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Gupta A, Burgess R, Drozd M, Gierula J, Witte K, Straw S. The Surprise Question and clinician-predicted prognosis: systematic review and meta-analysis. BMJ Support Palliat Care 2024:spcare-2024-004879. [PMID: 38925876 DOI: 10.1136/spcare-2024-004879] [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: 03/10/2024] [Accepted: 06/02/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND The Surprise Question, 'Would you be surprised if this person died within the next year?' is a simple tool that can be used by clinicians to identify people within the last year of life. This review aimed to determine the accuracy of this assessment, across different healthcare settings, specialties, follow-up periods and respondents. METHODS Searches were conducted of Medline, Embase, AMED, PubMed and the Cochrane Central Register of Controlled Trials, from inception until 01 January 2024. Studies were included if they reported original data on the ability of the Surprise Question to predict survival. For each study (including subgroups), sensitivity, specificity, positive and negative predictive values and accuracy were determined. RESULTS Our dataset comprised 56 distinct cohorts, including 68 829 patients. In a pooled analysis, the sensitivity of the Surprise Question was 0.69 ((0.64 to 0.74) I2=97.2%), specificity 0.69 ((0.63 to 0.74) I2=99.7%), positive predictive value 0.40 ((0.35 to 0.45) I2=99.4%), negative predictive value 0.89 ((0.87 to 0.91) I2=99.7%) and accuracy 0.71 ((0.68 to 0.75) I2=99.3%). The prompt performed best in populations with high event rates, shorter timeframes and when posed to more experienced respondents. CONCLUSIONS The Surprise Question demonstrated modest accuracy with considerable heterogeneity across the population to which it was applied and to whom it was posed. Prospective studies should test whether the prompt can facilitate timely access to palliative care services, as originally envisioned. PROSPERO REGISTRATION NUMBER CRD32022298236.
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Affiliation(s)
- Ankit Gupta
- Leeds Institute of Medical Education, University of Leeds, Leeds, UK
| | | | - Michael Drozd
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - John Gierula
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Klaus Witte
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Sam Straw
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
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Harrison M, Jo HE, Troy LK, Nguyen B, Webster SE, Geis M, Lai S, Mulyadi E, Cooper WA, Mahar A, Teoh A, Jee A, Corte TJ. Disease Behaviour Classification: A pragmatic model for predicting outcomes in Interstitial Lung Disease. Respir Med 2024; 224:107533. [PMID: 38355019 DOI: 10.1016/j.rmed.2024.107533] [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: 06/26/2023] [Revised: 12/04/2023] [Accepted: 01/15/2024] [Indexed: 02/16/2024]
Abstract
BACKGROUND AND OBJECTIVE The interstitial lung diseases (ILD) are a heterogenous group of disorders with similar clinical presentation, but widely varying prognoses. The use of a pragmatic disease behaviour classification (DBC), first proposed in international guidelines in 2013, categorises diseases into five behavioural classes based on their predicted clinical course. This study aimed to determine the prognostic utility of the DBC in an ILD cohort. METHODS Consecutive patients presented at the weekly multidisciplinary meeting (MDM) of a specialist ILD centre were included. MDM consensus was obtained for diagnosis and DBC category (1-5). Baseline and serial clinical and physiological data were collected over the study period (median 3.9 years, range 0-5.4 years). The relationship between DBC and prognostic outcomes was explored. RESULTS 137 ILD patients, [64 (47%) female] were included with mean age 67.0 ± 1.1 years, baseline FVC% 72.7 ± 1.7, and baseline DLco% 57.8 ± 1.6%. Patients were stratified into DBC by consensus at MDM: DBC1 n = 0 (0%), DBC2 n = 16 (12%), DBC3 n = 10 (7.3%), DBC4 n = 55 (40%), and DBC5 n = 56 (41%). On univariable Cox regression, increasing DBC class was associated with poorer progression-free survival (HR 1.6, 95% CI 1.2-2.0, p < 0.001). On multivariable Cox regression, DBC remained predictive of PFS when combined with age and gender (HR 1.4, 95% CI 1.1-1.9, p = 0.011), baseline FVC% (HR 1.5, 95% CI 1.1-1.8, p = 0.003) and ILD diagnosis (HR 1.6, 95% CI 1.2-2.2, p < 0.0001). CONCLUSION DBC as determined at ILD multidisciplinary meeting may be a useful prognostic tool for the management of ILD patients.
