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Comes A, Sgalla G, Ielo S, Magrì T, Richeldi L. Challenges in the diagnosis of idiopathic pulmonary fibrosis: the importance of a multidisciplinary approach. Expert Rev Respir Med 2023; 17:1-11. [PMID: 37005289 DOI: 10.1080/17476348.2023.2199156] [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: 04/04/2023]
Abstract
INTRODUCTION The diagnosis of Idiopathic pulmonary fibrosis (IPF) requires the careful exclusion of secondary causes of interstitial lung disease (ILD), and the collaboration among different specialists is considered paramount to establish a diagnosis with high diagnostic confidence. The multidisciplinary discussion (MDD) has assumed an increasing importance over the years in the different phases of the IPF diagnostic work-up. AREAS COVERED The role of MDD in the diagnosis and management of IPF will be described. Practical insights will be provided into how and when to perform MDD based on the available scientific evidence. Current limitations and future perspectives will be discussed. EXPERT OPINION In the absence of high diagnostic confidence, agreement between different specialists during MDD is recognized as a surrogate indicator of diagnostic accuracy. Often, despite a lengthy evaluation, the diagnosis remains unclassifiable in a significant percentage of patients. MDD therefore appears to be pivotal in attaining an accurate diagnosis of ILDs. The discussion among different specialists can also include other specialists, such as rheumatologists and thoracic surgeons, in addition to the core group of pulmonologists, radiologists, and pathologists. Such discussions can allow greater diagnostic accuracy and have important effects on management, pharmacologic therapies, and prognosis.
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Affiliation(s)
- Alessia Comes
- Facoltà di Medicina e Chirurgia, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Giacomo Sgalla
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
| | - Simone Ielo
- Facoltà di Medicina e Chirurgia, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Tonia Magrì
- Facoltà di Medicina e Chirurgia, Università Cattolica del Sacro Cuore, Roma, Italy
| | - L Richeldi
- Facoltà di Medicina e Chirurgia, Università Cattolica del Sacro Cuore, Roma, Italy
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
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Viewpoint: a multidisciplinary approach to the assessment of patients with systemic sclerosis-associated interstitial lung disease. Clin Rheumatol 2023; 42:653-661. [PMID: 36271064 PMCID: PMC9935731 DOI: 10.1007/s10067-022-06408-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 10/05/2022] [Accepted: 10/07/2022] [Indexed: 11/03/2022]
Abstract
Systemic sclerosis (SSc) is a rare and heterogeneous disease affecting the skin and internal organs. SSc-associated ILD (SSc-ILD) is a common and often early manifestation of SSc. This article discusses the rationale for a multidisciplinary approach (MDA) to the early identification and assessment of patients with SSc-ILD. Diagnosis of SSc-ILD is often challenging as patients with early disease can be asymptomatic, and SSc-ILD symptoms, such as exertional dyspnea and cough, are non-specific. High-resolution computed tomography (HRCT) of the lungs is the gold standard for diagnosis of SSc-ILD since pulmonary function tests lack sensitivity and specificity, especially in early disease. On HRCT, most patients with SSc-ILD have a non-specific interstitial pneumonia (NSIP) pattern. In addition, findings of pulmonary hypertension and esophageal dysmotility may be present. The multi-organ involvement of SSc and the diverse spectrum of symptoms support an MDA for the diagnosis and assessment of patients with SSc-ILD, with input from rheumatologists, pulmonologists, gastroenterologists, radiologists, and other specialists. Key Points • Interstitial lung disease (ILD) is a common manifestation of systemic sclerosis (SSc). • Early diagnosis is key to reducing the morbidity and mortality associated with SSc-ILD and other manifestations of SSc. • The multi-organ involvement of SSc supports a multidisciplinary approach to the diagnosis and assessment of patients with SSc-ILD, with input from rheumatologists, pulmonologists, gastroenterologists, radiologists, and other specialists.
