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Blanco Loures J, Guimarães Assis M, Pereira HLA, Mancuzo EV, Parreira VF. Perception of patients with interstitial lung diseases submitted to inspiratory muscle training. Physiother Theory Pract 2024; 40:1317-1325. [PMID: 36326066 DOI: 10.1080/09593985.2022.2141598] [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: 03/16/2022] [Revised: 10/12/2022] [Accepted: 10/12/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Although inspiratory muscle training reduces dyspnea in patients with chronic respiratory diseases, it was not yet evaluated in a sample composed exclusively of patients with interstitial lung diseases. OBJECTIVE To discuss the perception of patients with interstitial lung diseases about inspiratory muscle training intervention. METHODS This is a qualitative study. Data were collected using semi-structured interviews, transcribed, and analyzed by thematic analysis. RESULTS Fourteen patients (64 ± 7 years) with interstitial lung disease were interviewed. Average participation in the inspiratory muscle training program was 90% (range, 66-100%). Three themes were elaborated: 1) dyspnea and other symptoms in daily life (e.g. "I could not carry out a bag; I was very uncomfortable"); 2) less symptom and greater performance (e.g. "I wash and change my clothes, house cleaning, do everything without feeling anything"); and 3) IMT: a time dedicated to my health (e.g. "For me it was great because I saw my evolution every day"). CONCLUSION Patients noticed improvements in symptoms and performance related to daily activities. Despite initial difficulties, patients continued training as planned.
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Affiliation(s)
- Jéssica Blanco Loures
- Rehabilitation Sciences Program, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Marcella Guimarães Assis
- Department of Occupacional Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Eliane Viana Mancuzo
- Department of Medical Clinic, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Wells M, Harding S, Dixon G, Buckley K, Russell AM, Barratt SL. Patient and caregiver shared experiences of pulmonary fibrosis (PF): A systematic literature review. Respir Med 2024; 227:107659. [PMID: 38729528 DOI: 10.1016/j.rmed.2024.107659] [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: 02/26/2024] [Revised: 04/30/2024] [Accepted: 05/03/2024] [Indexed: 05/12/2024]
Abstract
Pulmonary Fibrosis (PF) describes a group of lung diseases characterised by progressive scarring (fibrosis). Symptoms worsen over time and include breathlessness, tiredness, and cough, giving rise to psychological distress. Significant morbidity accompanies PF, so ensuring patients' care needs are well defined and provided for, represents an important treatment strategy. The purpose of this systematic review was to synthesise what is currently known about the psychosocial morbidity, illness experience and needs of people with pulmonary fibrosis and their informal caregivers. Eight databases (MEDLINE, EMBASE, PUBMED, Cochrane database of Systematic reviews (CDSR), Web of Science Social Sciences Citation Index, PsycINFO, PsycARTICLES and CINAHL) were used to identify studies exploring the supportive needs of adults with PF and/or their caregivers. Methodological quality was assessed using the Mixed Methods Appraisal Tool. 53 studies were included, the majority using qualitative methodology (79 %, 42/53), 6 as part of mixed methodological studies. Supportive care needs were mapped to eight domains using an a priori framework analysis. Findings highlight a lack of psychological support throughout the course of the illness, misconceptions about and barriers to, the provision of palliative care despite its potential positive impacts. Patients and caregivers express a desire for greater disease specific education and information provision throughout the illness. Trials of complex interventions are needed to address the unique set of challenges for patients and carers living with PF.
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Affiliation(s)
- Matthew Wells
- Bristol Interstitial Lung Disease Service, North Bristol NHS Trust, Bristol, UK.
| | - Sam Harding
- Research and Development, North Bristol NHS Trust, Bristol, UK.
| | - Giles Dixon
- Bristol Interstitial Lung Disease Service, North Bristol NHS Trust, Bristol, UK; Department of Clinical and Biomedical Sciences, University of Exeter, Exeter, UK.
| | - Kirsten Buckley
- Library and Knowledge Services, North Bristol NHS Trust, Bristol, UK
| | - Anne-Marie Russell
- Birmingham Regional Interstitial Lung Disease Service, University Hospitals Birmingham NHS Trust, Birmingham, UK; Faculty of Life Sciences, University of Exeter, Exeter, UK.
| | - Shaney L Barratt
- Bristol Interstitial Lung Disease Service, North Bristol NHS Trust, Bristol, UK; Academic Respiratory Unit, Department of Clinical Sciences, University of Bristol, Bristol, UK.
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3
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Alamer AA, Ward C, Forrest I, Drinnan M, Patterson J. Eating and drinking experience in patients with idiopathic pulmonary fibrosis: a qualitative study. BMJ Open 2024; 14:e078608. [PMID: 38582536 PMCID: PMC11002418 DOI: 10.1136/bmjopen-2023-078608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 03/11/2024] [Indexed: 04/08/2024] Open
Abstract
OBJECTIVE To explore eating and drinking experiences of patients with idiopathic pulmonary fibrosis (IPF), the impact of any changes associated with their diagnosis and any coping mechanisms developed by patients. SETTING Pulmonary fibrosis support groups around the UK and the regional Interstitial Lung Diseases Clinic, Newcastle upon Tyne. PARTICIPANTS 15 patients with IPF (9 men, 6 women), median age 71 years, range (54-92) years, were interviewed. Inclusion criteria included competent adults (over the age of 18 years) with a secure diagnosis of IPF as defined by international consensus guidelines. Patients were required to have sufficient English language competence to consent and participate in an interview. Exclusion criteria were a history of other lung diseases, a history of pre-existing swallowing problem of other causes that may be associated with dysphagia and individuals with significant communication or other memory difficulties that render them unable to participate in an interview. DESIGN A qualitative study based on semistructured interviews used purpose sampling conducted between February 2021 and November 2021. Interviews were conducted via video videoconferencing call platform or telephone call, transcribed and data coded and analysed using a reflexive thematic analysis. RESULTS Three main themes were identified, along with several subthemes, which were: (1) Eating, as such, is no longer a pleasure. This theme mainly focused on the physical and sensory changes associated with eating and drinking and their effects and the subsequent emotional and social impact of these changes; (2) It is something that happens naturally and just try and get on with it. This theme centred on the self-determined strategies employed to manage changes to eating and drinking; and (3) What is normal. This theme focused on patients seeking information to better understand the changes in their eating and drinking and the patients' beliefs about what has changed their eating and drinking. CONCLUSIONS To our knowledge, this is the first study to report on IPF patients' lived experience of eating and drinking changes associated with their diagnosis. Findings demonstrate that some patients have substantial struggles and challenges with eating and drinking, affecting them physically, emotionally and socially. There is a need to provide better patient information for this area and further study.
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Affiliation(s)
- Amal Ahmad Alamer
- Respiratory Care, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Christopher Ward
- Translational and Clinical Research Institute, School of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Ian Forrest
- Royal Victoria Infirmary, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | | | - Joanne Patterson
- School of Health Sciences, University of Liverpool, Liverpool, UK
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Piccari L, Kovacs G, Jones S, Skaara H, Herms CR, Jeanneret GSB, Vinardell MC, Guix NG, Delgado MF, García HG, Schwicker D. The European Voice of the Patient living with pulmonary hypertension associated with interstitial lung disease: Diagnosis, symptoms, impacts, and treatments. Pulm Circ 2024; 14:e12405. [PMID: 38911184 PMCID: PMC11193837 DOI: 10.1002/pul2.12405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 06/03/2024] [Accepted: 06/12/2024] [Indexed: 06/25/2024] Open
Abstract
Pulmonary hypertension (PH) adds a substantial disease burden, including higher mortality, when associated with interstitial lung disease (ILD), a severe, chronic, progressive condition. Yet little is known of the lived experiences, perspectives, priorities, and viewpoints of patients and carers living with PH-ILD. The Voice of the Patient meeting at the center of this qualitative research study aims to provide these difficult-to-obtain insights from a European perspective for the first time. The multistakeholder approach brought together four PH-ILD patients, three primary caregivers, two patient associations, clinical experts, sponsor representatives, and a facilitator. Of the six major themes identified in the thematic analysis, symptoms, and physical limitations were the most impactful. Shortness of breath was the most bothersome symptom affecting patients daily. Further symptoms included fatigue, cough, dizziness, syncope, edema, and palpitations. Physical limitations focused on reduced mobility, impacting patients' ability to perform daily tasks, hobbies, sports, and to enjoy travel. Existing antifibrotic and pulmonary arterial hypertension-targeted treatments were perceived as beneficial. However, despite advances in treatment, severe disease burdens and high unmet medical needs persist from the perspectives of patients. Most meaningful to patients' daily wellbeing was supplemental oxygen, enabling greater mobility. Patients and carers reported difficulties and barriers in navigating the healthcare system and obtaining adequate information to reduce their considerable uncertainties, documenting the substantial challenges that rare and complex conditions such as PH-ILD pose for routine clinical practice beyond PH expert centers and indicating an urgent need for high-quality patient- and clinician-directed information to support patient-centered care.
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Affiliation(s)
| | - Gabor Kovacs
- Division of PulmonologyUniversity Clinic for Internal Medicine, Medical University of GrazGrazAustria
| | - Steve Jones
- European Pulmonary Fibrosis Federation (EU‐PFF)OverijseBelgium
| | - Hall Skaara
- Pulmonary Hypertension Association Europe (PHA Europe)ViennaAustria
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Raghu G, Ghazipura M, Fleming TR, Aronson KI, Behr J, Brown KK, Flaherty KR, Kazerooni EA, Maher TM, Richeldi L, Lasky JA, Swigris JJ, Busch R, Garrard L, Ahn DH, Li J, Puthawala K, Rodal G, Seymour S, Weir N, Danoff SK, Ettinger N, Goldin J, Glassberg MK, Kawano-Dourado L, Khalil N, Lancaster L, Lynch DA, Mageto Y, Noth I, Shore JE, Wijsenbeek M, Brown R, Grogan D, Ivey D, Golinska P, Karimi-Shah B, Martinez FJ. Meaningful Endpoints for Idiopathic Pulmonary Fibrosis (IPF) Clinical Trials: Emphasis on 'Feels, Functions, Survives'. Report of a Collaborative Discussion in a Symposium with Direct Engagement from Representatives of Patients, Investigators, the National Institutes of Health, a Patient Advocacy Organization, and a Regulatory Agency. Am J Respir Crit Care Med 2024; 209:647-669. [PMID: 38174955 DOI: 10.1164/rccm.202312-2213so] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 01/02/2024] [Indexed: 01/05/2024] Open
Abstract
Background: Idiopathic pulmonary fibrosis (IPF) carries significant mortality and unpredictable progression, with limited therapeutic options. Designing trials with patient-meaningful endpoints, enhancing the reliability and interpretability of results, and streamlining the regulatory approval process are of critical importance to advancing clinical care in IPF. Methods: A landmark in-person symposium in June 2023 assembled 43 participants from the US and internationally, including patients with IPF, investigators, and regulatory representatives, to discuss the immediate future of IPF clinical trial endpoints. Patient advocates were central to discussions, which evaluated endpoints according to regulatory standards and the FDA's 'feels, functions, survives' criteria. Results: Three themes emerged: 1) consensus on endpoints mirroring the lived experiences of patients with IPF; 2) consideration of replacing forced vital capacity (FVC) as the primary endpoint, potentially by composite endpoints that include 'feels, functions, survives' measures or FVC as components; 3) support for simplified, user-friendly patient-reported outcomes (PROs) as either components of primary composite endpoints or key secondary endpoints, supplemented by functional tests as secondary endpoints and novel biomarkers as supportive measures (FDA Guidance for Industry (Multiple Endpoints in Clinical Trials) available at: https://www.fda.gov/media/162416/download). Conclusions: This report, detailing the proceedings of this pivotal symposium, suggests a potential turning point in designing future IPF clinical trials more attuned to outcomes meaningful to patients, and documents the collective agreement across multidisciplinary stakeholders on the importance of anchoring IPF trial endpoints on real patient experiences-namely, how they feel, function, and survive. There is considerable optimism that clinical care in IPF will progress through trials focused on patient-centric insights, ultimately guiding transformative treatment strategies to enhance patients' quality of life and survival.
