable addition to their chronic lung disease care. CONCLUSIONS These findings emphasize the need for a patient-centered, shared care planning approach in chronic lung disease. The TIPC model may be one option that may be acceptable to individuals with chronic lung disease. Future work includes using findings to refine our TIPC model and conducting pilot testing to assess acceptability and utility of the model.
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Affiliation(s)
- Jeannette Kates
- College of Nursing, Thomas Jefferson University, 901 Walnut Street, Suite 702, Philadelphia, PA, 19107, USA.
| | - Carrie Tompkins Stricker
- College of Nursing, Thomas Jefferson University, 901 Walnut Street, Suite 702, Philadelphia, PA, 19107, USA
- Canopy Cancer Collective, P.O. Box 3141, Saratoga, CA, 95070, USA
| | - Kristin L Rising
- Center for Connected Care, Thomas Jefferson University, 1025 Walnut Street, Suite 300, Philadelphia, PA, 19107, USA
- Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, 132 South 10th Street, Philadelphia, PA, 19107, USA
| | - Alexzandra T Gentsch
- Center for Connected Care, Thomas Jefferson University, 1025 Walnut Street, Suite 300, Philadelphia, PA, 19107, USA
| | - Ellen Solomon
- Department of Internal Medicine, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Victoria Powers
- Center for Connected Care, Thomas Jefferson University, 1025 Walnut Street, Suite 300, Philadelphia, PA, 19107, USA
| | - Venise J Salcedo
- Center for Connected Care, Thomas Jefferson University, 1025 Walnut Street, Suite 300, Philadelphia, PA, 19107, USA
| | - Brooke Worster
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, 925 Chestnut Street, Suite 420A, Philadelphia, PA, USA
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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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4
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DiFiglia S, Georgiopoulos AM, Portenoy R, Seng E, Berdella M, Friedman D, Kier C, Linnemann RW, Middour-Oxler B, Walker P, Wang J, Yonker LM, Buehler B, Chaudhary N, Esposito C, Frantzen T, Henthorne K, Plachta A, Pollinger S, Stables-Carney T, Trentacoste J, Dhingra L. Palliative care needs among outpatient adults with cystic fibrosis: Baseline data from the Improving Life with CF trial. J Cyst Fibros 2023:S1569-1993(23)01664-8. [PMID: 37951787 DOI: 10.1016/j.jcf.2023.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 10/26/2023] [Accepted: 10/28/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND Little is known about the burden of illness experienced by people with cystic fibrosis (pwCF) since the advent of CF transmembrane conductance regulator (CFTR) modulator therapies. Studies that characterize the nature of illness burden are needed to inform the development and implementation of palliative care programs that can serve this population and address quality of life concerns. METHODS Adults with CF treated at five U.S. CF centers were surveyed to obtain baseline data for the Improving Life with CF primary palliative care implementation trial. Consenting patients completed the Integrated Palliative Care Outcome Scale (IPOS), a multidimensional measure of unmet needs for palliative care. Sociodemographic and clinical information was also obtained. The associations among these variables were examined through bivariate and multivariable analyses. RESULTS Among 256 adults, the most distressing symptoms included not feeling "at peace", communication difficulties with family/friends, anxiety over illness or its treatment, and a lack of energy. In the multivariable analyses, CFTR modulator use was associated with lower IPOS total and physical symptoms scores; female sex and increased hospitalizations were associated with higher scores. Increased age and history of distal intestinal obstructive syndrome were associated with higher IPOS physical symptoms scores. CONCLUSIONS These findings illuminate the nature of illness burden for pwCF in the era of CFTR modulator therapies. Although illness burden is positively affected by modulator therapy, there is a continuing need for palliative care to address physical, emotional, and spiritual distress, and the communication and practical needs experienced by adults with CF.
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Affiliation(s)
- Stephanie DiFiglia
- MJHS Institute for Innovation in Palliative Care, New York, NY, United States.