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Patient-Perceived Satisfaction and Knowledge Uptake in a Combined Cardio-Obstetrics Clinic. J Cardiovasc Dev Dis 2022; 9:jcdd9120433. [PMID: 36547430 PMCID: PMC9781400 DOI: 10.3390/jcdd9120433] [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: 10/11/2022] [Revised: 11/28/2022] [Accepted: 11/29/2022] [Indexed: 12/07/2022] Open
Abstract
Heart disease is the leading cause of pregnancy-related mortality in the United States and has led to the development of combined cardio-obstetrics (COB) clinics as a model for prenatal care. In other areas of medicine, these types of collaborative care models have shown improvement in morbidity, mortality, and patient satisfaction. There is some data to suggest that a combined COB clinic improves maternal outcomes but there is no data to suggest patients prefer this type of care model. This study aims to evaluate patient satisfaction in a combined COB clinic and whether this type of model enhances perceived communication and knowledge uptake. A quality questionnaire was developed to assess patient perceptions regarding communication, satisfaction, and perceived knowledge. Patients who attended the clinic (n = 960) from 2014-2020 were contacted by email, with a response received from 119 (12.5%). Participants completed a questionnaire assessing satisfaction and perceived knowledge uptake with answers based on a Likert scale (7 representing very satisfied and 1 representing very unsatisfied). Safe and effective contraceptive use was evaluated by multiple choice options. Knowledge was also assessed by comparing contraceptive use before and after the clinic. Participants reported high levels of satisfaction with the clinic (6.2 ± 1.5), provider-to-patient communication (6.1 ± 1.6), and with the multidisciplinary appointment approach (6.3 ± 1.5). As well, participants reported an increase in knowledge about heart disease a result of collaborative counseling. In summary, a multidisciplinary approach to cardio-obstetrics not only improves outcomes but is a patient satisfier.
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Aronson KI, Danoff SK, Russell AM, Ryerson CJ, Suzuki A, Wijsenbeek MS, Bajwah S, Bianchi P, Corte TJ, Lee JS, Lindell KO, Maher TM, Martinez FJ, Meek PM, Raghu G, Rouland G, Rudell R, Safford MM, Sheth JS, Swigris JJ. Patient-centered Outcomes Research in Interstitial Lung Disease: An Official American Thoracic Society Research Statement. Am J Respir Crit Care Med 2021; 204:e3-e23. [PMID: 34283696 PMCID: PMC8650796 DOI: 10.1164/rccm.202105-1193st] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background: In the past two decades, many advances have been made to our understanding of interstitial lung disease (ILD) and the way we approach its treatment. Despite this, many questions remain unanswered, particularly those related to how the disease and its therapies impact outcomes that are most important to patients. There is currently a lack of guidance on how to best define and incorporate these patient-centered outcomes in ILD research. Objectives: To summarize the current state of patient-centered outcomes research in ILD, identify gaps in knowledge and research, and highlight opportunities and methods for future patient-centered research agendas in ILD. Methods: An international interdisciplinary group of experts was assembled. The group identified top patient-centered outcomes in ILD, reviewed available literature for each outcome, highlighted important discoveries and knowledge gaps, and formulated research recommendations. Results: The committee identified seven themes around patient-centered outcomes as the focus of the statement. After a review of the literature and expert committee discussion, we developed 28 research recommendations. Conclusions: Patient-centered outcomes are key to ascertaining whether and how ILD and interventions used to treat it affect the way patients feel and function in their daily lives. Ample opportunities exist to conduct additional work dedicated to elevating and incorporating patient-centered outcomes in ILD research.
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Russo L, Willis K, Smallwood N. Assisting People With Their Living, Not Their Dying: Health Professionals' Perspectives of Palliative Care and Opioids in ILD. Am J Hosp Palliat Care 2021; 39:211-219. [PMID: 34056929 DOI: 10.1177/10499091211018664] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Interstitial lung disease (ILD) is a debilitating and life-limiting condition, requiring multi-disciplinary care. While guidelines recommend early specialist palliative care referral to improve symptoms and quality of life, few patients access such care towards the end-of-life. This study aimed to explore clinicians' perspectives regarding specialist palliative care and opioids to understand barriers to optimal care and guide clinical practice improvement initiatives. METHODS A cross-sectional, exploratory, qualitative study was undertaken with Australian respiratory clinicians caring for people with ILD (n = 17). In-depth, semi-structured interviews were audio-recorded, transcribed verbatim and coded. Thematic analysis was undertaken to extrapolate recurring ideas from the data. RESULTS Four themes were identified: 1) understanding how to improve patient care and support, 2) the need to dispel stigmatized beliefs and misconceptions, 3) the importance of trusted relationships and good communication and 4) the challenges of navigating the health-care system. Participants discussed the need to implement early specialist palliative care and symptom palliation to alleviate symptoms, provide emotional support and augment quality of life. Participants described challenges accessing palliative care and opioids due to stigmatized beliefs amongst patients and clinicians and difficulties navigating the health-care system. Trusted therapeutic relationships with patients and strong inter-disciplinary partnerships with collaborative education and communication were perceived to improve patients' access to symptom palliation. CONCLUSION Specialist palliative care and opioids were believed to improve patients' quality of life, however, many barriers can make accessing such care challenging. To address these issues, multi-disciplinary collaboration, high-quality communication and trusted therapeutic relationships are crucial throughout the ILD illness journey.