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Affiliation(s)
- Ganesh Raghu
- Center for Interstitial Lung Diseases, Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine
- Department of Laboratory Medicine and Pathology, and
| | - Marya Ghazipura
- ZS Associates, Global Health Economics and Outcomes Research, New York, New York
- Division of Epidemiology and
- Division of Biostatistics, Department of Population Health, New York University Langone Health, New York, New York
| | - Thomas R Fleming
- Department of Biostatistics, University of Washington, Seattle, Washington
| | - Kerri I Aronson
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Jürgen Behr
- Department of Medicine V, LMU University Hospital, Ludwig-Maximilians-University Munich, Member of the German Center for Lung Research, Munich, Germany
| | | | - Kevin R Flaherty
- Division of Pulmonary and Critical Care, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Ella A Kazerooni
- Division of Pulmonary and Critical Care, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
- Division of Cardiothoracic Radiology, Department of Radiology, University of Michigan Health System, Detroit, Michigan
| | - Toby M Maher
- Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Luca Richeldi
- Divisione di Medicina Polmonare, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Joseph A Lasky
- Department of Medicine, Tulane University, New Orleans, Louisiana
| | | | - Robert Busch
- Division of Pulmonology, Allergy, and Critical Care, Office of Immunology and Inflammation, and
| | - Lili Garrard
- Division of Biometrics III, Office of Biostatistics, Office of Translational Sciences, Center for Drug Evaluation and Research, and
| | - Dong-Hyun Ahn
- Division of Biometrics III, Office of Biostatistics, Office of Translational Sciences, Center for Drug Evaluation and Research, and
| | - Ji Li
- Division of Clinical Outcome Assessment, Office of Drug Evaluation Sciences, Office of New Drugs, and
| | - Khalid Puthawala
- Division of Pulmonology, Allergy, and Critical Care, Office of Immunology and Inflammation, and
| | - Gabriela Rodal
- Office of Product Evaluation and Quality, Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, Maryland
| | - Sally Seymour
- Division of Pulmonology, Allergy, and Critical Care, Office of Immunology and Inflammation, and
| | - Nargues Weir
- Office of Product Evaluation and Quality, Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, Maryland
| | - Sonye K Danoff
- Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Neil Ettinger
- Division of Pulmonary Medicine, St. Luke's Hospital, Chesterfield, Missouri
| | - Jonathan Goldin
- Department of Radiology, University of California, Los Angeles, Los Angeles, California
| | - Marilyn K Glassberg
- Department of Medicine, Stritch School of Medicine, Loyola Chicago, Chicago, Illinois
| | - Leticia Kawano-Dourado
- Hcor Research Institute - Hcor Hospital, São Paolo, Brazil
- Pulmonary Division, Heart Institute (InCor), University of São Paulo, São Paulo, Brazil
| | - Nasreen Khalil
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lisa Lancaster
- Division of Pulmonary, Critical Care, and Sleep Medicine, Vanderbilt University, Nashville, Tennessee
| | - David A Lynch
- Department of Radiology, National Jewish Health, Denver, Colorado
| | - Yolanda Mageto
- Division of Pulmonary, Critical Care, and Sleep Medicine, Baylor University, Dallas, Texas
| | - Imre Noth
- Division of Pulmonary and Critical Care Medicine, University of Virginia, Charlottesville, Virginia
| | | | - Marlies Wijsenbeek
- Centre of Interstitial Lung Diseases, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
| | - Robert Brown
- Patient representative and patient living with IPF, Lovettsville, Virginia
| | - Daniel Grogan
- Patient representative and patient living with IPF, Charlottesville, Virginia; and
| | - Dorothy Ivey
- Patient representative and patient living with IPF, Richmond, Virginia
| | - Patrycja Golinska
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Banu Karimi-Shah
- Division of Pulmonology, Allergy, and Critical Care, Office of Immunology and Inflammation, and
| | - Fernando J Martinez
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York
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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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Janssen DJA, Bajwah S, Boon MH, Coleman C, Currow DC, Devillers A, Vandendungen C, Ekström M, Flewett R, Greenley S, Guldin MB, Jácome C, Johnson MJ, Kurita GP, Maddocks M, Marques A, Pinnock H, Simon ST, Tonia T, Marsaa K. European Respiratory Society clinical practice guideline: palliative care for people with COPD or interstitial lung disease. Eur Respir J 2023; 62:2202014. [PMID: 37290789 DOI: 10.1183/13993003.02014-2022] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 05/06/2023] [Indexed: 06/10/2023]
Abstract
There is increased awareness of palliative care needs in people with COPD or interstitial lung disease (ILD). This European Respiratory Society (ERS) task force aimed to provide recommendations for initiation and integration of palliative care into the respiratory care of adult people with COPD or ILD. The ERS task force consisted of 20 members, including representatives of people with COPD or ILD and informal caregivers. Eight questions were formulated, four in the Population, Intervention, Comparison, Outcome format. These were addressed with full systematic reviews and application of Grading of Recommendations Assessment, Development and Evaluation for assessing the evidence. Four additional questions were addressed narratively. An "evidence-to-decision" framework was used to formulate recommendations. The following definition of palliative care for people with COPD or ILD was agreed. A holistic and multidisciplinary person-centred approach aiming to control symptoms and improve quality of life of people with serious health-related suffering because of COPD or ILD, and to support their informal caregivers. Recommendations were made regarding people with COPD or ILD and their informal caregivers: to consider palliative care when physical, psychological, social or existential needs are identified through holistic needs assessment; to offer palliative care interventions, including support for informal caregivers, in accordance with such needs; to offer advance care planning in accordance with preferences; and to integrate palliative care into routine COPD and ILD care. Recommendations should be reconsidered as new evidence becomes available.
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Affiliation(s)
- Daisy J A Janssen
- Department of Research & Development, Ciro, Horn, The Netherlands
- Department of Health Services Research and Department of Family Medicine, Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Sabrina Bajwah
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Michele Hilton Boon
- WiSE Centre for Economic Justice, Glasgow Caledonian University, Glasgow, UK
| | | | - David C Currow
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia
| | - Albert Devillers
- Association Belge Francophone contre la Fibrose Pulmonaire (ABFFP), Rebecq, Belgium
| | - Chantal Vandendungen
- Association Belge Francophone contre la Fibrose Pulmonaire (ABFFP), Rebecq, Belgium
| | - Magnus Ekström
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Respiratory Medicine, Allergology and Palliative Medicine, Lund, Sweden
| | | | - Sarah Greenley
- Institute for Clinical and Applied Health Research, Hull York Medical School, University of Hull, Hull, UK
| | | | - Cristina Jácome
- CINTESIS@RISE, Department of Community Medicine, Health Information and Decision, Faculty of Medicine of University of Porto, Porto, Portugal
| | - Miriam J Johnson
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Geana Paula Kurita
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Multidisciplinary Pain Centre, Department of Anaesthesiology, Pain and Respiratory Support, Neuroscience Centre and Palliative Research Group, Department of Oncology, Centre for Cancer and Organ Diseases, Rigshospitalet, Copenhagen, Denmark
| | - Matthew Maddocks
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Alda Marques
- Respiratory Research and Rehabilitation Laboratory (Lab3R), School of Health Sciences (ESSUA) and Institute of Biomedicine (iBiMED), University of Aveiro, Aveiro, Portugal
| | - Hilary Pinnock
- Allergy and Respiratory Research Group, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Steffen T Simon
- University of Cologne, Faculty of Medicine and University Hospital, Department of Palliative Medicine and Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf (CIO ABCD), Cologne, Germany
| | - Thomy Tonia
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Kristoffer Marsaa
- Department of Multidisease, Nordsjaellands Hospital, University of Copenhagen, Copenhagen, Denmark
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Marsaa K, Mendahl J, Nielsen S, Mørk L, Sjøgren P, Kurita GP. Development of a systematic multidisciplinary clinical and teaching model for the palliative approaches in patients with severe lung failure. Eur Clin Respir J 2022; 9:2108195. [PMID: 35979343 PMCID: PMC9377267 DOI: 10.1080/20018525.2022.2108195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Palliative medicine has traditionally focused on people affected by cancer with rapidly advancing disease progression. However, as more people live longer time with serious illnesses, including lung diseases, the need of palliative care for these patients if also increasing. There is a lack of research and clinical knowledge about what palliative care is for people affected by chronic obstructive pulmonary disease and interstitial lung disease. The aim of this paper is to describe the development process of an easy to use and clinically relevant model for the palliative care approach in people affected by severe illnesses. The developed model consists of four components, which originated the title” 4,2,4,2 model”. Each number has a specific meaning: the first 4 = the four disease trajectories that patients may experience; 2 = the two forms of knowledge, objective, and intuitive that must be achieved by the health professionals to gain an understanding of the situation; 4 = the four dimensions of suffering physically, mentally, socially and existentially/spiritually; and 2 = the two roles that health-care professionals must be able to take in when treating patients with serious illnesses. The 4-2-4-2 model proposes an easy-to-use and clinically relevant model for palliative approach and integration of PC and pulmonary medicine. Another important purpose of this model is to provide HPs with different educational backgrounds and from different medical fields with a ‘golden standard approach’ to enhance the focus of the palliative approach in both the clinic and teaching. The effect and consequences of the use of the 4-2-4-2 model should be explored in future clinical trials. Furthermore, it should be investigated whether teaching the model creates a change in clinical approach to patients with serious illnesses as well as whether these changes are long-lasting.
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Affiliation(s)
| | - Janni Mendahl
- Palliative Unit, Department of Urology, Herlev and Gentofte hospital Copenhagen University Hospital, Denmark
| | - Steen Nielsen
- The Danish Cancer Society, Denmark
- Sankt Lukas hospice, Hellerup, Denmark
| | - Lotte Mørk
- Section of Palliative Medicine, Department of Oncology, Centre for Cancer and Organ Diseases, Rigshospitalet - Copenhagen University Hospital, Denmark
| | - Per Sjøgren
- Section of Palliative Medicine, Department of Oncology, Centre for Cancer and Organ Diseases, Rigshospitalet - Copenhagen University Hospital, Denmark
| | - Geana Paula Kurita
- Multidisciplinary Pain Centre, Department of Anaesthesiology, Pain and Respiratory Support, Neuroscience Centre, Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
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Patel H, Shah JR, Patel DR, Avanthika C, Jhaveri S, Gor K. Idiopathic pulmonary fibrosis: Diagnosis, biomarkers and newer treatment protocols. Dis Mon 2022:101484. [DOI: 10.1016/j.disamonth.2022.101484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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10
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Cottin V, Bonniaud P, Cadranel J, Crestani B, Jouneau S, Marchand-Adam S, Nunes H, Wémeau-Stervinou L, Bergot E, Blanchard E, Borie R, Bourdin A, Chenivesse C, Clément A, Gomez E, Gondouin A, Hirschi S, Lebargy F, Marquette CH, Montani D, Prévot G, Quetant S, Reynaud-Gaubert M, Salaun M, Sanchez O, Trumbic B, Berkani K, Brillet PY, Campana M, Chalabreysse L, Chatté G, Debieuvre D, Ferretti G, Fourrier JM, Just N, Kambouchner M, Legrand B, Le Guillou F, Lhuillier JP, Mehdaoui A, Naccache JM, Paganon C, Rémy-Jardin M, Si-Mohamed S, Terrioux P. [French practical guidelines for the diagnosis and management of IPF - 2021 update, full version]. Rev Mal Respir 2022; 39:e35-e106. [PMID: 35752506 DOI: 10.1016/j.rmr.2022.01.014] [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] [Indexed: 10/17/2022]
Abstract
BACKGROUND Since the previous French guidelines were published in 2017, substantial additional knowledge about idiopathic pulmonary fibrosis has accumulated. METHODS Under the auspices of the French-speaking Learned Society of Pulmonology and at the initiative of the coordinating reference center, practical guidelines for treatment of rare pulmonary diseases have been established. They were elaborated by groups of writers, reviewers and coordinators with the help of the OrphaLung network, as well as pulmonologists with varying practice modalities, radiologists, pathologists, a general practitioner, a head nurse, and a patients' association. The method was developed according to rules entitled "Good clinical practice" in the overall framework of the "Guidelines for clinical practice" of the official French health authority (HAS), taking into account the results of an online vote using a Likert scale. RESULTS After analysis of the literature, 54 recommendations were formulated, improved, and validated by the working groups. The recommendations covered a wide-ranging aspects of the disease and its treatment: epidemiology, diagnostic modalities, quality criteria and interpretation of chest CT, indication and modalities of lung biopsy, etiologic workup, approach to familial disease entailing indications and modalities of genetic testing, evaluation of possible functional impairments and prognosis, indications for and use of antifibrotic therapy, lung transplantation, symptom management, comorbidities and complications, treatment of chronic respiratory failure, diagnosis and management of acute exacerbations of fibrosis. CONCLUSION These evidence-based guidelines are aimed at guiding the diagnosis and the management in clinical practice of idiopathic pulmonary fibrosis.
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Affiliation(s)
- V Cottin
- Centre national coordonnateur de référence des maladies pulmonaires rares, service de pneumologie, hôpital Louis-Pradel, Hospices Civils de Lyon (HCL), Lyon, France; UMR 754, IVPC, INRAE, Université de Lyon, Université Claude-Bernard Lyon 1, Lyon, France; Membre d'OrphaLung, RespiFil, Radico-ILD2, et ERN-LUNG, Lyon, France.