| | - Anna M Georgiopoulos
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Russell Portenoy
- MJHS Institute for Innovation in Palliative Care, New York, NY, United States; Departments of Family and Social Medicine and Neurology, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Elizabeth Seng
- Ferkauf Graduate School of Psychology, New York, NY, United States; Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Maria Berdella
- Lenox Hill Hospital Northwell Health, New York, NY, United States
| | - Deborah Friedman
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | | | - Rachel W Linnemann
- Emory University School of Medicine, Atlanta, GA, United States; Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Brandi Middour-Oxler
- Emory University School of Medicine, Atlanta, GA, United States; Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Patricia Walker
- Lenox Hill Hospital Northwell Health, New York, NY, United States
| | - Janice Wang
- Feinstein Institute for Medical Research, New Hyde Park, NY, United States
| | - Lael M Yonker
- Pulmonary Division, Massachusetts General Hospital for Children, Boston, MA, United States
| | - Brian Buehler
- Emory University School of Medicine, Atlanta, GA, United States; Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Nivedita Chaudhary
- Department of Pediatrics, Massachusetts General Hospital, Boston, MA, United States
| | - Christine Esposito
- Feinstein Institute for Medical Research, New Hyde Park, NY, United States
| | - Theresa Frantzen
- Feinstein Institute for Medical Research, New Hyde Park, NY, United States
| | | | - Amy Plachta
- Lenox Hill Hospital Northwell Health, New York, NY, United States
| | - Sophie Pollinger
- Department of Pediatrics, Massachusetts General Hospital, Boston, MA, United States
| | | | | | - Lara Dhingra
- MJHS Institute for Innovation in Palliative Care, New York, NY, United States; Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, NY, United States
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5
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Smirnova N, Trandel ET, Dubin E, Lowers J, Dellon EP, Hempstead S, Faro A, Tallarico E, Kavalieratos D. Clinician perspectives on barriers and solutions to symptom management in cystic fibrosis. J Cyst Fibros 2023; 22:1100-1103. [PMID: 37263825 PMCID: PMC10687299 DOI: 10.1016/j.jcf.2023.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 05/16/2023] [Accepted: 05/28/2023] [Indexed: 06/03/2023]
Abstract
People living with cystic fibrosis (PLwCF) experience high symptom burden. 146 clinicians completed online surveys regarding barriers and solutions to symptom management between September and October 2020. The surveys contained both closed-ended and free-text entries. The symptom management specialists that CF clinicians most wished to consult included mental health (88, 65%), palliative care (59, 41%), and pain specialists (48, 33%). Barriers to symptom management included concerns about controlled substances prescribed for symptom control causing addiction and precluding transplantation, a lack of trust and collaboration among clinical specialties, a lack of symptom management specialists with CF expertise, and a worry about the affordability of specialist-level symptom management care. Potential solutions included non-pharmacological approaches, expanding access to affordable specialist symptom management care, the creation of clinical care guidelines for symptom management in CF, and having CF clinicians and symptom management specialists work alongside each other in CF clinic to build interdisciplinary trust and education.
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Affiliation(s)
- Natalia Smirnova
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, Emory University, Atlanta, GA, United States.
| | | | - Ethan Dubin
- Rollins School of Public Health, Emory University, Atlanta, GA, United States; Division of Palliative Medicine, Department of Family and Preventive Medicine, Emory University, Atlanta, GA, United States
| | - Jane Lowers
- Division of Palliative Medicine, Department of Family and Preventive Medicine, Emory University, Atlanta, GA, United States
| | - Elisabeth P Dellon
- Department of Pediatrics, UNC Chapel Hill, Chapel Hill, NC, United States
| | | | - Albert Faro
- Cystic Fibrosis Foundation, Bethesda, MD, United States
| | | | - Dio Kavalieratos
- Rollins School of Public Health, Emory University, Atlanta, GA, United States; Division of Palliative Medicine, Department of Family and Preventive Medicine, Emory University, Atlanta, GA, United States; Department of Pediatrics, Emory University, Atlanta, GA, United States
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6
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Ladores S, Woods BM, Pitts LN, Belay D, Washington L, Bray LA. The Lived Experience of African American Persons with Cystic Fibrosis. Creat Nurs 2023; 29:374-382. [PMID: 37990506 DOI: 10.1177/10784535231216461] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
Abstract
Background: Cystic fibrosis (CF) is a rare genetic disease affecting approximately 30,000 people in the United States (US). African American persons with CF are even rarer, comprising approximately 5% of this population. Purpose: The purpose of this study was to explore the lived experiences of African American persons with CF to identify potential disparities in health care. Methods: Descriptive phenomenology was used to explore lived experiences of African American persons with CF over age 18 recruited from CF Foundation-accredited Centers in the US, CF-specific social media, and via snowball sampling. Study data was obtained through telephone interviews that were audio-recorded, transcribed verbatim, and analyzed using Colaizzi's method of thematic analysis. Results: Six men and six women (ages 23-45) completed the study. Interviews revealed three themes: (1) Accepting a Diagnosis of CF; (2) Desiring a Normal Life while Living with an Invisible Disease; and 3) A Slippery Slope of Subtle Racism. Each theme had 2-3 subthemes. Conclusions: It is critical to explore the unique challenges faced by African American persons with CF in order to develop interventions that improve their daily lives and create better futures. Implications for Practice: Findings highlight the unique challenges faced by underrepresented groups with CF and the need to address health inequities to improve care delivery.