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Affiliation(s)
- Megan Harrison
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia.
| | - Helen E Jo
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Lauren K Troy
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Benjamin Nguyen
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Susanne E Webster
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Monika Geis
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Simon Lai
- Department of Radiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Ellie Mulyadi
- Department of Radiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Wendy A Cooper
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Department of Tissue Pathology and Diagnostic Oncology, NSW Health Pathology, Royal Prince Alfred Hospital, Sydney, Australia; School of Medicine, University of Western Sydney, Sydney, Australia
| | - Annabelle Mahar
- Department of Tissue Pathology and Diagnostic Oncology, NSW Health Pathology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Alan Teoh
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Adelle Jee
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Tamera J Corte
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Centre of Research Excellence in Pulmonary Fibrosis, Australia
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Bramhill C, Langan D, Mulryan H, Eustace-Cook J, Russell AM, Brady AM. A scoping review of the unmet needs of patients diagnosed with idiopathic pulmonary fibrosis (IPF). PLoS One 2024; 19:e0297832. [PMID: 38354191 PMCID: PMC10866483 DOI: 10.1371/journal.pone.0297832] [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: 09/14/2023] [Accepted: 01/11/2024] [Indexed: 02/16/2024] Open
Abstract
AIMS Patients diagnosed with idiopathic pulmonary fibrosis (IPF) have a high symptom burden and numerous needs that remain largely unaddressed despite advances in available treatment options. There is a need to comprehensively identify patients' needs and create opportunities to address them. This scoping review aimed to synthesise the available evidence and identify gaps in the literature regarding the unmet needs of patients diagnosed with IPF. METHODS The protocol for the review was registered with Open Science Framework (DOI 10.17605/OSF.IO/SY4KM). A systematic search was performed in March 2022, in CINAHL, MEDLINE, Embase, PsychInfo, Web of Science Core Collection and ASSIA Applied Social Science Index. A comprehensive review of grey literature was also completed. Inclusion criteria included patients diagnosed with IPF and date range 2011-2022. A range of review types were included. Data was extracted using a data extraction form. Data was analysed using descriptive and thematic analysis. A total of 884 citations were reviewed. Ethical approval was not required. RESULTS 52 citations were selected for final inclusion. Five themes were identified: 1.) psychological impact of an IPF diagnosis. 2.) adequate information and education: at the right time and in the right way. 3.) high symptom burden support needs. 4.) referral to palliative care and advance care planning (ACP). 5.) health service provision-a systems approach. CONCLUSION This review highlights the myriad of needs patients with IPF have and highlights the urgent need for a systems approach to care, underpinned by an appropriately resourced multi-disciplinary team. The range of needs experienced by patients with IPF are broad and varied and require a holistic approach to care including targeted research, coupled with the continuing development of patient-focused services and establishment of clinical care programmes.