| | - P Bonniaud
- Centre de référence constitutif des maladies pulmonaires rares, service de pneumologie et soins intensifs respiratoires, centre hospitalo-universitaire de Bourgogne et faculté de médecine et pharmacie, université de Bourgogne-Franche Comté, Dijon ; Inserm U123-1, Dijon, France
| | - J Cadranel
- Centre de référence constitutif des maladies pulmonaires rares, service de pneumologie et oncologie thoracique, Assistance publique-Hôpitaux de Paris (AP-HP), hôpital Tenon, Paris ; Sorbonne université GRC 04 Theranoscan, Paris, France
| | - B Crestani
- Centre de référence constitutif des maladies pulmonaires rares, service de pneumologie A, AP-HP, hôpital Bichat, Paris, France
| | - S Jouneau
- Centre de compétence pour les maladies pulmonaires rares de l'adulte, service de pneumologie, hôpital Pontchaillou, Rennes ; IRSET UMR1085, université de Rennes 1, Rennes, France
| | - S Marchand-Adam
- Centre de compétence pour les maladies pulmonaires rares de l'adulte, hôpital Bretonneau, service de pneumologie, CHRU, Tours, France
| | - H Nunes
- Centre de référence constitutif des maladies pulmonaires rares, service de pneumologie, AP-HP, hôpital Avicenne, Bobigny ; université Sorbonne Paris Nord, Bobigny, France
| | - L Wémeau-Stervinou
- Centre de référence constitutif des maladies pulmonaires rares, Institut Cœur-Poumon, service de pneumologie et immuno-allergologie, CHRU de Lille, Lille, France
| | - E Bergot
- Centre de compétence pour les maladies pulmonaires rares de l'adulte, service de pneumologie et oncologie thoracique, hôpital Côte de Nacre, CHU de Caen, Caen, France
| | - E Blanchard
- Centre de compétence pour les maladies pulmonaires rares de l'adulte, service de pneumologie, hôpital Haut Levêque, CHU de Bordeaux, Pessac, France
| | - R Borie
- Centre de référence constitutif des maladies pulmonaires rares, service de pneumologie A, AP-HP, hôpital Bichat, Paris, France
| | - A Bourdin
- Centre de compétence pour les maladies pulmonaires rares de l'adulte, département de pneumologie et addictologie, hôpital Arnaud-de-Villeneuve, CHU de Montpellier, Montpellier ; Inserm U1046, CNRS UMR 921, Montpellier, France
| | - C Chenivesse
- Centre de référence constitutif des maladies pulmonaires rares, service de pneumologie et d'immuno-allergologie, hôpital Albert Calmette ; CHRU de Lille, Lille ; centre d'infection et d'immunité de Lille U1019 - UMR 9017, Université de Lille, CHU Lille, CNRS, Inserm, Institut Pasteur de Lille, Lille, France
| | - A Clément
- Centre de ressources et de compétence de la mucoviscidose pédiatrique, centre de référence des maladies respiratoires rares (RespiRare), service de pneumologie pédiatrique, hôpital d'enfants Armand-Trousseau, CHU Paris Est, Paris ; Sorbonne université, Paris, France
| | - E Gomez
- Centre de compétence pour les maladies pulmonaires rares, département de pneumologie, hôpitaux de Brabois, CHRU de Nancy, Vandoeuvre-les Nancy, France
| | - A Gondouin
- Centre de compétence pour les maladies pulmonaires rares, service de pneumologie, CHU Jean-Minjoz, Besançon, France
| | - S Hirschi
- Centre de compétence pour les maladies pulmonaires rares, service de pneumologie, Nouvel Hôpital civil, Strasbourg, France
| | - F Lebargy
- Centre de compétence pour les maladies pulmonaires rares, service de pneumologie, CHU Maison Blanche, Reims, France
| | - C-H Marquette
- Centre de compétence pour les maladies pulmonaires rares, FHU OncoAge, département de pneumologie et oncologie thoracique, hôpital Pasteur, CHU de Nice, Nice cedex 1 ; Université Côte d'Azur, CNRS, Inserm, Institute of Research on Cancer and Aging (IRCAN), Nice, France
| | - D Montani
- Centre de compétence pour les maladies pulmonaires rares, centre national coordonnateur de référence de l'hypertension pulmonaire, service de pneumologie et soins intensifs pneumologiques, AP-HP, DMU 5 Thorinno, Inserm UMR S999, CHU Paris-Sud, hôpital de Bicêtre, Le Kremlin-Bicêtre ; Université Paris-Saclay, Faculté de médecine, Le Kremlin-Bicêtre, France
| | - G Prévot
- Centre de compétence pour les maladies pulmonaires rares, service de pneumologie, CHU Larrey, Toulouse, France
| | - S Quetant
- Centre de compétence pour les maladies pulmonaires rares, service de pneumologie et physiologie, CHU Grenoble Alpes, Grenoble, France
| | - M Reynaud-Gaubert
- Centre de compétence pour les maladies pulmonaires rares, service de pneumologie, AP-HM, CHU Nord, Marseille ; Aix Marseille Université, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille, France
| | - M Salaun
- Centre de compétence pour les maladies pulmonaires rares, service de pneumologie, oncologie thoracique et soins intensifs respiratoires & CIC 1404, hôpital Charles Nicole, CHU de Rouen, Rouen ; IRIB, laboratoire QuantiIF-LITIS, EA 4108, université de Rouen, Rouen, France
| | - O Sanchez
- Centre de compétence pour les maladies pulmonaires rares, service de pneumologie et soins intensifs, hôpital européen Georges-Pompidou, AP-HP, Paris, France
| | | | - K Berkani
- Clinique Pierre de Soleil, Vetraz Monthoux, France
| | - P-Y Brillet
- Université Paris 13, UPRES EA 2363, Bobigny ; service de radiologie, AP-HP, hôpital Avicenne, Bobigny, France
| | - M Campana
- Service de pneumologie et oncologie thoracique, CHR Orléans, Orléans, France
| | - L Chalabreysse
- Service d'anatomie-pathologique, groupement hospitalier est, HCL, Bron, France
| | - G Chatté
- Cabinet de pneumologie et infirmerie protestante, Caluire, France
| | - D Debieuvre
- Service de pneumologie, GHRMSA, hôpital Emile-Muller, Mulhouse, France
| | - G Ferretti
- Université Grenoble Alpes, Grenoble ; service de radiologie diagnostique et interventionnelle, CHU Grenoble Alpes, Grenoble, France
| | - J-M Fourrier
- Association Pierre-Enjalran Fibrose Pulmonaire Idiopathique (APEFPI), Meyzieu, France
| | - N Just
- Service de pneumologie, CH Victor-Provo, Roubaix, France
| | - M Kambouchner
- Service de pathologie, AP-HP, hôpital Avicenne, Bobigny, France
| | - B Legrand
- Cabinet médical de la Bourgogne, Tourcoing ; Université de Lille, CHU Lille, ULR 2694 METRICS, CERIM, Lille, France
| | - F Le Guillou
- Cabinet de pneumologie, pôle santé de l'Esquirol, Le Pradet, France
| | - J-P Lhuillier
- Cabinet de pneumologie, La Varenne Saint-Hilaire, France
| | - A Mehdaoui
- Service de pneumologie et oncologie thoracique, CH Eure-Seine, Évreux, France
| | - J-M Naccache
- Service de pneumologie, allergologie et oncologie thoracique, GH Paris Saint-Joseph, Paris, France
| | - C Paganon
- Centre national coordonnateur de référence des maladies pulmonaires rares, service de pneumologie, hôpital Louis-Pradel, Hospices Civils de Lyon (HCL), Lyon, France
| | - M Rémy-Jardin
- Institut Cœur-Poumon, service de radiologie et d'imagerie thoracique, CHRU de Lille, Lille, France
| | - S Si-Mohamed
- Département d'imagerie cardiovasculaire et thoracique, hôpital Louis-Pradel, HCL, Bron ; Université de Lyon, INSA-Lyon, Université Claude-Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, Villeurbanne, France
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11
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Palmer E, Kavanagh E, Visram S, Bourke AM, Forrest I, Exley C. When should palliative care be introduced for people with progressive fibrotic interstitial lung disease? A meta-ethnography of the experiences of people with end-stage interstitial lung disease and their family carers. Palliat Med 2022; 36:1171-1185. [PMID: 35694777 PMCID: PMC9446428 DOI: 10.1177/02692163221101753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
BACKGROUND Little is currently known about the perspectives of people with interstitial lung disease and their carers in relation to the timing of palliative care conversations. AIM To establish patients' and carers' views on palliative care in interstitial lung disease and identify an optimum time to introduce the concept of palliative care. DESIGN Meta-ethnography of qualitative evidence. The review protocol was prospectively registered with PROSPERO (CRD42021243179). DATA SOURCES Five electronic healthcare databases were searched (Medline, Embase, CINAHL, Scopus and Web of Science) from 1st January 1996 to 31st March 2022. Studies were included that used qualitative methodology and included patients' or carers' perspectives on living with end-stage disease or palliative care. Quality was assessed using the Critical Appraisal Skills Programme checklist. RESULTS About 1779 articles were identified by initial searches. Twelve met the inclusion criteria, providing evidence from 266 individuals across five countries. Three stages were identified in the illness journey of a person with interstitial lung disease: (1) Information seeking, (2) Grief and adjustment, (3) Fear of the future. Palliative care involvement was believed to be most appropriate in the latter two stages and should be prompted by changes in patients' health such as respiratory infections, onset of new symptoms, hospital admission, decline in physical function and initiation of oxygen. CONCLUSIONS Patients and carers prefer referral to palliative care services to be prompted by changes in health status. Future research should focus on supporting timely recognition of changes in patients' health status and how to respond in a community setting.
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Affiliation(s)
- Evelyn Palmer
- Royal Victoria Infirmary, Newcastle upon Tyne, UK.,Marie Curie Hospice Newcastle, Newcastle upon Tyne, UK.,Population Health Sciences, Newcastle University, Newcastle upon Tyne, UK
| | | | - Shelina Visram
- Population Health Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Anne-Marie Bourke
- Royal Victoria Infirmary, Newcastle upon Tyne, UK.,Marie Curie Hospice Newcastle, Newcastle upon Tyne, UK
| | - Ian Forrest
- Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Catherine Exley
- Population Health Sciences, Newcastle University, Newcastle upon Tyne, UK
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12
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French practical guidelines for the diagnosis and management of idiopathic pulmonary fibrosis - 2021 update. Full-length version. Respir Med Res 2022; 83:100948. [PMID: 36630775 DOI: 10.1016/j.resmer.2022.100948] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Since the latest 2017 French guidelines, knowledge about idiopathic pulmonary fibrosis has evolved considerably. METHODS Practical guidelines were drafted on the initiative of the Coordinating Reference Center for Rare Pulmonary Diseases, led by the French Language Pulmonology Society (SPLF), by a coordinating group, a writing group, and a review group, with the involvement of the entire OrphaLung network, pulmonologists practicing in various settings, radiologists, pathologists, a general practitioner, a health manager, and a patient association. The method followed the "Clinical Practice Guidelines" process of the French National Authority for Health (HAS), including an online vote using a Likert scale. RESULTS After a literature review, 54 guidelines were formulated, improved, and then validated by the working groups. These guidelines addressed multiple aspects of the disease: epidemiology, diagnostic procedures, quality criteria and interpretation of chest CT scans, lung biopsy indication and procedures, etiological workup, methods and indications for family screening and genetic testing, assessment of the functional impairment and prognosis, indication and use of antifibrotic agents, lung transplantation, management of symptoms, comorbidities and complications, treatment of chronic respiratory failure, diagnosis and management of acute exacerbations of fibrosis. CONCLUSION These evidence-based guidelines are intended to guide the diagnosis and practical management of idiopathic pulmonary fibrosis.
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13
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Wuyts WA, Dahlqvist C, Slabbynck H, Schlesser M, Gusbin N, Compere C, Maddens S, Rizzo S, Kirchgaessler KU, Bartley K, Bondue B. Quality of Life and Healthcare Resource Use in a Real-world Patient Population with Idiopathic Pulmonary Fibrosis: The PROOF Registry. Pulm Ther 2022; 8:181-194. [PMID: 35429319 PMCID: PMC9098727 DOI: 10.1007/s41030-022-00187-8] [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: 01/21/2022] [Accepted: 03/21/2022] [Indexed: 11/28/2022] Open
Abstract
Introduction The PROOF registry is a prospective, observational study that aimed to monitor disease progression in a real-world cohort of patients with idiopathic pulmonary fibrosis (IPF). Here, longitudinal quality-of-life (QoL) outcomes, healthcare resource use (HCRU), and the association between QoL and mortality in patients enrolled in the PROOF registry are presented. Methods QoL outcomes (St. George’s Respiratory Questionnaire [SGRQ], EuroQoL-5 dimensions-5 levels Health Questionnaire [EQ-5D-5L], EuroQoL-5 dimensions Health Questionnaire [EQ-5D] visual analogue scale [VAS] and cough VAS) and HCRU were collected for all patients. Associations between baseline QoL and mortality were assessed using univariate and multivariate analyses. During multivariate analyses, individual QoL measures were adjusted for the following covariates: age, sex, percent predicted forced vital capacity, percent predicted diffusing capacity of the lungs for carbon monoxide, smoking status, and supplementary oxygen use at registry inclusion. Results In total, 277 patients were enrolled in the PROOF registry. During the follow-up period, worsening in cough VAS score, SGRQ symptom score, and SGRQ activity score was observed, while EQ-5D VAS, SGRQ total score, and SGRQ impact score remained stable. During univariate analyses, EQ-5D VAS and all SGRQ sub-scores and total score at baseline were associated with mortality; however, during multivariate analyses, only the SGRQ total score, SGRQ impact score, and SGRQ symptom score at baseline were associated with mortality. During the follow-up period, 261 (94.2%) patients required an outpatient consultation (IPF- or non-IPF-related) and there were 182 hospitalizations in total, most of which were respiratory related (66.5%). Conclusions The PROOF registry provided valuable, real-world data on the association between baseline QoL and mortality, and longitudinal HCRU and QoL outcomes in patients with IPF over 24 months and identified that SGRQ may be an independent prognostic factor in IPF. Supplementary Information The online version contains supplementary material available at 10.1007/s41030-022-00187-8.
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Affiliation(s)
- Wim A. Wuyts
- Department of Respiratory Medicine, Unit for Interstitial Lung Diseases, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | | | - Hans Slabbynck
- Department of Respiratory Medicine, ZNA Middelheim, Antwerp, Belgium
| | - Marc Schlesser
- Department of Respiratory Care, Hôpitaux Robert Schuman, Luxembourg City, Luxembourg
| | | | | | | | | | | | | | - Benjamin Bondue
- Department of Respiratory Medicine, Erasme University Hospital, Brussels, Belgium
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14
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Hsp90 in Human Diseases: Molecular Mechanisms to Therapeutic Approaches. Cells 2022; 11:cells11060976. [PMID: 35326427 PMCID: PMC8946885 DOI: 10.3390/cells11060976] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 03/09/2022] [Accepted: 03/10/2022] [Indexed: 02/04/2023] Open
Abstract
The maturation of hemeprotein dictates that they incorporate heme and become active, but knowledge of this essential cellular process remains incomplete. Studies on chaperon Hsp90 has revealed that it drives functional heme maturation of inducible nitric oxide synthase (iNOS), soluble guanylate cyclase (sGC) hemoglobin (Hb) and myoglobin (Mb) along with other proteins including GAPDH, while globin heme maturations also need an active sGC. In all these cases, Hsp90 interacts with the heme-free or apo-protein and then drives the heme maturation by an ATP dependent process before dissociating from the heme-replete proteins, suggesting that it is a key player in such heme-insertion processes. As the studies on globin maturation also need an active sGC, it connects the globin maturation to the NO-sGC (Nitric oxide-sGC) signal pathway, thereby constituting a novel NO-sGC-Globin axis. Since many aggressive cancer cells make Hbβ/Mb to survive, the dependence of the globin maturation of cancer cells places the NO-sGC signal pathway in a new light for therapeutic intervention. Given the ATPase function of Hsp90 in heme-maturation of client hemeproteins, Hsp90 inhibitors often cause serious side effects and this can encourage the alternate use of sGC activators/stimulators in combination with specific Hsp90 inhibitors for better therapeutic intervention.