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Affiliation(s)
- Sigrid Ladores
- School of Nursing, University of Alabama, Birmingham, AL, USA
| | | | - Leslie N Pitts
- School of Nursing, University of Alabama, Birmingham, AL, USA
| | - Deyana Belay
- School of Nursing, University of Alabama, Birmingham, AL, USA
| | | | - Leigh Ann Bray
- Capstone College of Nursing, The University of Alabama, Tuscaloosa, AL, USA
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7
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Dellon EP, Goggin J. End-of-life care in cystic fibrosis in the era of new therapies. THE LANCET. RESPIRATORY MEDICINE 2023; 11:861-863. [PMID: 37699422 DOI: 10.1016/s2213-2600(23)00260-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 06/28/2023] [Indexed: 09/14/2023]
Affiliation(s)
- Elisabeth P Dellon
- Department of Pediatrics, Division of Pulmonology, University of North Carolina, Chapel Hill, NC 27514, USA.
| | - Jessica Goggin
- Pulmonary Service Line, UC San Diego Health, San Diego, CA 92121, USA
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8
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DiFiglia S, Dhingra L, Georgiopoulos AM, Papia K, Sullivan E, Plachta A, Boccio C, Portenoy R, Basile M. Addressing Symptom Burden and Palliative Care Needs in Cystic Fibrosis: A Narrative Review of the Literature. Life (Basel) 2023; 13:1620. [PMID: 37629478 PMCID: PMC10455429 DOI: 10.3390/life13081620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 07/06/2023] [Accepted: 07/18/2023] [Indexed: 08/27/2023] Open
Abstract
Among people with cystic fibrosis (CF), illness burden is multifaceted, and symptoms may fluctuate in intensity across a lifespan. Caregivers of people with CF may also experience distressing symptoms. Recent developments in CF care, including the availability of highly effective modulator therapies (HEMTs) and new palliative care guidelines promoting palliative care screening may help alleviate symptoms. The objective of this review was to present a narrative view of the recent literature on symptom burden in CF, new screening approaches informed by the Cystic Fibrosis Foundation (CFF) palliative care guidelines, and early data from studies examining the impact of HEMTs on CF symptom burden. A review of the relevant literature was conducted using Google Scholar and PubMed. Included articles covered approaches to burden assessment in CF and other chronic illnesses, epidemiology of CF symptom burden, the impact of HEMTs on symptom burden, and the CFF palliative care guidelines. A primary palliative care model implementing the CFF guidelines was also described. Results of this review show that while recent developments in CF care have led to a reduction in physical symptoms, mental health symptoms remain prevalent. Ongoing screening and triage can ensure that physical symptoms, psychological symptoms, social needs, practical problems, and communication concerns are addressed by care teams.
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Affiliation(s)
- Stephanie DiFiglia
- MJHS Institute for Innovation in Palliative Care, New York, NY 10006, USA; (S.D.); (L.D.); (R.P.)
| | - Lara Dhingra
- MJHS Institute for Innovation in Palliative Care, New York, NY 10006, USA; (S.D.); (L.D.); (R.P.)
- Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Anna M. Georgiopoulos
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA;
- Harvard Medical School, Boston, MA 02115, USA
| | - Katherine Papia
- Cystic Fibrosis Center, Northwell Health, New Hyde Park, NY 11042, USA; (K.P.); (E.S.); (C.B.)
| | - Erin Sullivan
- Cystic Fibrosis Center, Northwell Health, New Hyde Park, NY 11042, USA; (K.P.); (E.S.); (C.B.)
| | - Amy Plachta
- Cystic Fibrosis Center, Lennox Hill, New York, NY 10021, USA;
| | - Courtney Boccio
- Cystic Fibrosis Center, Northwell Health, New Hyde Park, NY 11042, USA; (K.P.); (E.S.); (C.B.)
| | - Russell Portenoy
- MJHS Institute for Innovation in Palliative Care, New York, NY 10006, USA; (S.D.); (L.D.); (R.P.)
- Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, NY 10461, USA
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Melissa Basile
- Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY 11030, USA
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9
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Kavalieratos D, Lowers J, Moreines LT, Hoydich ZP, Arnold RM, Yabes JG, Richless C, Ikejiani DZ, Teuteberg W, Pilewski JM. Embedded Specialist Palliative Care in Cystic Fibrosis: Results of a Randomized Feasibility Clinical Trial. J Palliat Med 2023; 26:489-496. [PMID: 36350712 PMCID: PMC10066777 DOI: 10.1089/jpm.2022.0349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2012] [Indexed: 11/10/2022] Open
Abstract
Background: Cystic fibrosis (CF) is a progressive genetic disease characterized by multisystem symptom burden. Specialist palliative care (PC), as a model of care, has been shown to be effective in improving quality of life and reducing symptom burden in other conditions, but has not been tested in CF. Objectives: To develop and test the feasibility and acceptability of a specialist PC intervention embedded within an outpatient CF clinic. Design: Single-site, equal-allocation randomized pilot study comparing usual care with addition of four protocolized quarterly visits with a PC nurse practitioner. Participants: Adults with CF age ≥18 years with any of the following: FEV1% predicted ≤50, ≥2 CF-related hospitalizations in the past 12 months, supplemental oxygen use, or noninvasive mechanical ventilation use, and moderate-or-greater severity of any symptoms on the Edmonton Symptom Assessment Scale. Measurements: Randomization rate, intervention visit completion, data completements, participant ratings of intervention acceptability and benefit, and intervention delivery fidelity. Results: We randomized 50 adults with CF of 65 approached (77% randomization rate) to intervention (n = 25) or usual care (n = 25), mean age 38, baseline mean FEV1% predicted 41.8 (usual care), and 41.2 (intervention). No participants withdrew, five were lost to follow-up, and two died (88% retention). In the intervention group, 23 of 25 completed all study visits; 94% stated the intervention was not burdensome, and 97.6% would recommend the intervention to others with CF. More than 90% of study visits addressed topics prescribed by intervention manual. Conclusions: Adding specialist PC to standard clinic visits for adults with CF is feasible and acceptable.
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Affiliation(s)
| | - Jane Lowers
- Emory University School of Medicine, Atlanta, Georgia, USA
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10
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Mueller R, Lee BM, Callahan KP. Managing Prognosis in Precision Medicine: Utility, Imagination, and Communication. CHILDREN 2023; 10:children10040664. [PMID: 37189913 DOI: 10.3390/children10040664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 03/22/2023] [Accepted: 03/28/2023] [Indexed: 04/03/2023]
Abstract
Research on how physicians predict and communicate prognosis focuses primarily on end-of-life care. Unsurprisingly, as genomic technology gains traction as a prognostic tool, the focus has also been on terminality, with research focused on how genetic results may be used to terminate pregnancies or redirect care towards palliation for neonates. However, genomic results also have powerful impacts on how patients who live prepare for their futures. Genomic testing provides broad-reaching and early—albeit complex, uncertain, and shifting—prognostic information. In this essay, we argue that as genomic testing occurs earlier and increasingly in a screening context, researchers and clinicians must strive to understand and manage the prognostic implications of results. While our understanding of the psychosocial and communicational aspects of prognosis in symptomatic populations is incomplete, it has progressed further than our understanding in a screening context and therefore provides useful lessons and feasible opportunities for further research. By providing an interdisciplinary and inter-specialty perspective on the psychosocial and communicational aspects of prognosis in genetics, we discuss prognostication with respect to genetics from the neonatal period through adulthood, highlighting medical specialties and patient populations that are especially informative for considering the longitudinal management of prognostic information in genomic medicine.
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Affiliation(s)
- Rebecca Mueller
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, PA 19104, USA
- Masters Genetic Counseling Program, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Brittany M. Lee
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA 98195, USA
- Seattle Children’s Research Institute, Seattle, WA 98101, USA
| | - Katharine Press Callahan
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, PA 19104, USA
- Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
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11
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Blume ED, Kirsch R, Cousino MK, Walter JK, Steiner JM, Miller TA, Machado D, Peyton C, Bacha E, Morell E. Palliative Care Across the Life Span for Children With Heart Disease: A Scientific Statement From the American Heart Association. Circ Cardiovasc Qual Outcomes 2023; 16:e000114. [PMID: 36633003 PMCID: PMC10472747 DOI: 10.1161/hcq.0000000000000114] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
AIM This summary from the American Heart Association provides guidance for the provision of primary and subspecialty palliative care in pediatric congenital and acquired heart disease. METHODS A comprehensive literature search was conducted from January 2010 to December 2021. Seminal articles published before January 2010 were also included in the review. Human subject studies and systematic reviews published in English in PubMed, ClinicalTrials.gov, and the Cochrane Collaboration were included. Structure: Although survival for pediatric congenital and acquired heart disease has tremendously improved in recent decades, morbidity and mortality risks remain for a subset of young people with heart disease, necessitating a role for palliative care. This scientific statement provides an evidence-based approach to the provision of primary and specialty palliative care for children with heart disease. Primary and specialty palliative care specific to pediatric heart disease is defined, and triggers for palliative care are outlined. Palliative care training in pediatric cardiology; diversity, equity, and inclusion considerations; and future research directions are discussed.