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Affiliation(s)
- Carita Bramhill
- Trinity Centre for Practice & Innovation, School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Donna Langan
- Respiratory Department, Galway University Hospital, Galway, Ireland
| | - Helen Mulryan
- Respiratory Department, Galway University Hospital, Galway, Ireland
| | | | - Anne-Marie Russell
- Institute of Clinical Sciences, College of Medical and Dental Sciences (MDS) University of Birmingham, Birmingham, United Kingdom
| | - Anne-Marie Brady
- Trinity Centre for Practice & Innovation, School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
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Liao YW, Chen YM, Liu MC, Wu YC, Hsu CY, Fu PK, Huang WN, Chen YH. Multidisciplinary-derived clinical score for accurate prediction of long-term mortality in fibrotic lung disease patients. Eur J Med Res 2024; 29:69. [PMID: 38245785 PMCID: PMC10799536 DOI: 10.1186/s40001-024-01644-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 01/06/2024] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND Idiopathic pulmonary fibrosis (IPF) stands out as one of the most aggressive forms of interstitial lung diseases (ILDs), currently without a definitive cure. Multidisciplinary discussion (MDD) is now considered a cornerstone in diagnosing and differentiating ILD subtypes. The Gender-Age-Physiology (GAP) score, developed to assess IPF prognosis based on sex, age, forced vital capacity, and diffusion capacity for carbon monoxide (DLCO), is limited in not considering dyspnea and functional impairment during the walking test. We proposed a MDD-based clinical score for mortality prediction among those patients. METHODS From December 2018 to December 2019, we enrolled ILD patients with IPF and non-IPF and followed-up them till December 2020. Based on DLCO, modified Medical Research Council (mMRC) Dyspnea Scale, and six-minute walking test (6MWT) distance, a functional score was developed for mortality prediction. RESULTS We enrolled 104 ILD patients, 12 (11.5%) died by the one-year follow-up. In receiver operating characteristic (ROC) curve analysis, DLCO (% predicted) was the most accurate variable predicting one-year mortality with an area under curve (AUC) of 0.88 (95% confidence interval [CI] = 0.80-0.94), followed by mMRC Dyspnea Score (AUC = 0.82 [95% CI = 0.73-0.89]), 6MWT distance (AUC = 0.80 [95% CI = 0.71-0.88]), and GAP score (AUC = 0.77 [95% CI = 0.67-0.84]). Only the GAP score (hazard ratio [HR] = 1.55, 95% CI = 1.03-2.34, p = 0.0.37) and functional score (HR = 3.45, 95% CI = 1.11-10.73, p = 0.032) were significantly associated with one-year mortality in multivariable analysis. CONCLUSION The clinical score composite of DLCO, mMRC Dyspnea Scale, and 6MWT distance could provide an accurate prediction for long-term mortality in ILD patients, laying out a helpful tool for managing and following these patients.
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Affiliation(s)
- Yu-Wan Liao
- Integrated Care Center of Interstitial Lung Disease, Taichung Veterans General Hospital, Taichung, 40705, Taiwan
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Division of Allergy, Taichung Veterans General Hospital, Taichung, 40705, Taiwan
| | - Yi-Ming Chen
- Division of Translation Medicine, Department of Medical Research, Taichung Veterans General Hospital, Taichung, 40705, Taiwan
| | - Ming-Cheng Liu
- Department of Radiology, Taichung Veterans General Hospital, Taichung, 40705, Taiwan
| | - Yu-Cheng Wu
- Integrated Care Center of Interstitial Lung Disease, Taichung Veterans General Hospital, Taichung, 40705, Taiwan
- Department of Critical Care Medicine, Taichung Veterans General Hospital, Taichung, 40705, Taiwan
| | - Chiann-Yi Hsu
- Biostatistics Task Force, Department of Medical Research, Taichung Veterans General Hospital, Taichung, 40705, Taiwan
| | - Pin-Kuei Fu
- Integrated Care Center of Interstitial Lung Disease, Taichung Veterans General Hospital, Taichung, 40705, Taiwan.
- Division of Clinical Research, Department of Medical Research, Taichung Veterans General Hospital, Taichung, 40705, Taiwan.
- Department of Medical Research, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, 407219, Taiwan.