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15
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Scerri D, Borg Xuereb C, Scerri J. Caring for a parent with pulmonary fibrosis in Malta: The lived experiences of daughters in mid-adulthood. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e195-e203. [PMID: 33978275 DOI: 10.1111/hsc.13426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 04/07/2021] [Accepted: 04/18/2021] [Indexed: 06/12/2023]
Abstract
Idiopathic pulmonary fibrosis is a progressive fibrotic lung disease that is on the rise globally. The disease is associated with significant morbidity and hence poses significant challenges for their informal carers, particularly daughters in mid-adulthood, who struggle with their own personal demands and that of their ill parents. Yet there is a dearth of literature on the experiences of these specific carers. Hence, the purpose of this study is to explore the lived experiences of daughters caring for a parent with pulmonary fibrosis within a community setting. This was explored using a phenomenological qualitative framework that was conducted between January and April 2017. Semi-structured audio-recorded interviews were conducted with six adult daughters who provided care to a parent having pulmonary fibrosis. Purposive sampling was used to recruit study participants. Transcribed data were analysed using Interpretative Phenomenological Analysis. Three main themes were extracted which communicate the essence of the daughters' lived experiences: "Walking on tiptoes", "Flooded by emotions" and "Shifts in family dynamics." Participants described experiencing the toll of being constantly vigilant for symptoms. They also expressed a range of emotions that included guilt, helplessness and worry related to their care experience. However, these emotional struggles were suppressed in order to present an external facade of strength and control. A shift in roles was also described where the daughters became the informal carers/support for both their ill and well parent, albeit in different ways. Caring for a person with pulmonary fibrosis is an emotional and life changing experience and hence, there is the need for individualised interventions that target the unique perceptions of these informal carers.
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Affiliation(s)
| | - Christian Borg Xuereb
- Department of Gerontology and Dementia Studies, Faculty for Social Wellbeing, University of Malta, Msida, Malta
| | - Josianne Scerri
- Department of Mental Health, Faculty of Health Sciences, University of Malta, Msida, Malta
- Faculty of Health, Social Care and Education, Kingston University and St George's, University of London, London, UK
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16
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Wijsenbeek MS, Bonella F, Orsatti L, Russell AM, Valenzuela C, Wuyts WA, Baile WF. Communicating with patients with idiopathic pulmonary fibrosis: can we do it better? ERJ Open Res 2021; 8:00422-2021. [PMID: 35083325 PMCID: PMC8784894 DOI: 10.1183/23120541.00422-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 10/10/2021] [Indexed: 11/07/2022] Open
Abstract
Communications between clinicians and patients with idiopathic pulmonary fibrosis (IPF) have the potential to be challenging. The variable course and poor prognosis of IPF complicate discussions around life expectancy but should not prevent clinicians from having meaningful conversations about patients’ fears and needs, while acknowledging uncertainties. Patients want information about the course of their disease and management options, but the provision of information needs to be individualised to the needs and preferences of the patient. Communication from clinicians should be empathetic and take account of the patient's perceptions and concerns. Models, tools and protocols are available that can help clinicians to improve their interactions with patients. In this article, we consider the difficulties inherent in discussions with patients with IPF and their loved ones, and how clinicians might communicate with patients more effectively, from breaking the news about the diagnosis to providing support throughout the course of the disease. Communication from clinicians to patients with idiopathic pulmonary fibrosis should be empathetic, and take account of the patient's perceptions and concerns. Tools are available to help clinicians improve their interactions with patients with IPF.https://bit.ly/3BWjA7h
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17
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Tomassetti S, Sebastiani A, Caminati A, Oggionni T, Davì M, Ghirardini A, Martinoli MM. Raising awareness on physician-patient communication in IPF: an Italian multicenter study exploring the pulmonologist's perspective. SARCOIDOSIS VASCULITIS AND DIFFUSE LUNG DISEASES 2021; 38:e2021042. [PMID: 34744429 PMCID: PMC8552572 DOI: 10.36141/svdld.v38i3.11400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 07/15/2021] [Indexed: 11/30/2022]
Abstract
Background: Idiopathic pulmonary fibrosis (IPF) remains a debilitating, poor prognosis disease requiring a patient-centered approach. Objectives: To explore the pulmonologist’s perspective on physician-patient communication. Methods: A faculty of psychologists and pulmonologists organized a training course consisting of two workshops 12 months apart. Self-assessment questionnaires (pre- and post-course), role play (RP) simulations (during both workshops) and clinical consultation observations followed by semi-structured interviews (during the 12 months) were employed to evaluate the pulmonologists’ knowledge of patient-centered medicine and communication/relational skills (questionnaires), their communication style (RP) and possible communication/relational difficulties (semi-structured interviews). Results: Twenty-three pulmonologists attended the first workshop and 14 the second one; 10 attended both. The questionnaires revealed the interest in patient-centered medicine and communication but also the need for deeper knowledge and improved skills. From the RP sessions performed during the first workshop, a disease-oriented approach emerged; notably, after the training, some improvements suggested a more patient-centered approach, e.g., a more frequent exploration of the patient agenda. Finally, the semi-structured interviews allowed to identify the low patients’ cultural level and the poor general knowledge of IPF among the barriers hampering an effective communication with the clinician, who, however, is responsible for overcoming these obstacles. Conclusions: Despite the overall disease-prone approach to IPF patients, there was room for improvement through adequate training, which, in practice, may ameliorate communication and drive towards patient-centeredness. Exploring the pulmonologists’ needs may help tailoring training interventions. Raising awareness on these topics is crucial to ensure IPF patients optimal care.
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Affiliation(s)
- Sara Tomassetti
- Department of Diseases of the Thorax, GB Morgagni Hospital, Forlì, Italy.,Present address: Department of Experimental and Clinical Medicine, Careggi University Hospital, Florence, Italy
| | | | - Antonella Caminati
- Semi-Intensive Care Unit, Department of Pneumology, Department of Respiratory Physiopathology and Pulmonary Hemodynamics, San Giuseppe Hospital - MultiMedica IRCCS, Milan, Italy
| | - Tiberio Oggionni
- Pulmonology Unit, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | | | | | - Monica M Martinoli
- Freelancer; Adjunct Professor, University of the Studies of Milan, Milan, Italy
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18
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Cassidy N, Fox L, Love M, Byrne I, Doyle AM, Korn B, Shanagher D, Shone T, Cullen M, Cullen T, Mullaney P, O'Carroll N, O'Dowd G, O'Sullivan T, Russell AM. Fibrotic interstitial lung disease - palliative care needs: a World-Café qualitative study. BMJ Support Palliat Care 2021:bmjspcare-2021-003249. [PMID: 34635541 DOI: 10.1136/bmjspcare-2021-003249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 09/11/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVES The importance of palliative care in those with advanced fibrotic interstitial lung diseases (F-ILD) is recognised, but the palliative care requirements of patients and caregivers affected by F-ILD regardless of disease course are not established. We set out to explore this and identify optimal solutions in meeting the needs of a F-ILD population in Ireland. METHODS Implementing a World-Café qualitative research approach, we captured insights evolving, iteratively in interactive small group discussions in response to six predefined topics on palliative care and planning for the future. Thirty-nine stakeholders participated in the World-Café including 12 patients, 13 caregivers, 9 healthcare professionals, 4 industry representatives and 1 representative of the clergy. RESULTS Palliative care emerged as fundamental to the care and treatment of F-ILDs, regardless of disease progression. Unmet palliative care needs were identified as psychological and social support, disease education, inclusion of caregivers and practical/legal advice for disease progression and end-of-life planning. Participants identified diagnosis as a particularly distressing time for patients and families. They called for the introduction of palliative care discussions at this early-stage alongside improvements in integrated care, specifically increasing the involvement of primary care practitioners in referrals to palliative services. CONCLUSION Patients and caregivers need discussions on palliative care associated with F-ILD to be included at the point of diagnosis. This approach may address persisting inadequacies in service provision previously identified over the course of the last decade in the UK, Ireland and European F-ILD patient charters.
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Affiliation(s)
| | - Lynn Fox
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - Maria Love
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - Irene Byrne
- Mater Misericordiae University Hospital, Dublin, Ireland
| | | | - Bettina Korn
- Hospice Friendly Hospitals Programme, St. James's Hospital, Dublin, Ireland
| | | | | | - Matt Cullen
- Irish Lung Fibrosis Association, Dublin, Ireland
| | | | | | | | - Gemma O'Dowd
- Irish Lung Fibrosis Association, Dublin, Ireland
| | | | - Anne-Marie Russell
- University of Exeter, Exeter, UK
- Imperial College Health Care Trust, London, UK
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19
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Kalluri M, Orenstein S, Archibald N, Pooler C. Advance Care Planning Needs in Idiopathic Pulmonary Fibrosis: A Qualitative Study. Am J Hosp Palliat Care 2021; 39:641-651. [PMID: 34433294 PMCID: PMC9082969 DOI: 10.1177/10499091211041724] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Introduction: Advance care planning is recommended in chronic respiratory diseases, including Idiopathic Pulmonary Fibrosis. In practice, uptake remains low due to patient, physician and system-related factors, including lack of time, training and guidance on timing, components and content of conversations. Our aim was to explore perspectives, experiences and needs to inform a framework. Methods: We conducted a qualitative study in western Canada, using semi-structured interviews and inductive analysis. Patient, caregiver and health care professional participants described advance care planning experiences with Idiopathic Pulmonary Fibrosis. Results: Twenty participants were interviewed individually: 5 patients, 5 caregivers, 5 home care and 5 acute care health care professionals. Two categories, perceptions and recommendations, were identified with themes and subthemes. Participant perceptions were insufficient information and conversations occur late. Recommendations were: have earlier conversations; have open conversations; provide detailed information; and plan for end-of-life. Patients and caregivers wanted honesty, openness and clarity. Professionals related delayed timing to poor end-of-life care and distressing deaths. Home care professionals described comfort with and an engaged approach to advance care planning. Acute care professionals perceived lack of clarity of roles and described personal, patient and caregiver distress. Interpretation: Analysis of diverse experiences provided further understanding of advance care planning in Idiopathic Pulmonary Fibrosis. Advance care planning is desired by patients and caregivers early in their illness experience. Health care professionals described a need to clarify role, scope and responsibility. Practical guidance and training must be available to care providers to improve competency and confidence in these conversations.
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Affiliation(s)
- Meena Kalluri
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.,Alberta Health Services, Edmonton, Alberta, Canada
| | - Sara Orenstein
- Department of Community Health Sciences, University of Calgary, Alberta, Canada
| | - Nathan Archibald
- Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Charlotte Pooler
- Alberta Health Services, Edmonton, Alberta, Canada.,Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
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20
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van der Sar IG, Jones S, Clarke DL, Bonella F, Fourrier JM, Lewandowska K, Bermudo G, Simidchiev A, Strambu IR, Wijsenbeek MS, Parfrey H. Patient Reported Experiences and Delays During the Diagnostic Pathway for Pulmonary Fibrosis: A Multinational European Survey. Front Med (Lausanne) 2021; 8:711194. [PMID: 34422866 PMCID: PMC8371687 DOI: 10.3389/fmed.2021.711194] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 07/12/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Pulmonary fibrosis includes a spectrum of diseases and is incurable. There is a variation in disease course, but it is often progressive leading to increased breathlessness, impaired quality of life, and decreased life expectancy. Detection of pulmonary fibrosis is challenging, which contributes to considerable delays in diagnosis and treatment. More knowledge about the diagnostic journey from patients' perspective is needed to improve the diagnostic pathway. The aims of this study were to evaluate the time to diagnosis of pulmonary fibrosis, identify potential reasons for delays, and document patients emotions. Methods: Members of European patient organisations, with a self-reported diagnosis of pulmonary fibrosis, were invited to participate in an online survey. The survey assessed the diagnostic pathway retrospectively, focusing on four stages: (1) time from initial symptoms to first appointment in primary care; (2) time to hospital referral; (3) time to first hospital appointment; (4) time to final diagnosis. It comprised open-ended and closed questions focusing on time to diagnosis, factors contributing to delays, diagnostic tests, patient emotions, and information provision. Results: Two hundred and seventy three participants (214 idiopathic pulmonary fibrosis, 28 sarcoidosis, 31 other) from 13 countries responded. Forty percent of individuals took ≥1 year to receive a final diagnosis. Greatest delays were reported in stage 1, with only 50.2% making an appointment within 3 months. For stage 2, 73.3% reported a hospital referral within three primary care visits. However, 9.9% reported six or more visits. After referral, 76.9% of patients were assessed by a specialist within 3 months (stage 3) and 62.6% received a final diagnosis within 3 months of their first hospital visit (stage 4). Emotions during the journey were overall negative. A major need for more information and support during and after the diagnostic process was identified. Conclusion: The time to diagnose pulmonary fibrosis varies widely across Europe. Delays occur at each stage of the diagnostic pathway. Raising awareness about pulmonary fibrosis amongst the general population and healthcare workers is essential to shorten the time to diagnosis. Furthermore, there remains a need to provide patients with sufficient information and support at all stages of their diagnostic journey.