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12
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Basile MJ, Dhingra L, DiFiglia S, Polo J, Portenoy R, Wang J, Walker P, Middour-Oxler B, Linnemann RW, Kier C, Friedman D, Berdella M, Abdullah R, Yonker LM, Markovitz M, Hadjiliadis D, Shiffman M, Fischer F, Pollinger S, Hardcastle M, Chaudhary N, Georgiopoulos AM. Development of a Cystic Fibrosis Primary Palliative Care Intervention: Qualitative Analysis of Patient and Family Caregiver Preferences. J Patient Exp 2023; 10:23743735231161486. [PMID: 36936380 PMCID: PMC10021085 DOI: 10.1177/23743735231161486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
To prevent or mitigate chronic illness burden, people with cystic fibrosis (pwCF) and their family caregivers need primary (generalist-level) palliative care from the time of diagnosis forward. We used qualitative methods to explore their preferences about a screening-and-triage model ("Improving Life with CF") developed to standardize this care. We purposively sampled and interviewed 14 pwCF and caregivers from 5 Improving Life with CF study sites. Thematic analysis was guided by a priori codes using the National Consensus Project's Guidelines for Quality Palliative Care. Participants included 7 adults and 2 adolescents with CF (3 with advanced disease), 4 parents, 1 partner (7 women; 5 people of color). Few were familiar with palliative care. Illness burden was described in multiple domains, including physical (e.g., dyspnea, pain), psychological (e.g., anxiety), and social (e.g., family well-being; impact on work/school). Most preferred survey-based screening with care coordination by the CF team. Preferences for screening approaches varied. PwCF and caregivers experience illness burden and are receptive to a CF-team delivered primary palliative care screening-and-triage model with flexible processes.
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Affiliation(s)
- Melissa J Basile
- Feinstein Institutes for Medical Research, Northwell Health, New
York, NY, USA
- Melissa J Basile, Center for Health
Innovations and Outcomes Research, Feinstein Institutes for Medical Research,
Northwell Health, New York, NY, USA.
| | - Lara Dhingra
- MJHS Institute for Innovation in Palliative Care, New York, NY,
USA
- Department of Family and Social Medicine,
Albert Einstein
College of Medicine, Bronx, NY, USA
| | | | - Jennifer Polo
- Feinstein Institutes for Medical Research, Northwell Health, New
York, NY, USA
| | - Russell Portenoy
- MJHS Institute for Innovation in Palliative Care, New York, NY,
USA
- Department of Family and Social Medicine, Department of Neurology,
Albert Einstein
College of Medicine, Bronx, NY, USA
| | - Janice Wang
- Division of Pulmonary, Critical Care and Sleep Medicine,
Donald and
Barbara Zucker School of Medicine at
Hofstra/Northwell, New Hyde Park, NY, USA
| | - Patricia Walker
- Department of Pulmonary Medicine, Icahn School of Medicine at Mount
Sinai, New York, NY, USA
| | - Brandi Middour-Oxler
- Division of Pulmonary, Asthma, Cystic Fibrosis and Sleep, Department
of Pediatrics, Emory
University, Atlanta, GA, USA
- Department of Pediatrics, Children's Healthcare of Atlanta, Atlanta,
GA, USA
| | - Rachel W Linnemann
- Division of Pulmonary, Asthma, Cystic Fibrosis and Sleep, Department
of Pediatrics, Emory
University, Atlanta, GA, USA
- Department of Pediatrics, Children's Healthcare of Atlanta, Atlanta,
GA, USA
| | - Catherine Kier
- Department of Pediatrics, Stony Brook University Medical
Center, Stony Brook, NY, USA
| | - Deborah Friedman
- Department of Psychiatry, Massachusetts General
Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical
School, Boston, MA, USA
| | - Maria Berdella
- Department of Pulmonary Medicine, Icahn School of Medicine at Mount
Sinai, New York, NY, USA
| | - Robert Abdullah
- Department of Pediatrics, Stony Brook University Medical
Center, Stony Brook, NY, USA
| | - Lael M Yonker
- Department of Psychiatry, Massachusetts General
Hospital, Boston, MA, USA
- Pulmonary Division, Massachusetts General Hospital for Children,
Boston, MA, USA
| | - Martha Markovitz
- Keck Medicine of University of Southern California, Los Angeles,
California, USA (retired)
| | - Denis Hadjiliadis
- Division of Pulmonary and Critical Care Medicine, Department of
Medicine, Hospital of
the University of Pennsylvania,
Philadelphia, PA, USA
| | | | | | - Sophie Pollinger
- Department of Pediatrics, Massachusetts General
Hospital, Boston, MA, USA