| | - Wen-Nan Huang
- Integrated Care Center of Interstitial Lung Disease, Taichung Veterans General Hospital, Taichung, 40705, Taiwan
| | - Yi-Hsing Chen
- Integrated Care Center of Interstitial Lung Disease, Taichung Veterans General Hospital, Taichung, 40705, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, 40200, Taiwan
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Koudstaal T, Wijsenbeek MS. Idiopathic pulmonary fibrosis. Presse Med 2023; 52:104166. [PMID: 37156412 DOI: 10.1016/j.lpm.2023.104166] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/14/2023] [Accepted: 05/02/2023] [Indexed: 05/10/2023] Open
Abstract
Idiopathic pulmonary fibrosis (IPF) is a progressive devastating lung disease with substantial morbidity. It is associated with cough, dyspnea and impaired quality of life. If left untreated, IPF has a median survival of 3 years. IPF affects ∼3 million people worldwide, with increasing incidence in older patients. The current concept of pathogenesis is that pulmonary fibrosis results from repetitive injury to the lung epithelium, with fibroblast accumulation, myofibroblast activation, and deposition of matrix. These injuries, in combination with innate and adaptive immune responses, dysregulated wound repair and fibroblast dysfunction, lead to recurring tissue remodeling and self-perpetuating fibrosis as seen in IPF. The diagnostic approach includes the exclusion of other interstitial lung diseases or underlying conditions and depends on a multidisciplinary team-based discussion combining radiological and clinical features and well as in some cases histology. In the last decade, considerable progress has been made in the understanding of IPF clinical management, with the availability of two drugs, pirfenidone and nintedanib, that decrease pulmonary lung function decline. However, current IPF therapies only slow disease progression and prognosis remains poor. Fortunately, there are multiple clinical trials ongoing with potential new therapies targeting different disease pathways. This review provides an overview of IPF epidemiology, current insights in pathophysiology, diagnostic and therapeutic management approaches. Finally, a detailed description of current and evolving therapeutic approaches is also provided.
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Affiliation(s)
- Thomas Koudstaal
- Center for Interstitial Lung Diseases and Sarcoidosis, Department of Pulmonary Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands.
| | - Marlies S Wijsenbeek
- Center for Interstitial Lung Diseases and Sarcoidosis, Department of Pulmonary Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
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Di J, Li X, Yang J, Li L, Yu X. Bias and Reporting Quality of Clinical Prognostic Models for Idiopathic Pulmonary Fibrosis: A Cross-Sectional Study. Healthc Policy 2022; 15:1189-1201. [PMID: 35702399 PMCID: PMC9188804 DOI: 10.2147/rmhp.s357606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 05/09/2022] [Indexed: 11/23/2022] Open
Abstract
Objective This study aims to evaluate the risk of bias (ROB) and reporting quality of idiopathic pulmonary fibrosis (IPF) prediction models by assessing characteristics of these models. Methods The development and/or validation of IPF prognostic models were identified via an electronic search of PubMed, Embase, and Web of Science (from inception to 12 August, 2021). Two researchers independently assessed the risk of bias (ROB) and reporting quality of IPF prediction models based on the Prediction model Risk Of Bias Assessment Tool (PROBAST) and Transparent Reporting of a multivariable prognostic model for Individual Prognosis or Diagnosis (TRIPOD) checklist. Results Twenty prognostic model studies for IPF were included, including 7 (35%) model development and external validation studies, 8 (40%) development studies, and 5 (25%) external validation studies. According to PROBAST, all studies were appraised with high ROB, because of deficient reporting in the domains of participants (45.0%) and analysis (67.3%), and at least 55% studies were susceptible to 4 of 20 sources of bias. For the reporting quality, none of them completely adhered to the TRIPOD checklist, with the lowest mean reporting score for the methods and results domains (46.6% and 44.7%). For specific items, eight sub-items had a reporting rate ≥80% and adhered to the TRIPOD checklist, and nine sub-items had a very poor reporting rate, less than 30%. Conclusion Studies adhering to PROBAST and TRIPOD checklists are recommended in the future. The reproducibility and transparency can be improved when studies completely adhere to PROBAST and TRIPOD checklists.
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Affiliation(s)
- Jiaqi Di
- Co-Construction Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases by Henan & Education Ministry of P.R, Henna University of Chinese Medicine, Zhengzhou, 450046, People’s Republic of China
| | - Xuanlin Li
- Co-Construction Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases by Henan & Education Ministry of P.R, Henna University of Chinese Medicine, Zhengzhou, 450046, People’s Republic of China
| | - Jingjing Yang
- Co-Construction Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases by Henan & Education Ministry of P.R, Henna University of Chinese Medicine, Zhengzhou, 450046, People’s Republic of China
| | - Luguang Li
- Department of Respiratory Diseases, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, Henan, 450000, People’s Republic of China
| | - Xueqing Yu
- Department of Respiratory Diseases, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, Henan, 450000, People’s Republic of China
- Correspondence: Xueqing Yu, Email
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