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Affiliation(s)
| | - Steve Jones
- Action for Pulmonary Fibrosis, Lichfield, United Kingdom
| | | | | | | | - Katarzyna Lewandowska
- Department of Pulmonary Diseases, National Research Institute of Tuberculosis and Lung Diseases, Warsaw, Poland
| | | | | | - Irina R Strambu
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
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21
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Looking Ahead: Interstitial Lung Disease Diagnosis and Management in 2030. Clin Chest Med 2021; 42:375-384. [PMID: 34024412 DOI: 10.1016/j.ccm.2021.03.014] [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: 10/21/2022]
Abstract
Important advancements have been made in interstitial lung disease (ILD) in recent years, with improved understanding of risk factors, disease pathogenesis, and clinical care. This article summarizes the current and future state of ILD management, with proposed short-term initiatives for immediate action, and longer-term objectives for innovation and discovery.
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22
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Abstract
Progress in the past 2 decades has led to widespread use of 2 medications to slow loss of lung function in patients with pulmonary fibrosis. Treatment of individual patients with currently available pharmacotherapies can be limited by side effects, and neither drug has a consistent effect on patient symptoms or function. Several promising new pharmacotherapies are under development. Comprehensive management of pulmonary fibrosis hinges on shared decision making. Patient and caregiver education, and early identification and management of symptoms and comorbidities, can help improve quality of life.
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Affiliation(s)
- Margaret L Salisbury
- Department of Medicine, Division of Allergy, Pulmonary and Critical Care, Vanderbilt University Medical Center, 1161 21st Avenue South, T-1209A Medical Center North, Nashville, TN 37232, USA.
| | - Marlies S Wijsenbeek
- Department of Respiratory Medicine, Centre for Interstitial Lung Diseases and Sarcoidosis, Erasmus Medical Center, University Medical Centre Rotterdam, Dr. Molewaterplein 40, Rotterdam 3015, GD, the Netherlands
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23
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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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24
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Delameillieure A, Dobbels F, Vandekerkhof S, Wuyts WA. Patients' and healthcare professionals' perspectives on the idiopathic pulmonary fibrosis care journey: a qualitative study. BMC Pulm Med 2021; 21:93. [PMID: 33736646 PMCID: PMC7972327 DOI: 10.1186/s12890-021-01431-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 01/19/2021] [Indexed: 12/24/2022] Open
Abstract
Background Idiopathic pulmonary fibrosis (IPF) highly impacts patients on several life dimensions and challenges healthcare practices in providing high-quality care. Consequently, it is crucial to establish integrated care processes, maximizing patient value and patients’ individual needs. The aim of the study was to shed light on the care trajectory based on the perspectives of patients and healthcare professionals. Methods The study was conducted at a tertiary Belgian IPF centre of excellence. We conducted individual interviews with patients and healthcare professionals, guided by the Chronic Care Model (CCM) as a framework for integrated care. Thematic analysis was used to underpin data analysis. Results Experiences were gathered of nine patients with IPF (aged 57–83 years, of which the informal caregivers were present at five interviews) and nine professionals involved in the IPF care trajectory. Our findings identified pitfalls and suggestions for improvement covering all elements of the CCM, primarily at the level of the individual patient and the care team. We covered suggestions to improve the team-based care and pro-active follow-up of patients’ needs. Self-management support was highlighted as an important area and we identified possibilities, but also challenges regarding the use of patient-reported outcomes and eHealth-tools. Furthermore, the importance of continuous training for professionals and the implementation of guidelines in routine care was pointed out. Also, participants mentioned an opportunity to collaborate with community-based organizations and raised challenges regarding the overall health system. Lastly, the pertaining lack of IPF awareness and the disease burden on patients and their caregivers were covered. Conclusions Our research team has initiated a project aiming to optimize the current care delivery practice for IPF patients at a Belgian centre of excellence. These results will inform the further optimisation of the care program and the development of feasible supportive interventions. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-021-01431-8.
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Affiliation(s)
- Anouk Delameillieure
- Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery, KU Leuven, Leuven, Belgium.,Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Kapucijnenvoer 35 blok D-box 7001, 3000, Leuven, Belgium
| | - Fabienne Dobbels
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Kapucijnenvoer 35 blok D-box 7001, 3000, Leuven, Belgium.
| | - Sarah Vandekerkhof
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Kapucijnenvoer 35 blok D-box 7001, 3000, Leuven, Belgium
| | - Wim A Wuyts
- Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery, KU Leuven, Leuven, Belgium.,Department of Respiratory Diseases, Unit for Interstitial Lung Diseases, University Hospitals Leuven, Leuven, Belgium
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25
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Lyu Y, Jia Y, Gao F, Huang YL, Lin F. Lived experiences of the disease journey among patients with idiopathic pulmonary fibrosis. Int J Nurs Sci 2021; 8:175-180. [PMID: 33997131 PMCID: PMC8105533 DOI: 10.1016/j.ijnss.2021.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 02/14/2021] [Accepted: 02/24/2021] [Indexed: 11/22/2022] Open
Abstract
Objective This study aimed to explore the lived experiences of the disease journey and patients’ care needs with idiopathic pulmonary fibrosis (IPF). Methods Face-to-face semi-structured interviews were conducted with a purposive sampling of IPF patients admitted to the department of respiratory medicine in a tertiary hospital in Beijing. Interview data were analyzed using the thematic analysis method. In the end, 16 patients were interviewed. Results Four themes emerged from the qualitative data included the long and confusing journey to reach a diagnosis, living with the disease, understanding the disease and treatment and desire for continuity of care. A series of subthemes were also identified, including uncertainty of diagnosis, delaying the process, living with physical symptoms, living with emotional distress, loss of independence, uncertainty with the prognosis, questioning the cause of the disease, concerning the side effects of treatments, lacking continuity of care, and wanting a better quality of healthcare in community hospitals. Conclusions Based on the findings, there is an urgent need to improve the care delivery to this vulnerable population in China. To meet their health needs, it is of paramount importance to develop effective education programs for health professionals and IPF patients and improve care models of healthcare systems, especially in remote areas, to enhance care continuity in the communities.
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Affiliation(s)
- Yang Lyu
- Department of Emergency Medicine, Beijing Chao-Yang Hospital, Beijing, China
| | - Yanrui Jia
- Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Beijing, China
| | - Fengli Gao
- Department of Nursing, Beijing Chao-Yang Hospital, Beijing, China
| | - Ya-Ling Huang
- Department of Emergency Medicine, Gold Coast Hospital and Health Service, Gold Coast University Hospital, Queensland, Australia.,Department of Respiratory Medicine, Gold Coast Hospital and Health Service, Gold Coast University Hospital, Queensland, Australia
| | - Frances Lin
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Queensland, Australia.,Sunshine Coast Health Institute, Queensland, Australia
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26
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Cottin V, Bergot E, Bourdin A, Nunes H, Prévot G, Wallaert B, Marchand-Adam S. Expectations about treatment of idiopathic pulmonary fibrosis: Comparative survey of patients, carers and physicians (the RESPIR French survey). Respir Med Res 2021; 79:100811. [PMID: 33618076 DOI: 10.1016/j.resmer.2020.100811] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 12/22/2020] [Accepted: 12/27/2020] [Indexed: 10/22/2022]
Abstract
CONTEXT Idiopathic pulmonary fibrosis (IPF) is a severe chronic disease during which anxiety and depression are frequent comorbidities. Better knowledge of patients' expectations is needed to inform an action plan to improve medical care. AIM To describe feelings and expectations of patients suffering from IPF and of their carers about antifibrotic therapy and compare them to what is perceived by their pulmonologist. METHODS National prospective study on practices and perceptions. Specific questionnaires were e-mailed to all 3276 pulmonologists in France who, in turn, invited patients and carers to participate in a survey. RESULTS 147 pulmonologists, 161 patients and 144 carers participated in the survey. The role of the carer was evaluated as "important" or "very important" by more than 90% of participants, i.e. pulmonologists, patients or carers. Inconsistencies between how patients felt and how pulmonologists perceived them were identified: 88% of patients responded that they understood quite well what IPF is (vs. 75% of patients according to pulmonologists); 85.5% of patients said they were determined to fight the disease (vs. 68.0%); 61.7% of patients wanted to be kept informed of potential complications before they occurred (vs. 69.6%) and 81.2% wanted to be involved in therapeutic decisions (vs. 43.1%). Globally, patients had a more positive view of antifibrotic therapies than expected by pulmonologists: 41.5% evaluated their advantages superior to what they had expected (vs. 29.1% of patients according to pulmonologists) and 76.5% had a positive image of the benefits/disadvantages ratio (vs. 62.4%). Although pulmonologists had the impression that they were keeping their patients well-informed about exacerbations, hospital stays and the possible negative evolution of the disease despite antifibrotic therapies, 34.0%, 42.0% and 22.0% of patients respectively declared not being aware of these aspects. CONCLUSION The feelings of patients suffering from IPF regarding their disease and treatment globally proved more positive compared with how pulmonologists perceived them. Taking into account the expectations and needs of patients may allow healthcare professionals to better address their needs and priorities.
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Affiliation(s)
- V Cottin
- National reference coordinating center for rare lung diseases, pulmonology department, Louis-Pradel hospital, hospices civils de Lyon, UMR754, université de Lyon, université Claude-Bernard Lyon 1, INREA, member of OrphaLung, RespiFil, Radico-ILD, and ERN-LUNG, Lyon, France.
| | - E Bergot
- Pulmonology department, University-affiliated hospital of Caen, Caen, France
| | - A Bourdin
- Pulmonology and addictology department, University-affiliated hospital of Montpellier, Montpellier, France
| | - H Nunes
- Pulmonology department, AP-HP, Avicenne University Hospital, Bobigny, France
| | - G Prévot
- Pulmonology department, Hospital of Toulouse, Toulouse, France
| | - B Wallaert
- Pulmonology and Allergy/immunology department, Regional University-affiliated hospital of Lille, Lille, France
| | - S Marchand-Adam
- Pulmonology department, Regional University-affiliated hospital of Tours, Tours, France
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27
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Dean A, Miller B, Hewitt C, Cook M, Nicell C, Spicer K. Caring for carers: exploring the benefits of group support for carers of people with pulmonary fibrosis. PROGRESS IN PALLIATIVE CARE 2021. [DOI: 10.1080/09699260.2020.1826777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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28
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Russell AM, Saketkoo LA. Patient-Centredness and Patient-Reported Measures (PRMs) in Palliation of Lung Disease. Respir Med 2021. [DOI: 10.1007/978-3-030-81788-6_4] [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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29
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Burley CV, Casey AN, Chenoweth L, Brodaty H. Reconceptualising Behavioral and Psychological Symptoms of Dementia: Views of People Living With Dementia and Families/Care Partners. Front Psychiatry 2021; 12:710703. [PMID: 34484001 PMCID: PMC8415310 DOI: 10.3389/fpsyt.2021.710703] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 07/22/2021] [Indexed: 12/02/2022] Open
Abstract
Background: Behavioral and psychological symptoms of dementia (BPSD, also known as neuropsychiatric symptoms (NPS), changed behaviors and responsive behaviors), occur in up to 90 percent of people living with dementia (PLWD). These symptoms and behaviors strongly correlate with functional and cognitive impairment and contribute to ~30% of overall dementia costs. As decisions regarding care and strategies for BPSD are generally based on professional frames of reference, this study investigates whether the perspectives of PLWD and families/care partner on BPSD terminology can inform a more nuanced conceptualization of BPSD. Methods: PLWD and families/care partners participated in one-on-one semi-structured interviews. A thematic iterative approach was used to code the data and identify common themes until theoretical saturation was reached. Themes were compared between groups. Data were analyzed deductively in relation to pre-existing terminology regarding BPSD, and inductively to discover new ideas on use of such terminology as perceived by PLWD and others. Results: Forty-one volunteers were interviewed: 21 PLWD, mean age 71 yrs, mean Mini-Mental State Examination score 25, and 20 family members/care partners. Three main themes emerged from the data: (1) descriptions of BPSD from people with lived experience compared to clinical terms, (2) viewpoints on interpreting causes, and (3) experiences of concurrent BPSD. The experiences described and terms used by PLWD and families/care partners differed from terms used in existing professional frameworks (e.g., "disinhibition" described as 'loss of filter') and there were differences between PLWD and family members' interpretations of BPSD causes. Discussion/Conclusion: Reports from PLWD and families/carers describing their experiences of BPSD suggest a reconceptualization of BPSD terminology is needed to understand and de-stigmatize these symptoms and behaviors. For example, the term "agitated/hard to handle" would benefit by clearer, contextualized description, such as "frustrated with cognitive decline, discriminatory behavior and inadequate support systems." In better understanding individual expressions of BPSD, families, professionals and societies will be able to respond in ways that are helpful for PLWD. An informed, integrated understanding of BPSD and improved terminology use will have the potential to improve the quality of care and support for PLWD.