| | - Margot Hardcastle
- Department of Pediatrics, Massachusetts General
Hospital, Boston, MA, USA
| | - Nivedita Chaudhary
- Department of Pediatrics, Massachusetts General
Hospital, Boston, MA, USA
| | - Anna M Georgiopoulos
- Department of Psychiatry, Massachusetts General
Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical
School, Boston, MA, USA
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13
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DeFilippo EMM, Talwalkar JS, Harris ZM, Butcher J, Nasr SZ. Transitions of Care in Cystic Fibrosis. Clin Chest Med 2022; 43:757-771. [PMID: 36344079 DOI: 10.1016/j.ccm.2022.06.016] [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: 11/06/2022]
Abstract
The development of formal transition models emerged to reduce variability in care, including cystic fibrosis (CF) responsibility, independence, self-care, and education (RISE), which provides a standardized transition program, including knowledge assessments, self-management checklists, and milestones for people with CF. Despite these interventions, the current landscape of health care transition (HCT) remains suboptimal, and additional focused attention on HCT is necessary. Standardization of assessment tools to gauge the efficacy of transfer from pediatric to adult care is a high priority. Such tools should incorporate both clinical and patient-centered outcomes to provide a comprehensive picture of progress and deficiencies of the HCT process.
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Affiliation(s)
| | - Jaideep S Talwalkar
- Internal Medicine and Pediatrics, Yale School of Medicine, New Haven, CT, USA; Yale Adult Cystic Fibrosis Program, Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Zachary M Harris
- Yale Adult Cystic Fibrosis Program, Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Jennifer Butcher
- Department of Pediatrics, Division of Pediatric Psychology, Mott Children's Hospital, University of Michigan Health, Ann Arbor, MI, USA
| | - Samya Z Nasr
- Department of Pediatrics, Division of Pediatric Pulmonology, Mott Children's Hospital, University of Michigan Health, 1500 E. Medical Center Dr., Ann Arbor, MI 48109-5212, USA.
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Jewitt N, Mah K, Bonares M, Weingarten K, Ross H, Amin R, Morgan CT, Zimmermann C, Wentlandt K. Pediatric and Adult Cardiologists' and Respirologists' Referral Practices to Palliative Care. J Pain Symptom Manage 2022; 64:461-470. [PMID: 35905938 DOI: 10.1016/j.jpainsymman.2022.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 07/05/2022] [Accepted: 07/21/2022] [Indexed: 12/24/2022]
Abstract
CONTEXT Children and adults with advanced cardiac or respiratory disease may benefit from specialized palliative care (SPC), but there has been little SPC research in this area. OBJECTIVES To explore pediatric cardiologists' and respirologists' (pediatric clinicians) beliefs about and referral practices to SPC and compare these results to adult cardiologists and respirologists (adult clinicians). METHODS Pediatric and adult clinicians were sent a survey exploring SPC referral practices and beliefs. Responses were summarized with descriptive statistics. Pediatric and adult clinicians' responses were compared using Pearson's chi-square test. RESULTS The response rate was 56% (989/1759); 9% (87/989) were pediatric clinicians. Pediatric clinicians were more likely than adult clinicians to be female, work in an academic center, and experience fewer patient deaths (P<0.001). Pediatric clinicians reported better access to SPC clinical nurse specialists, spiritual care specialists and bereavement counselors (P<0.001), while adult clinicians reported better access to palliative care units (P<0.001). Pediatric clinicians referred to SPC earlier, while adult clinicians tended to refer after disease directed therapies were stopped (P<0.001). More than half of all clinicians felt patients had negative perceptions of the phrase "palliative care". Although most clinicians were satisfied with SPC quality (73-82%), fewer adult clinicians were satisfied with SPC availability (74 vs. 47%; P<0.001). Fewer pediatric clinicians felt that SPC prioritized oncology patients (13 vs. 53%; P<0.001). CONCLUSION There are important differences between pediatric and adult clinicians' beliefs about and referral practices to SPC. This may reflect unique features of pediatric diseases, provider characteristics, care philosophies, or service availability.