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Affiliation(s)
- Lauren Russo
- Melbourne Medical School, 2281The University of Melbourne, Parkville, Victoria, Australia
| | - Karen Willis
- School of Allied Health, Human Services and Sport, 2080La Trobe University, Melbourne, Victoria, Australia.,Division of Critical Care and Investigative Services, 90134Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Natasha Smallwood
- Department of Respiratory and Sleep Medicine, 90134The Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Medicine, 2281The University of Melbourne, Parkville, Victoria Australia
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Hur JW, Ko KM, Park KS, Hong SJ, Kim HS, Lee MS. Real-world experiences of the diagnosis process in Korean patients with ankylosing spondylitis based on a self-report questionnaire. J Int Med Res 2021; 49:3000605211004201. [PMID: 33823632 PMCID: PMC8033485 DOI: 10.1177/03000605211004201] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Objectives The diagnosis of ankylosing spondylitis (AS) is often delayed, which affects
various clinical outcomes. This study examined the real-world situation of
patients with AS during diagnosis and treatment. Methods Data were obtained from 26 tertiary care hospitals in Korea using a
self-report questionnaire. The questionnaire assessed symptoms, pain,
extra-articular manifestations, the initial pattern of pain before
diagnosis, factors leading to delayed referral to rheumatology, time until
receiving an AS diagnosis, comorbid diseases, treatment status, and disease
education needs. Results Between September and October 2019, 1012 patients with AS completed the
survey. Of these, 75.8% were men and 51.8% were in their 30s or 40s. Median
disease duration was 76 months. The median time to diagnosis with AS was 12
months. When pain occurred, the medical departments most frequently visited
first were orthopedic (61.5%) and rheumatology (18.7%) departments. The
likelihood of the first visit being to the orthopedic department and the
frequency of biologics use increased with the disease duration. The rates of
uveitis, depressed mood, and comorbid diseases were higher in the group with
delayed diagnosis. Conclusions Physicians should be aware of subtypes of AS that take longer to diagnose and
comorbid diseases in the real-world clinical setting.
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Affiliation(s)
- Jin-Wuk Hur
- Division of Rheumatology, Department of Internal Medicine, Nowon
Eulji University Hospital, Seoul, Republic of Korea
| | - Kyung Min Ko
- Division of Rheumatology, Department of Internal Medicine,
International St. Mary's Hospital, Catholic Kwandong University, Incheon,
Republic of Korea
| | - Kyung-Su Park
- Division of Rheumatology, Department of Internal Medicine, St.
Vincent’s Hospital, The Catholic University of Korea College of Medicine, Suwon,
Republic of Korea
| | - Seung-Jae Hong
- Division of Rheumatology, Department of Internal Medicine, Kyung
Hee University Medical Center, Seoul, Republic of Korea
| | - Hyun-Sook Kim
- Division of Rheumatology, Department of Internal Medicine,
Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
- Hyun-Sook Kim, Division of Rheumatology,
Department of Internal Medicine, Division of Rheumatology, Soonchunhyang Univ.
Seoul Hospital, 59 Daesagwan-ro, Yongsan-gu. Seoul 04401, Republic of Korea.
| | - Myeung-Su Lee
- Division of Rheumatology, Department of Internal Medicine,
Wonkwang University Hospital, Iksan, Republic of Korea
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Li KL, Fang CH, Ferastraoaru D, Akbar NA, Jerschow E, Abuzeid WM. Patient Satisfaction and Efficiency Benefits of a Novel Multidisciplinary Rhinology and Allergy Clinic. Ann Otol Rhinol Laryngol 2020; 129:699-706. [PMID: 32059621 DOI: 10.1177/0003489420905859] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Chronic rhinosinusitis (CRS) is a chronic inflammatory disease of the sinonasal mucosa and with strong associations to other immune-mediated comorbidities. Patients often require referral to both an otolaryngologist and an allergist/immunologist. This study is the first in the literature to describe a multidisciplinary clinic that offers patient care by subspecialists in rhinology and in allergy/immunology. METHODS One hundred twenty-nine patients were seen in the Comprehensive Sinus and Allergy Clinic (CSAC) between January 2016 and June 2017 and 43 selected patients were seen in both the standalone allergy and rhinology clinics over the same time period. Patient satisfaction was retrospectively assessed using a modified Press-Ganey satisfaction survey. Time to evaluation and time to follow up appointment were compared between the CSAC and both the standalone rhinology and allergy/immunology clinics. RESULTS Patients seen in the CSAC reported high satisfaction with the amount of time spent with the physicians (98.3%), quality of medical care (9.3 ± 1.0), and most importantly, the convenience of seeing two physicians in one day (9.5 ± 1.2). Time from referral placement to clinic evaluation (P ≤ .02) and time to follow up appointment (P ≤ .002) was significantly shorter for the CSAC than for the standalone Rhinology or Allergy clinics. CONCLUSION Patients reported high satisfaction with the medical care provided and were also seen much faster in our multidisciplinary clinic as compared to standalone rhinology or allergy/immunology clinics. Overall, a multidisciplinary approach may be beneficial to patients presenting to tertiary referral centers with CRS and atopic conditions.