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Affiliation(s)
- Claire V Burley
- School of Psychiatry, Dementia Centre for Research Collaboration, University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
| | - Anne-Nicole Casey
- School of Psychiatry, Dementia Centre for Research Collaboration, University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia.,School of Psychiatry, Centre for Healthy Brain Ageing, University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
| | - Lynn Chenoweth
- School of Psychiatry, Centre for Healthy Brain Ageing, University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
| | - Henry Brodaty
- School of Psychiatry, Dementia Centre for Research Collaboration, University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia.,School of Psychiatry, Centre for Healthy Brain Ageing, University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia.,Academic Department for Old Age Psychiatry, Prince of Wales Hospital, South Eastern Sydney Local Health District, Sydney, NSW, Australia
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30
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Palliative Care in Interstitial Lung Disease. Respir Med 2021. [DOI: 10.1007/978-3-030-81788-6_11] [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: 02/07/2023]
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31
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Wilsher ML, Beckert L. Bring out the stethoscope. Respirology 2020; 25:1227-1228. [DOI: 10.1111/resp.13906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 06/17/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Margaret L. Wilsher
- Respiratory Medicine Auckland District Health Board, Auckland City Hospital Auckland New Zealand
- Faculty of Medical and Health Sciences, School of Medicine University of Auckland Auckland New Zealand
| | - Lutz Beckert
- Respiratory Medicine Christchurch Hospital Christchurch New Zealand
- Department of Medicine University of Otago Christchurch New Zealand
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32
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Ramadurai D, Corder S, Churney T, Graney B, Harshman A, Meadows S, Swigris JJ. Idiopathic pulmonary fibrosis: Educational needs of health-care providers, patients, and caregivers. Chron Respir Dis 2020; 16:1479973119858961. [PMID: 31288534 PMCID: PMC6616062 DOI: 10.1177/1479973119858961] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Idiopathic pulmonary fibrosis (IPF) is a progressive disease associated with poor
quality of life. Debilitating symptoms and the reality of shortened survival
impact patients’ physical and emotional well-being and constrain the lives of
patients’ caregivers. This study assessed the informational needs of medical
providers who care for patients with IPF, IPF patients themselves, and their
caregivers. Tailored surveys were sent electronically to providers, patients
with IPF, and caregivers of patients with IPF collected on a rolling basis in
March of 2017. Providers answered questions regarding their own informational
needs and what information they believed patients needed. Patients and
caregivers identified their own informational needs and the perceived needs for
each other. About 2636 surveys were sent to providers, including 2041 to
physicians, of whom 156 completed it. One hundred sixty patients and 29
caregivers responded to the survey via a link on a website. Eighty-six percent
of providers described themselves as physicians who diagnose and treat IPF
patients themselves. Providers ranked information on “making the diagnosis of
IPF” as their top informational need. Patients and caregivers chose “disease
progression/what to expect” as the most important informational need for
themselves and for each other. Providers want to make a correct diagnosis when
IPF is in the differential diagnosis. Patients and caregivers desire clarity
around how IPF will behave over time and what their futures with IPF will look
like. Resources for patients and their caregivers should include information on
disease natural history in empathically worded, clear, and easily accessible
formats.
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Affiliation(s)
- Deepa Ramadurai
- 1 Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Stephanie Corder
- 2 Office of Professional Education, National Jewish Health, Denver, CO, USA
| | - Tara Churney
- 3 Interstitial Lung Disease Program, National Jewish Health, Denver, CO, USA
| | - Bridget Graney
- 4 Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Andrea Harshman
- 2 Office of Professional Education, National Jewish Health, Denver, CO, USA
| | | | - Jeffrey J Swigris
- 3 Interstitial Lung Disease Program, National Jewish Health, Denver, CO, USA
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Patients With Fibrotic Interstitial Lung Disease Receive Supportive and Palliative Care Just Prior to Death. Am J Hosp Palliat Care 2020; 38:154-160. [DOI: 10.1177/1049909120938629] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Background: Fibrotic interstitial lung diseases (f-ILDs) are often progressive and incurable. As patients experience significant symptoms and have a poor prognosis, early palliative care referral is recommended. Objective: To examine the care delivered to patients with f-ILD during the terminal hospital admission and the past 2 years of life. Methods: A retrospective audit was performed for consecutive patients who died from f-ILD at 2 Australian teaching hospitals between January 1, 2012, and December 31, 2016. Results: Of 67 patients, 44 (66%) had idiopathic pulmonary fibrosis. Median age was 78 years. Median respiratory function: forced expiratory volume in 1 second 69.0% predicted (interquartile range [IQR]: 58.0%-77.0%), forced vital capacity 64.0% predicted (IQR = 46.8%-74.3%), and diffusing capacity of carbon monoxide 36.0% predicted (IQR = 31.0%-44.0%). In the 2 years prior to the terminal admission, 38 (57%) patients reported severe breathlessness and 17 (25%) used opioids for symptom relief. Twenty-four (36%) patients received specialist palliative care (SPC) and 11 (16%) completed advance care planning. During the terminal admission, 10 (15%) patients were admitted directly under SPC. A further 33 (49%) patients were referred to SPC, on average 1 day prior to death. Sixty-three (94%) patients received opioids and 49 (73%) received benzodiazepines for symptom management. Median starting and final opioid doses were 10 and 23 mg oral morphine equivalent/24 hours, respectively. Opioids were commenced on average 2 (IQR 1-3) days prior to death. Conclusions: Although most patients were identified as actively dying in the final admission, referral to SPC and use of palliative medications occurred late. Additionally, few patients accessed symptom palliation earlier in their illness.
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Sørensen AR, Marsaa K, Prior TS, Bendstrup E. Attitude and Barriers in Palliative Care and Advance Care Planning in Nonmalignant Chronic Lung Disease: Results From a Danish National Survey. J Palliat Care 2020; 35:232-235. [PMID: 32573354 DOI: 10.1177/0825859720936012] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Patients with chronic obstructive pulmonary disease and interstitial lung disease have a significant burden of symptoms. Many are not offered palliative care (PC). Our aim was to investigate the attitudes to and barriers for PC among physicians. METHOD A web-based survey was conducted among members of the Danish Respiratory Society. The questionnaire included contextual (gender, age, clinical experience, type of center, patient caseload) and outcome questions (knowledge and use of statements for PC and advance care planning [ACP], practice of communication about end-of-life decisions, practice for referral to PC, barriers regarding structural surroundings, clinical skills, and organization). RESULTS One hundred fifty-six (45%) physicians responded. Median age was 40 - 49 years and 55% were female. Fifty-two percent were specialists; 71% worked at a university hospital. The majority of physicians (60%) reported barriers for discussions about PC and ACP; 63% reported lack of time, 52% lack of multidisciplinary staff settings, 63% reported the unpredictability of the prognosis, and 20% insufficient awareness of patient's culture, religion, or spirituality. Fewer specialists than nonspecialists reported barriers toward ACP. The majority had knowledge of guidelines in PC and ACP, but only a minority used these in daily clinical practice. CONCLUSION The attitude toward PC and ACP conversations was positive and implementation was regarded as important, but only a minority performed these conversations in practice. Main barriers were lack of time and staff. Palliative care guidelines were known but only scarcely used. Structural changes at the organizational level to improve access to palliation for patients with nonmalignant chronic lung diseases are needed.
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Affiliation(s)
- Anita Rath Sørensen
- Department of Internal Medicine, Horsens Regional Hospital, Horsens, Denmark
| | - Kristoffer Marsaa
- Palliative Unit Copenhagen University, Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - Thomas Skovhus Prior
- Center for Rare Lung Disease, Department of Respiratory Diseases and Allergy, 11297Aarhus University Hospital, Aarhus, Denmark
| | - Elisabeth Bendstrup
- Center for Rare Lung Disease, Department of Respiratory Diseases and Allergy, 11297Aarhus University Hospital, Aarhus, Denmark
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Health Care Costs at the End of Life for Patients with Idiopathic Pulmonary Fibrosis. Evaluation of a Pilot Multidisciplinary Collaborative Interstitial Lung Disease Clinic. Ann Am Thorac Soc 2020; 17:706-713. [DOI: 10.1513/annalsats.201909-707oc] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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Rozenberg D, Sitzer N, Porter S, Weiss A, Colman R, Reid WD, Shapera S, Fisher J, Wentlandt K. Idiopathic Pulmonary Fibrosis: A Review of Disease, Pharmacological, and Nonpharmacological Strategies With a Focus on Symptoms, Function, and Health-Related Quality of Life. J Pain Symptom Manage 2020; 59:1362-1378. [PMID: 31887400 DOI: 10.1016/j.jpainsymman.2019.12.364] [Citation(s) in RCA: 12] [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: 05/13/2019] [Revised: 12/16/2019] [Accepted: 12/18/2019] [Indexed: 01/13/2023]
Abstract
Despite several advances in treatment, idiopathic pulmonary fibrosis (IPF) remains a progressive, symptomatic, and terminal disease in patients not suitable for lung transplantation. With disease progression, IPF often leads to a constellation of symptoms, including dyspnea, cough, anxiety, and depression. Palliative care is appropriate to support these patients. However, traditional curriculum in palliative care has often focused on supporting patients with malignant disease, and clinicians are not universally trained to manage patients with progressive nonmalignant diseases such as IPF. Current antifibrotic therapies aim to slow disease progression but are not able to reduce symptoms or improve daily function and health-related quality of life (HRQL). Palliative care in this patient group requires an understanding of the clinical characteristics of IPF, comorbidities, common medications used, and nonpharmacological strategies that can be undertaken to improve daily function and HRQL. This review focuses on IPF management strategies and their effects on symptoms, exercise tolerance, HRQL, and survival. Pharmacological interactions and considerations related to commonly used palliative care medications are also reviewed. This review highlights the needs of patients with IPF and caregivers, psychosocial function, patient-reported assessment tools, and topics related to advance care planning.
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Affiliation(s)
- Dmitry Rozenberg
- Division of Respirology, Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada; Toronto Lung Transplant Program, University Health Network, Toronto, Ontario, Canada; Toronto General Hospital Research Institute, Toronto, Ontario, Canada
| | - Nicole Sitzer
- Division of Respirology, Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Sandra Porter
- Department of Pharmacy, University Health Network, Toronto, Ontario, Canada
| | - Andrea Weiss
- Division of Palliative Care, Department of Supportive Care, University Health Network, Toronto, Ontario, Canada; Division of Palliative Care, Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Rebecca Colman
- Division of Respirology, Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada; Toronto Lung Transplant Program, University Health Network, Toronto, Ontario, Canada
| | - W Darlene Reid
- Interdepartmental Division of Critical Care, Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada; Interdepartmental Division of Critical Care Medicine, Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Shane Shapera
- Division of Respirology, Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada; Toronto Lung Transplant Program, University Health Network, Toronto, Ontario, Canada
| | - Jolene Fisher
- Division of Respirology, Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Kirsten Wentlandt
- Division of Palliative Care, Department of Supportive Care, University Health Network, Toronto, Ontario, Canada; Division of Palliative Care, Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.
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Lee JYT, Tikellis G, Corte TJ, Goh NS, Keir GJ, Spencer L, Sandford D, Khor YH, Glaspole I, Price J, Hey-Cunningham AJ, Maloney J, Teoh AKY, Watson AL, Holland AE. The supportive care needs of people living with pulmonary fibrosis and their caregivers: a systematic review. Eur Respir Rev 2020; 29:29/156/190125. [PMID: 32350085 DOI: 10.1183/16000617.0125-2019] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 01/03/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND People with pulmonary fibrosis often experience a protracted time to diagnosis, high symptom burden and limited disease information. This review aimed to identify the supportive care needs reported by people with pulmonary fibrosis and their caregivers. METHODS A systematic review was conducted according to PRISMA guidelines. Studies that investigated the supportive care needs of people with pulmonary fibrosis or their caregivers were included. Supportive care needs were extracted and mapped to eight pre-specified domains using a framework synthesis method. RESULTS A total of 35 studies were included. The most frequently reported needs were in the domain of information/education, including information on supplemental oxygen, disease progression and prognosis, pharmacological treatments and end-of-life planning. Psychosocial/emotional needs were also frequently reported, including management of anxiety, anger, sadness and fear. An additional domain of "access to care" was identified that had not been specified a priori; this included access to peer support, psychological support, specialist centres and support for families of people with pulmonary fibrosis. CONCLUSION People with pulmonary fibrosis report many unmet needs for supportive care, particularly related to insufficient information and lack of psychosocial support. These data can inform the development of comprehensive care models for people with pulmonary fibrosis and their loved ones.