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Affiliation(s)
- Natalie Jewitt
- Pediatric Advanced Care Team (PACT), The Hospital for Sick Children, Toronto, Ontario, Canada (N.J., K.W.); Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada (N.J., K.W., R.A., C.T.M.)
| | - Kenneth Mah
- Department of Supportive Care, University Health Network, Toronto, Ontario, Canada (K.M., C.Z., K.W.)
| | - Michael Bonares
- Division of Palliative Care, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (M.B.); Division of Palliative Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada (M.B., C.Z.)
| | - Kevin Weingarten
- Pediatric Advanced Care Team (PACT), The Hospital for Sick Children, Toronto, Ontario, Canada (N.J., K.W.); Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada (N.J., K.W., R.A., C.T.M.)
| | - Heather Ross
- Peter Munk Cardiac Centre, Department of Medicine, University of Toronto and University Health Network, Toronto, Ontario, Canada (H.R.)
| | - Reshma Amin
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada (N.J., K.W., R.A., C.T.M.); Division of Respiratory Medicine, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada (R.A.)
| | - Conall Thomas Morgan
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada (N.J., K.W., R.A., C.T.M.); Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada (C.T.M.)
| | - Camilla Zimmermann
- Department of Supportive Care, University Health Network, Toronto, Ontario, Canada (K.M., C.Z., K.W.); Division of Palliative Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada (M.B., C.Z.)
| | - Kirsten Wentlandt
- Department of Supportive Care, University Health Network, Toronto, Ontario, Canada (K.M., C.Z., K.W.); Division of Palliative Care, Department of Community and Family Medicine, University of Toronto, Toronto, Ontario, Canada (K.W.).
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Lowers J, Dellon EP, Stephenson A, Arnold R, Althouse A, Jeong K, Dubin E, Soodalter J, Hovater C, Bakitas M, Goggin J, Hunt W, Ladores S, Curseen K, Winter G, Solomon G, Ailon J, Conrad D, Kavalieratos D. Integrating specialist palliative care to improve care and reduce suffering: cystic fibrosis (InSPIRe:CF) - study protocol for a multicentre randomised clinical trial. BMJ Open Respir Res 2022; 9:9/1/e001381. [PMID: 36126995 PMCID: PMC9490626 DOI: 10.1136/bmjresp-2022-001381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 09/11/2022] [Indexed: 11/20/2022] Open
Abstract
Introduction Cystic fibrosis (CF) is a life-limiting genetic disorder estimated to affect more than 160 000 individuals and their families worldwide. People living with CF commonly experience significant physical and emotional symptom burdens, disruptions to social roles and complex treatment decision making. While palliative care (PC) interventions have been shown to relieve many such burdens in other serious illnesses, no rigorous evidence exists for palliative care in CF. Thus, this study aims to compare the effect of specialist palliative care plus usual CF care vs usual CF care alone on patient quality of life. Methods and analysis This is a five-site, two-arm, partially masked, randomised superiority clinical trial. 264 adults with CF will be randomly assigned to usual CF care or usual CF care plus a longitudinal palliative care intervention delivered by a palliative care specialist. The trial’s primary outcome is patient quality of life (measured with the Functional Assessment of Chronic Illness Therapy-Palliative care instrument). Secondary outcomes include symptom burden, satisfaction with care and healthcare utilisation. Outcomes will be measured at 12 months (primary endpoint) and 15 months (secondary endpoint). In addition, we will conduct qualitative interviews with patient participants, caregivers, and palliative care and CF care team members to explore perceptions of the intervention’s impact and barriers and facilitators to dissemination. Ethics and dissemination Human subjects research ethics approval was obtained from all participating sites, and all study participants gave informed consent. We will publish the results of this trial in a peer-reviewed journal. Trial registration number ISRCTN53323164.