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Affiliation(s)
- Kevin L Li
- Department of Otorhinolaryngology-Head and Neck Surgery, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Christina H Fang
- Department of Otorhinolaryngology-Head and Neck Surgery, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Denisa Ferastraoaru
- Department of Allergy & Immunology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Nadeem A Akbar
- Department of Otorhinolaryngology-Head and Neck Surgery, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Elina Jerschow
- Department of Allergy & Immunology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Waleed M Abuzeid
- Department of Otorhinolaryngology-Head and Neck Surgery, Albert Einstein College of Medicine, Bronx, NY, USA
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Furini F, Carnevale A, Casoni GL, Guerrini G, Cavagna L, Govoni M, Sciré CA. The Role of the Multidisciplinary Evaluation of Interstitial Lung Diseases: Systematic Literature Review of the Current Evidence and Future Perspectives. Front Med (Lausanne) 2019; 6:246. [PMID: 31750308 PMCID: PMC6842981 DOI: 10.3389/fmed.2019.00246] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 10/15/2019] [Indexed: 12/02/2022] Open
Abstract
The opportunity of a multidisciplinary evaluation for the diagnosis of interstitial pneumonias highlighted a major change in the diagnostic approach to diffuse lung disease. The new American Thoracic Society, European Respiratory Society, Japanese Respiratory Society, and Latin American Thoracic Society guidelines for the diagnosis of idiopathic pulmonary fibrosis have reinforced this assumption and have underlined that the exclusion of connective tissue disease related lung involvement is mandatory, with obvious clinical and therapeutic impact. The multidisciplinary team discussion consists in a moment of interaction among the radiologist, pathologist and pulmonologist, also including the rheumatologist when considered necessary, to improve diagnostic agreement and optimize the definition of those cases in which pulmonary involvement may represent the first or prominent manifestation of an autoimmune systemic disease. Moreover, the proposal of classification criteria for interstitial lung disease with autoimmune features (IPAF) represents an effort to define lung involvement in clinically undefined autoimmune conditions. The complexity of autoimmune diseases, and in particular the lack of classification criteria defined for pathologies such as anti-synthetase syndrome, makes the involvement of the rheumatologist essential for the correct interpretation of the autoimmune element and for the application of classification criteria, that could replace clinical pictures initially interpreted as IPAF in defined autoimmune disease, minimizing the risk of misdiagnosis. The aim of this review was to evaluate the available evidence about the efficiency and efficacy of different multidisciplinary team approaches, in order to standardize the professional figures and the core set procedures that should be necessary for a correct approach in diagnosing patients with interstitial lung disease.
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Affiliation(s)
- Federica Furini
- Section of Rheumatology, Department of Medical Sciences, University of Ferrara and Azienda Ospedaliero-Universitaria Sant'Anna di Ferrara, Cona, Italy
| | - Aldo Carnevale
- Department of Radiology, Azienda Ospedaliero-Universitaria Sant'Anna di Ferrara, Cona, Italy
| | - Gian Luca Casoni
- Department of Medical Sciences, Research Centre on Asthma and COPD, University of Ferrara, Ferrara, Italy
| | - Giulio Guerrini
- Section of Rheumatology, Department of Medical Sciences, University of Ferrara and Azienda Ospedaliero-Universitaria Sant'Anna di Ferrara, Cona, Italy
| | - Lorenzo Cavagna
- Division of Rheumatology, University and IRCCS Policlinico S. Matteo Foundation, Pavia, Italy
| | - Marcello Govoni
- Section of Rheumatology, Department of Medical Sciences, University of Ferrara and Azienda Ospedaliero-Universitaria Sant'Anna di Ferrara, Cona, Italy
| | - Carlo Alberto Sciré
- Section of Rheumatology, Department of Medical Sciences, University of Ferrara and Azienda Ospedaliero-Universitaria Sant'Anna di Ferrara, Cona, Italy
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