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Affiliation(s)
- Joanna Y T Lee
- Physiotherapy, La Trobe University, Melbourne, Australia.,Allergy, Immunology and Respiratory Medicine, Monash University, Melbourne, Australia.,NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Sydney, Australia
| | - Gabriella Tikellis
- Physiotherapy, La Trobe University, Melbourne, Australia.,Allergy, Immunology and Respiratory Medicine, Monash University, Melbourne, Australia.,NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Sydney, Australia
| | - Tamera J Corte
- NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Sydney, Australia.,The University of Sydney, Sydney, Australia.,Respiratory Medicine, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Nicole S Goh
- Austin Health, Heidelberg, Australia.,Institute for Breathing and Sleep, Melbourne, Australia.,Alfred Health, Melbourne, Australia
| | | | - Lissa Spencer
- The University of Sydney, Sydney, Australia.,Royal Prince Alfred Hospital, Camperdown, Australia
| | - Debra Sandford
- Royal Adelaide Hospital, Adelaide, Australia.,The University of Adelaide, Adelaide, Australia
| | - Yet H Khor
- Austin Health, Heidelberg, Australia.,Institute for Breathing and Sleep, Melbourne, Australia.,Alfred Health, Melbourne, Australia.,University of Melbourne, Melbourne, Australia
| | - Ian Glaspole
- Allergy, Immunology and Respiratory Medicine, Monash University, Melbourne, Australia.,NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Sydney, Australia.,Alfred Health, Melbourne, Australia
| | - John Price
- Institute for Respiratory Health, Nedlands, Australia
| | - Alison J Hey-Cunningham
- NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Sydney, Australia.,The University of Sydney, Sydney, Australia
| | | | - Alan K Y Teoh
- NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Sydney, Australia.,The University of Sydney, Sydney, Australia.,Respiratory Medicine, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Alice L Watson
- Physiotherapy, La Trobe University, Melbourne, Australia
| | - Anne E Holland
- Physiotherapy, La Trobe University, Melbourne, Australia .,Allergy, Immunology and Respiratory Medicine, Monash University, Melbourne, Australia.,NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Sydney, Australia.,Institute for Breathing and Sleep, Melbourne, Australia.,Alfred Health, Melbourne, Australia
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Kalluri M, Luppi F, Ferrara G. What Patients With Idiopathic Pulmonary Fibrosis and Caregivers Want: Filling the Gaps With Patient Reported Outcomes and Experience Measures. Am J Med 2020; 133:281-289. [PMID: 31520625 DOI: 10.1016/j.amjmed.2019.08.032] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 08/20/2019] [Accepted: 08/22/2019] [Indexed: 01/11/2023]
Abstract
Idiopathic pulmonary fibrosis is a progressive disease, with a high mortality within the first 3-5 years from diagnosis and a poor quality of life mainly because of the burden of symptoms, such as dyspnea and cough, occurring usually many months before the diagnosis. Although available antifibrotic therapies slow down disease progression, they have no impact on quality of life. Moreover, health care around idiopathic pulmonary fibrosis patients is often "disease-centered" and relies on clinical surrogate outcomes that are poorly related to patients' quality of life and disease experience. Therefore, patients with idiopathic pulmonary fibrosis have several unmet needs in all domains of health that they wish to see recognized and addressed in the context of the treatment of their disease and its complications. In this review, we summarize the care pathway from the patients' perspective, identifying current gaps in care, education, support, and communication among patients with IPF, their caregivers, and care teams during the patient journey. The role of patient-reported outcomes (PROs), PRO measures (PROMs), and patient-reported experience measures (PREMs) in their care is discussed, as well as the need of disease-specific PROs, PROMs, and PREMs.
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Affiliation(s)
- Meena Kalluri
- Division of Pulmonary Medicine, Department of Medicine, University of Alberta and Alberta Health Services, Edmonton, Calgary, Canada
| | - Fabrizio Luppi
- Respiratory Unit, University of Milano Bicocca, S. Gerardo Hospital, ASST Monza, Italy
| | - Giovanni Ferrara
- Division of Pulmonary Medicine, Department of Medicine, University of Alberta and Alberta Health Services, Edmonton, Calgary, Canada.
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Wuyts WA, Wijsenbeek M, Bondue B, Bouros D, Bresser P, Robalo Cordeiro C, Hilberg O, Magnusson J, Manali ED, Morais A, Papiris S, Shaker S, Veltkamp M, Bendstrup E. Idiopathic Pulmonary Fibrosis: Best Practice in Monitoring and Managing a Relentless Fibrotic Disease. Respiration 2019; 99:73-82. [PMID: 31830755 DOI: 10.1159/000504763] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 11/12/2019] [Indexed: 12/19/2022] Open
Abstract
Idiopathic pulmonary fibrosis (IPF) is a fibrosing interstitial lung disease that is, by definition, progressive. Progression of IPF is reflected by a decline in lung function, worsening of dyspnea and exercise capacity, and deterioration in health-related quality of life. In the short term, the course of disease for an individual patient is impossible to predict. A period of relative stability in forced vital capacity (FVC) does not mean that FVC will remain stable in the near future. Frequent monitoring using multiple assessments, not limited to pulmonary function tests, is important to evaluate disease progression in individual patients and ensure that patients are offered appropriate care. Optimal management of IPF requires a multidimensional approach, including both pharmacological therapy to slow decline in lung function and supportive care to preserve patients' quality of life.
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Affiliation(s)
- Wim A Wuyts
- Department of Respiratory Diseases, Unit for Interstitial Lung Diseases, University Hospitals Leuven, Leuven, Belgium,
| | - Marlies Wijsenbeek
- Department of Respiratory Medicine, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
| | - Benjamin Bondue
- Department of Pneumology, Hôpital Erasme, Université libre de Bruxelles, Brussels, Belgium
| | - Demosthenes Bouros
- First Academic Department of Pneumonology, Interstitial Lung Diseases Unit, Department of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Paul Bresser
- Department of Respiratory Medicine, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | | | - Ole Hilberg
- Department of Respiratory Medicine and Allergology, Aarhus University Hospital, Aarhus, Denmark
| | - Jesper Magnusson
- Department of Internal Medicine/Respiratory Medicine and Allergology, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Effrosyni D Manali
- 2nd Pulmonary Medicine Department, General University Hospital "Attikon," Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - António Morais
- Department of Pulmonology, Hospital de São João, Porto, Portugal
| | - Spyridon Papiris
- 2nd Pulmonary Medicine Department, General University Hospital "Attikon," Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Saher Shaker
- Herlev and Gentofte University Hospital, Copenhagen, Denmark
| | - Marcel Veltkamp
- Department of Pulmonology ILD Center of Excellence, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Elisabeth Bendstrup
- Center for Rare Lung Diseases, Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
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Quinn C, Wisse A, Manns ST. Clinical course and management of idiopathic pulmonary fibrosis. Multidiscip Respir Med 2019; 14:35. [PMID: 31827795 PMCID: PMC6886217 DOI: 10.1186/s40248-019-0197-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 09/05/2019] [Indexed: 01/04/2023] Open
Abstract
Idiopathic pulmonary fibrosis (IPF) is a progressive, fatal interstitial lung disease (ILD) with an unpredictable clinical course. Although IPF is rare, healthcare professionals should consider IPF as a potential cause of unexplained chronic dyspnea and/or cough in middle-aged/elderly patients and refer patients to a pulmonologist for evaluation. Making a diagnosis of IPF requires specialist expertise. Multidisciplinary discussion, involving at minimum a pulmonologist and a radiologist with expertise in the differential diagnosis of ILDs, is required to ensure the most accurate diagnosis. Prompt diagnosis of IPF is important to enable patients to receive appropriate care from an early stage. Optimal management of IPF involves the use of antifibrotic drugs, as well as the provision of supportive care to alleviate symptoms and preserve patients' quality of life. Antifibrotic drugs have been shown to slow lung function decline seen in patients with IPF. Patients' symptoms and functional capacity can be improved through participation in pulmonary rehabilitation programs and the use of supplemental oxygen. Patient education is essential to help patients understand and manage their disease. The identification and management of comorbidities, such as obstructive sleep apnea, pulmonary hypertension, and emphysema, is also an important element of the overall care of patients with IPF. Patients with IPF should be evaluated for lung transplantation at an early stage to maximize their chances of meeting eligibility criteria. In this review, we describe the clinical course and impact of IPF and best practice in its management, highlighting the importance of taking a patient-centered approach.
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Affiliation(s)
- Caitlin Quinn
- Emory Critical Care Center, 1364 Clifton Road, NE, Atlanta, GA 30322 USA
| | - Amy Wisse
- 2Medical University of South Carolina (MUSC), 25 Courtenay Drive, MSC 114, Charleston, SC 29425 USA
| | - Stephenie T Manns
- Pulmonary and Critical Care Medicine, Wake Med Brier Creek Healthplex, Brier Creek, 8001 TW Alexander Drive, Suite 218, Raleigh, NC 27617 USA
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Moor CC, Wijsenbeek MS, Balestro E, Biondini D, Bondue B, Cottin V, Flewett R, Galvin L, Jones S, Molina-Molina M, Planas-Cerezales L, Prasse A, Prosch H, Russell AM, Viegas M, Wanke G, Wuyts W, Kreuter M, Bonella F. Gaps in care of patients living with pulmonary fibrosis: a joint patient and expert statement on the results of a Europe-wide survey. ERJ Open Res 2019; 5:00124-2019. [PMID: 31649949 PMCID: PMC6801215 DOI: 10.1183/23120541.00124-2019] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 07/20/2019] [Indexed: 12/26/2022] Open
Abstract
Introduction Pulmonary fibrosis (PF) and its most common form, idiopathic pulmonary fibrosis (IPF), are chronic, progressive diseases resulting in increasing loss of lung function and impaired quality of life and survival. The aim of this joint expert and patient statement was to highlight the most pressing common unmet needs of patients with PF/IPF, putting forward recommendations to improve the quality of life and health outcomes throughout the patient journey. Methods Two online surveys for patients and healthcare professionals (HCPs) were conducted by the European Idiopathic Pulmonary Fibrosis and Related Disorders Federation (EU-IPFF) in 14 European countries. Results The surveys were answered by 286 patients and 69 HCPs, including physicians and nurses. Delays in diagnosis and timely access to interstitial lung disease specialists and pharmacological treatment have been identified as important gaps in care. Additionally, patients and HCPs reported that a greater focus on symptom-centred management, adequate information, trial information and increasing awareness of PF/IPF is required. Conclusions The surveys offer important insights into the current unmet needs of PF/IPF patients. Interventions at different points of the care pathway are needed to improve patient experience.
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Affiliation(s)
- Catharina C Moor
- Dept of Respiratory Medicine, Erasmus MC, Rotterdam, The Netherlands.,These authors share first authorship
| | - Marlies S Wijsenbeek
- Dept of Respiratory Medicine, Erasmus MC, Rotterdam, The Netherlands.,These authors share first authorship
| | - Elisabetta Balestro
- Dept of Cardiac, Thoracic, Vascular Sciences and Public Health, Azienda Ospedaliera di Padova, Università degli Studi di Padova, Padua, Italy
| | - Davide Biondini
- Dept of Cardiac, Thoracic, Vascular Sciences and Public Health, Azienda Ospedaliera di Padova, Università degli Studi di Padova, Padua, Italy
| | - Benjamin Bondue
- Dept of Respiratory Medicine, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Vincent Cottin
- Dept of Respiratory Diseases, Centre Hospitalier Universitaire de Lyon, Lyon, France
| | - Ron Flewett
- Pulmonary Fibrosis Trust, Lichfield, UK.,These authors represent the patient's perspective
| | - Liam Galvin
- Irish Lung Fibrosis Association, Blackrock, Ireland.,These authors represent the patient's perspective
| | - Steve Jones
- Action for Pulmonary Fibrosis, Lichfield, UK.,These authors represent the patient's perspective
| | | | | | - Antje Prasse
- Dept of Pneumology, Hannover Medical School, Hannover, Germany
| | - Helmut Prosch
- Dept of Biomedical Imaging and Image Guided Interventions, Medical University Vienna, Vienna. Austria
| | | | - Michel Viegas
- Association Belge contre la Fibrose Pulmonaire Idiopathique, Waterloo, Belgium.,These authors represent the patient's perspective
| | - Guenther Wanke
- Dept of Respiratory Medicine, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium.,These authors represent the patient's perspective
| | - Wim Wuyts
- Dept of Respiratory Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Michael Kreuter
- Dept of Pneumology and Critical Care Medicine, Universitätsklinikum Heidelberg, Heidelberg, Germany.,These authors share senior authorship
| | - Francesco Bonella
- Dept of Pneumology and Allergy, Ruhrlandklinik Medical Faculty, University of Duisburg-Essen, Essen, Germany.,These authors share senior authorship
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Moran-Mendoza O, Colman R, Kalluri M, Cabalteja C, Harle I. A comprehensive and practical approach to the management of idiopathic pulmonary fibrosis. Expert Rev Respir Med 2019; 13:601-614. [PMID: 31177864 DOI: 10.1080/17476348.2019.1627204] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Introduction: Idiopathic pulmonary fibrosis (IPF) is a debilitating, progressive, and fatal fibrotic pulmonary disease with a prognosis comparable to that of lung cancer. IPF management is a complex process that involves pharmacological and nonpharmacological interventions, extensive patient education, and addressing patient needs that change through the course of the illness. Areas covered: This review summarizes the key aspects of a multifaceted, multidisciplinary, individualized approach to IPF care that incorporates available treatment options, strategies to improve compliance with antifibrotic therapies, pulmonary rehabilitation, and the integration of palliative care for symptom management. Aspects of care discussed include the use of antifibrotic therapy and nonpharmacological treatments, targeted education and psychosocial support, evaluation and management of comorbidities, and early integration of palliative care. Expert opinion: By incorporating this comprehensive approach to disease management, physicians can address most aspects of care for a patient with IPF to optimize survival and quality of life.
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Affiliation(s)
- Onofre Moran-Mendoza
- a Division of Respiratory Medicine, Department of Medicine , Queen's University , Kingston , ON , Canada
| | - Rebecca Colman
- b Division of Respirology, Department of Medicine , University Health Network , Toronto , ON , Canada
| | - Meena Kalluri
- c Division of Pulmonary Medicine, Department of Medicine , University of Alberta , Edmonton , AB , Canada
| | | | - Ingrid Harle
- e Division of Palliative Medicine, Department of Medicine and Department of Oncology , Queen's University , Kingston , ON , Canada
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Ghosh A, Stuehr DJ. Hsp90 and Its Role in Heme-Maturation of Client Proteins: Implications for Human Diseases. HEAT SHOCK PROTEINS 2019. [DOI: 10.1007/978-3-030-23158-3_12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Egerod I, Kaldan G, Shaker SB, Guldin MB, Browatski A, Marsaa K, Overgaard D. Spousal bereavement after fibrotic interstitial lung disease: A qualitative study. Respir Med 2018; 146:129-136. [PMID: 30665511 DOI: 10.1016/j.rmed.2018.12.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 11/11/2018] [Accepted: 12/17/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Fibrotic interstitial lung disease (f-ILD) comprises a group of diseases with lung scarring and reduced life expectancy. The short time from diagnosis to death affects the patients' bereaved spouses, who risk developing prolonged grief. In Denmark palliative care is most often offered to cancer patients. AIM We aimed to investigate the experience of spouses of f-ILD patients during the final stages of illness and up to the first year after the patient's death to investigate if palliative care could ease the transition and prevent PGD. METHODS Our study had a qualitative design triangulating in-depth interviews, field notes, participant diaries and the prolonged grief questionnaire PG-13. We included 20 spouses and applied thematic analysis. Initial coding was performed deductively according to the chronological stages of before, during and after the death of the patient. We subsequently coded inductively within the stages. RESULTS During the final days the spouses experienced emotional ambivalence shifting between hope, acceptance and despair. Factors affecting the spouses during the final hours were the timing, location, and process of death. After the patient's death the spouses experienced feelings of grief and optimism as they moved toward a new life on their own. CONCLUSIONS Some of the factors affecting the spouses and potentially causing prolonged grief might be alleviated by offering palliative/supportive care and advance care planning to f-ILD patients and their family.