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Affiliation(s)
- Jane Lowers
- Family and Preventive Medicine, Emory University, Atlanta, Georgia, USA
| | - Elisabeth P Dellon
- Pediatrics, The University of North Carolina, School of Medicine, Chapel Hill, North Carolina, USA
| | | | - Robert Arnold
- General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Andrew Althouse
- General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Kwonho Jeong
- General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ethan Dubin
- Family and Preventive Medicine, Emory University, Atlanta, Georgia, USA
| | - Jesse Soodalter
- Family and Preventive Medicine, Emory University, Atlanta, Georgia, USA
| | - Cade Hovater
- Family and Preventive Medicine, Emory University, Atlanta, Georgia, USA
| | - Marie Bakitas
- School of Nursing, The University of Alabama, Birmingham, Alabama, USA
| | - Jessica Goggin
- Medicine, University of California, La Jolla, California, USA
| | | | - Sigrid Ladores
- School of Nursing, The University of Alabama, Birmingham, Alabama, USA
| | - Kimberly Curseen
- Family and Preventive Medicine, Emory University, Atlanta, Georgia, USA
| | | | - George Solomon
- Medicine, The University of Alabama, Birmingham, AL, USA
| | - Jonathan Ailon
- Medicine, St Michael's Hospital, Toronto, Ontario, Canada
| | - Douglas Conrad
- Medicine, University of California, La Jolla, California, USA
| | - Dio Kavalieratos
- Family and Preventive Medicine, Emory University, Atlanta, Georgia, USA
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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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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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Mingora CM, Flume PA. Pulmonary Complications in Cystic Fibrosis: Past, Present, and Future. Chest 2021; 160:1232-1240. [PMID: 34147501 DOI: 10.1016/j.chest.2021.06.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 03/14/2021] [Accepted: 06/14/2021] [Indexed: 12/22/2022] Open
Abstract
Cystic fibrosis (CF) is an autosomal recessive genetic condition with multisystemic disease manifestations, the most prominent of which occur in the respiratory system. Despite significant developments in disease understanding and therapeutics, each contributing to improved lung function and survival in patients with CF, several pulmonary complications, including pneumothorax, massive hemoptysis, and respiratory failure, continue to occur. In this review, we briefly describe each of these complications and their management and discuss how they impact the care and disease trajectory of individuals in whom they occur. Finally, we discuss the evolving role that palliative care and CF transmembrane conductance regular modulator therapies play in the natural disease course and care of patients with CF.
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Affiliation(s)
- Christina M Mingora
- Department of Medicine, Medical University of South Carolina, Charleston, SC.
| | - Patrick A Flume
- Department of Medicine, Medical University of South Carolina, Charleston, SC
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Basile M, Jojan L, Hobler MR, Dellon EP, Georgiopoulos AM, Goggin JL, Chen E, Goss CH, Hempstead SE, Faro A, Kavalieratos D. Assessing Practices, Beliefs, and Attitudes about Palliative Care among People with Cystic Fibrosis, Their Caregivers, and Clinicians: Results of a Content Analysis. J Palliat Med 2021; 24:1650-1656. [PMID: 33885355 DOI: 10.1089/jpm.2020.0725] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Individuals with cystic fibrosis (CF) experience symptoms affecting quality of life and may benefit from palliative care (PC). Objectives: To present results of content analysis from open-ended survey questions assessing knowledge and experiences with PC among CF stakeholders. Design, Setting, Subjects: Online surveys were sent to CF stakeholders through CF-specific listservs predominantly in the United States. Measurements: Responses to five open-ended questions about CF PC-delivery, health care provider training, and lung transplant-underwent content analysis. Responses were coded using NVivo12 Software™. Results: Forty-eight CF adults, 59 caregivers, and 229 providers responded to the open-ended survey questions. Analysis showed 5 primary categories related to CF PC: (1) stakeholder perceptions of PC for CF, (2) delivering PC to people with CF, (3) conversations about PC for CF, (4) perceptions that PC services are underutilized for people with CF, and (5) beliefs that PC services are critical for people with CF considering or pursuing lung transplant. Analysis showed variation among and within groups in defining PC for CF, when, and how to deliver it. Many respondents felt PC was underutilized in CF. Most saw PC as particularly important when considering lung transplant, managing anxiety around transplant, and for goals of care discussions. Some believed PC and lung transplant were mutually exclusive. Conclusion: Respondents felt PC is underutilized for CF, and that people with CF may miss out on the benefits of PC. Among stakeholders, respondents felt people with CF would benefit from access to primary and secondary PC services.
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Affiliation(s)
| | - Lincy Jojan
- Molloy College, Rockville Centre, New York, USA
| | | | | | | | | | - Elaine Chen
- Rush University Medical Center, Chicago, Illinois, USA
| | | | | | - Albert Faro
- Cystic Fibrosis Foundation, Bethesda, Maryland, USA
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20
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Palliative Care for Children with Lung Diseases. Respir Med 2021. [DOI: 10.1007/978-3-030-81788-6_15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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