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Affiliation(s)
- Ingrid Egerod
- University of Copenhagen, Rigshospitalet, Intensive Care Unit, Copenhagen, Denmark.
| | - Gudrun Kaldan
- Copenhagen University Hospital, Rigshospitalet, Abdominal Centre, Copenhagen, Denmark
| | - Saher Burhan Shaker
- Department of Respiratory Medicine, Gentofte Hospital, University of Copenhagen, Denmark
| | - Mai-Britt Guldin
- Research Unit for General Practice, University of Aarhus, Aarhus, Denmark
| | - Andrea Browatski
- Department of Pulmonary and Infectious Diseases, North Zealand University Hospital, Denmark
| | - Kristoffer Marsaa
- Palliative Unit, Herlev and Gentofte Hospital, University of Copenhagen, Denmark
| | - Dorthe Overgaard
- Faculty of Health and Technology, Institute of Nursing and Nutrition, Copenhagen University College, Denmark
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Wuyts WA, Dahlqvist C, Slabbynck H, Schlesser M, Gusbin N, Compere C, Maddens S, Kirchgaessler KU, Bartley K, Bondue B. Baseline clinical characteristics, comorbidities and prescribed medication in a real-world population of patients with idiopathic pulmonary fibrosis: the PROOF registry. BMJ Open Respir Res 2018; 5:e000331. [PMID: 30555708 PMCID: PMC6267319 DOI: 10.1136/bmjresp-2018-000331] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 10/02/2018] [Indexed: 11/08/2022] Open
Abstract
Introduction PROOF (a Prospective Observational Registry to Describe the Disease Course and Outcomes of Idiopathic Pulmonary Fibrosis) is an ongoing, observational registry initiated in 2013 with the aim of collecting real-world data from patients with idiopathic pulmonary fibrosis (IPF). Here, we present comprehensive baseline data, which were collected from patients on registry inclusion. Methods Patients with IPF were enrolled across eight centres in Belgium and Luxembourg. Baseline data collected included demographics, diagnostic information and clinical characteristics, including lung function and health-related quality of life. Data on comorbidities and prescribed medication were also collected. Results A total of 277 patients were enrolled in the PROOF registry. At inclusion, 92.8% and 6.5% of patients had a definite or probable diagnosis of IPF, respectively. Mean per cent predicted forced vital capacity and carbon monoxide diffusing capacity were 80.6% and 46.9%, respectively. Mean St. George’s Respiratory Questionnaire total score was 47.0, and mean Cough-Visual Analogue Scale score was 30.5 mm. The most prevalent comorbidities reported at inclusion were gastrointestinal disorders (50.2%), including gastro-oesophageal reflux disease (47.3%) and metabolism and nutrition disorders (39.7%). At inclusion, 67.2% and 2.2% of patients were prescribed pirfenidone and nintedanib, respectively, with treatment initiated either prior to, or at the time of, inclusion. Medication prescribed concomitantly with pirfenidone included antihypertensives (54.8%), statins (37.1%) and prophylactic antithrombotics/anticoagulants (36.6%). Conclusion The PROOF registry provides valuable demographic and clinical data from a real-world population of patients with IPF in Belgium and Luxembourg, demonstrating the high burden of comorbidities and prescribed medication in these patients. Longitudinal data from this patient population will be investigated in future analyses. Trial registration PROOF is registered with the relevant authorities in Belgium and Luxembourg, with registration to Comité National d’Éthique et de Recherché (CNER) N201309/03 – 12 September 2013 and a notification to Comité National de Protection des Données (CNDP).
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Affiliation(s)
- Wim A Wuyts
- Department of Respiratory Medicine, University Hospitals Leuven, Leuven, Belgium
| | | | - Hans Slabbynck
- Department of Respiratory Medicine, ZNA Middelheim, Antwerp, Belgium
| | - Marc Schlesser
- Department of Respiratory Medicine, Centre Hospitalier de Luxembourg, Luxembourg City, Luxembourg
| | | | | | | | | | - Karen Bartley
- Genentech, Inc., South San Francisco, California, USA
| | - Benjamin Bondue
- Department of Respiratory Medicine, Erasme University Hospital, Brussels, Belgium
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Marsaa K, Gundestrup S, Jensen JU, Lange P, Løkke A, Roberts NB, Shaker SB, Sørensen AR, Titlestad IL, Thomsen LH, Weinreich UM, Bendstrup E, Wilcke T. Danish respiratory society position paper: palliative care in patients with chronic progressive non-malignant lung diseases. Eur Clin Respir J 2018; 5:1530029. [PMID: 30357015 PMCID: PMC6197032 DOI: 10.1080/20018525.2018.1530029] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Accepted: 09/25/2018] [Indexed: 12/31/2022] Open
Abstract
Background: Chronic non-malignant lung diseases such as chronic obstructive pulmonary disease (COPD) and interstitial lung diseases (ILD) result in reduced quality of life (QoL), a high symptom burden and reduced survival. Patients with chronic non-malignant lung disease often have limited access to palliative care. The symptom burden and the QoL of these patients resembles patients with cancer and the general palliative approach is similar. However, the disease trajectory is often slow and unpredictable, and the palliative effort must be built on accessibility, continuity and professional competences. The Danish Health Authority as well as the WHO recommends that there is access to palliative care for all patients with life-threatening diseases regardless of diagnosis. In 2011, the Danish Health Authority requested that the national medical societies would to formulate guidelines for palliation. Methods: In 2015, a group of members of the Danish Respiratory Society (DRS) was appointed for this purpose. It was composed of experienced ILD and COPD researchers as well as clinicians from different parts of Denmark. A literature review was made, a draft was prepared, and all recommendations were agreed upon unanimously. Results: The Danish version of the position paper was finally submitted for review and accepted by all members of DRS. Conclusion: In this position paper we provide recommendations on the terminology of chronic and terminal lung failure, rehabilitation and palliative care, advanced care planning, informal caregivers and bereavement, symptom management, the imminently dying patient, and organization of palliative care for patients with chronic non-malignant lung diseases.
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Affiliation(s)
- Kristoffer Marsaa
- Palliative Unit, Herlev-Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Svend Gundestrup
- Respiratory Research Unit, Department of Respiratory Medicine, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Jens-Ulrik Jensen
- Medical Department, Herlev-Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Peter Lange
- Medical Department, Herlev-Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Anders Løkke
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | - Nassim Bazeghi Roberts
- Respiratory Research Unit, Department of Respiratory Medicine, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Saher Burhan Shaker
- Medical Department, Herlev-Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Anita Rath Sørensen
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | | | - Laura Hohwü Thomsen
- Department of Respiratory Medicine, Hvidovre University Hospital, Copenhagen, Denmark
| | - Ulla Møller Weinreich
- Department of Respiratory Diseases, Aalborg University Hospital & Clinical Institute, Aalborg University, Aalborg, Denmark
| | - Elisabeth Bendstrup
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | - Torgny Wilcke
- Medical Department, Herlev-Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
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Grufstedt HK, Shaker SB, Konradsen H. Validation of the COPD Assessment Test (CAT) in patients with idiopathic pulmonary fibrosis. Eur Clin Respir J 2018; 5:1530028. [PMID: 30357006 PMCID: PMC6197013 DOI: 10.1080/20018525.2018.1530028] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Revised: 09/21/2018] [Accepted: 09/25/2018] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Idiopathic pulmonary fibrosis (IPF) is a chronic disease with high morbidity and mortality. A reliable and manageable questionnaire that assesses patients' quality of life is needed to help to improve the content of clinical consultations. The chronic obstructive pulmonary disease (COPD) Assessment Test (CAT) is used in clinical practice; therefore, the aim of this study was to investigate correlations among the CAT, St. George's Respiratory Questionnaire (SGRQ) and clinical parameters among patients diagnosed with IPF. Methods: A retrospective cohort design was employed in which 87 patients diagnosed with IPF who were receiving treatment at an outpatient clinic were included. Results: The CAT was found to be significantly correlated with SGRQ (p < 0.001). Furthermore, the CAT was significantly correlated with all of the included physiological variables. Conclusions: This add to support the validity of the COPD Assessment test (CAT) as a measure of symptoms in patients with IPF which in clinical practice in combination with dialogue between healthcare professionals and the patient, can help to improve the content of a clinical consultation.
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Affiliation(s)
| | - Saher Burhan Shaker
- Department of Respiratory Medicine, Gentofte University Hospital, Hellerup, Denmark
| | - Hanne Konradsen
- Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institut NVS, Huddinge, Sweden
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Burnett K, Glaspole I, Holland AE. Understanding the patient's experience of care in idiopathic pulmonary fibrosis. Respirology 2018; 24:270-277. [PMID: 30282111 DOI: 10.1111/resp.13414] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 08/02/2018] [Accepted: 09/05/2018] [Indexed: 12/27/2022]
Affiliation(s)
- Kimberley Burnett
- Department of Allergy, Immunology and Respiratory Medicine, Alfred Health, Melbourne, VIC, Australia
| | - Ian Glaspole
- Department of Allergy, Immunology and Respiratory Medicine, Alfred Health, Melbourne, VIC, Australia.,Department of Medicine, Monash University, Melbourne, VIC, Australia
| | - Anne E Holland
- Department of Physiotherapy, Alfred Health, Melbourne, VIC, Australia.,Discipline of Physiotherapy, La Trobe University, Melbourne, VIC, Australia.,Institute for Breathing and Sleep, Melbourne, VIC, Australia
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Pooler C, Richman-Eisenstat J, Kalluri M. Early integrated palliative approach for idiopathic pulmonary fibrosis: A narrative study of bereaved caregivers' experiences. Palliat Med 2018; 32:1455-1464. [PMID: 30056786 DOI: 10.1177/0269216318789025] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Idiopathic pulmonary fibrosis has an uncertain and rapid trajectory after diagnosis. Palliative care is rarely utilized, although both patients and caregivers experience a distressingly high symptom burden. Most patients die in hospital. AIM The purpose of this study was to explore bereaved caregivers' experiences and perceptions of an early integrated palliative approach implemented at a Multidisciplinary Interstitial Lung Disease Clinic. DESIGN A narrative approach was used, with thematic and content analysis of open-ended interviews. SETTING/PARTICIPANTS The clinic is located in a large western Canadian city. Caregivers of deceased patients were recruited through purposive sampling. The eight participants were either spouses or adult children. RESULTS Five major themes were identified: Having a Terminal Disease; Planning Goals and Wishes for Care; Living Life and Creating Memories; Feeling Strain and Responsibility; and Nearing the End. Caregivers had little understanding of prognosis prior to advance care planning conversations at the clinic. Advance care planning conversations enabled caregivers to know and support patients' goals and wishes. Caregivers described feeling informed, prepared, and supported when death was near. They expressed neither distress nor anxiety related to patients' symptoms or strain of relationships. CONCLUSION Collaboration and close communication among caregivers, respirologists, and home care enabled effective symptom management and out of hospital deaths. Patients and caregivers had opportunities to enjoy events, create memories, determine preferences, and make plans. Further research on an early integrated palliative approach in Idiopathic Pulmonary Fibrosis is warranted related to quality of life, experience with death and dying, and caregiver bereavement.
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Affiliation(s)
- Charlotte Pooler
- 1 Palliative and End of Life Care & Community Programs, Continuing Care, Alberta Health Services, Edmonton, AB, Canada
| | - Janice Richman-Eisenstat
- 2 Faculty of Medicine & Dentistry, University of Alberta.,3 Alberta Health Services, Edmonton, AB, Canada
| | - Meena Kalluri
- 2 Faculty of Medicine & Dentistry, University of Alberta.,3 Alberta Health Services, Edmonton, AB, Canada
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Igai Y. A narrative literature review of palliative care regarding patients with idiopathic pulmonary fibrosis. Nurs Open 2018; 5:536-545. [PMID: 30338099 PMCID: PMC6177544 DOI: 10.1002/nop2.163] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 03/27/2018] [Accepted: 04/21/2018] [Indexed: 11/25/2022] Open
Abstract
AIM The aim of this study was to examine the reported characteristics of extant studies on palliative care for patients with idiopathic pulmonary fibrosis. DESIGN Narrative review. METHODS A comprehensive search of the following electronic databases in English and Japanese commenced from 2002 - December 2017. Eligibility criteria was determined by the inclusion and exclusion criteria. RESULTS Nineteen articles were eligible. The characteristics of palliative care for patients with idiopathic pulmonary fibrosis were symptoms relief, start time of palliative care and palliative care needs of patients and care partners. Also, patients' education of disease management including advanced care planning and developing a palliative care system by the healthcare provider including multidisciplinary professional teams was identified. The care provided was a "care conference" and integrated palliative care was carried out in the patient's home. The majority of the studies were qualitative and retrospective in design. The palliative care system and the development of palliative care were limited.
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Affiliation(s)
- Yasuko Igai
- St. Luke's International UniversityTokyoJapan
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