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Singh S, Chaudhuri N, Samarasekera B. Global challenges and disparities of care for interstitial lung disease. Respirology 2024; 29:548-550. [PMID: 38816008 DOI: 10.1111/resp.14766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 05/20/2024] [Indexed: 06/01/2024]
Affiliation(s)
- Sheetu Singh
- Department of Pulmonary Medicine, Rajasthan Hospital, Jaipur, India
| | | | - Bodhika Samarasekera
- Department of Respiratory Medicine, District General Hospital, Negombo, Sri Lanka
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Grant-Orser A, Pooler C, Archibald N, Fell C, Ferrara G, Johannson KA, Kalluri M. The diagnostic pathway for patients with interstitial lung disease: a mixed-methods study of patients and physicians. BMJ Open Respir Res 2024; 11:e002333. [PMID: 38688689 PMCID: PMC11086372 DOI: 10.1136/bmjresp-2024-002333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 04/11/2024] [Indexed: 05/02/2024] Open
Abstract
OBJECTIVES The diagnostic process for patients with interstitial lung diseases (ILD) remains complex. The aim of this study was to characterise the diagnostic care pathway and identify barriers and potential solutions to access a timely and accurate ILD diagnosis. DESIGN This mixed-method study was comprised of a quantitative chart review, patient and physician surveys and focus groups. RESULTS Chart review was completed for 97 patients. Median time from symptom onset to ILD diagnosis was 12.0 (IQR 20.5) months, with 46% diagnosed within 1 year. Time from first computed tomography (CT) scan to respirology referral was 2.4 (IQR 21.2) months. Referrals with a prior CT were triaged sooner than referrals without (1.7±1.6 months vs 3.9±3.3 months, p=0.013, 95% CI 0.48 to 2.94). On patient surveys (n=70), 51% felt that their lung disease was not recognised early enough. Commonly reported challenges to timely diagnosis included delayed presentation to primary care, initial misdiagnoses and long wait-times for specialists. Forty-five per cent of physicians (n=20) identified diagnostic delays, attributed to delayed presentations to primary care (58%), initial misdiagnoses (67%) and delayed chest imaging (75%). Themes from patient and respirologist focus groups included patient-related, healthcare provider-related and system-related factors leading to delays in diagnosis. CONCLUSIONS This mixed-methods study identified patient and system-related factors that contribute to diagnostic delays for patients with ILD, with most delays occurring prior to respirology referral. ILD awareness and education, earlier presentation to primary care, expedited access to chest imaging and earlier referral to respirology may expedite diagnosis.
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Affiliation(s)
- Amanda Grant-Orser
- Department of Medicine, Division of Respirology, University of Calgary, Calgary, Alberta, Canada
- Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Charlotte Pooler
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
- Palliative and End of Life Program, Alberta Health Services, Edmonton, Alberta, Canada
| | - Nathan Archibald
- Department of Medicine, Division of Respirology, University of Alberta, Edmonton, Alberta, Canada
| | - Charlene Fell
- Department of Medicine, Division of Respirology, University of Calgary, Calgary, Alberta, Canada
| | - Giovanni Ferrara
- Department of Medicine, Division of Respirology, University of Alberta, Edmonton, Alberta, Canada
| | - Kerri A Johannson
- Department of Medicine, Division of Respirology, University of Calgary, Calgary, Alberta, Canada
- Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Meena Kalluri
- Department of Medicine, Division of Respirology, University of Alberta, Edmonton, Alberta, Canada
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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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Bermudo G, Roman-Rodriguez M, Molina-Molina M. Interstitial lung diseases: never forget to think about it in primary care. Expert Rev Respir Med 2024; 18:9-15. [PMID: 38486433 DOI: 10.1080/17476348.2024.2331763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 03/13/2024] [Indexed: 03/20/2024]
Affiliation(s)
- Guadalupe Bermudo
- ILD Unit, Respiratory Department, University Hospital of Bellvitge, IDIBELL, University of Barcelona, Hospitalet de Llobregat, Barcelona, Spain
- Respiratory Diseases Network Research Consortium (CIBERES), Spain
| | - Miguel Roman-Rodriguez
- Primary Care Respiratory Research Unit, Instituto de Investigación Sanitaria de Baleares (IdISBa), Palma de Mallorca, Spain
- Son Pisa Primary Care health centre, Palma de Mallorca, Spain
| | - Maria Molina-Molina
- ILD Unit, Respiratory Department, University Hospital of Bellvitge, IDIBELL, University of Barcelona, Hospitalet de Llobregat, Barcelona, Spain
- Respiratory Diseases Network Research Consortium (CIBERES), Spain
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Arcana RI, Crișan-Dabija RA, Caba B, Zamfir AS, Cernomaz TA, Zabara-Antal A, Zabara ML, Arcana Ș, Marcu DT, Trofor A. Speaking of the "Devil": Diagnostic Errors in Interstitial Lung Diseases. J Pers Med 2023; 13:1589. [PMID: 38003904 PMCID: PMC10672616 DOI: 10.3390/jpm13111589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 11/05/2023] [Accepted: 11/08/2023] [Indexed: 11/26/2023] Open
Abstract
Interstitial lung diseases are respiratory diseases, which affect the normal lung parenchyma and can lead to significant pulmonary fibrosis, chronic respiratory failure, pulmonary hypertension, and ultimately death. Reuniting more than 200 entities, interstitial lung diseases pose a significant challenge to the clinician, as they represent rare diseases with vague and insidious respiratory symptoms. As such, there are many diagnostic errors that can appear along the journey of the patient with ILD, which leads to significant delays with implications for the prognosis and the quality of life of the patient.
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Affiliation(s)
- Raluca Ioana Arcana
- Doctoral School of the Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (R.I.A.); (A.Z.-A.); (Ș.A.)
- Clinical Hospital of Pulmonary Diseases, 700115 Iasi, Romania; (R.A.C.-D.); (A.-S.Z.); (D.T.M.); (A.T.)
| | - Radu Adrian Crișan-Dabija
- Clinical Hospital of Pulmonary Diseases, 700115 Iasi, Romania; (R.A.C.-D.); (A.-S.Z.); (D.T.M.); (A.T.)
- Department of Medical Sciences III, Pulmonology, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania;
| | - Bogdan Caba
- Department of Biomedical Sciences, Faculty of Medical Bioengineering, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania
| | - Alexandra-Simona Zamfir
- Clinical Hospital of Pulmonary Diseases, 700115 Iasi, Romania; (R.A.C.-D.); (A.-S.Z.); (D.T.M.); (A.T.)
- Department of Medical Sciences III, Pulmonology, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania;
| | - Tudor Andrei Cernomaz
- Department of Medical Sciences III, Pulmonology, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania;
- Regional Institute of Oncology, 700483 Iasi, Romania
| | - Andreea Zabara-Antal
- Doctoral School of the Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (R.I.A.); (A.Z.-A.); (Ș.A.)
- Clinical Hospital of Pulmonary Diseases, 700115 Iasi, Romania; (R.A.C.-D.); (A.-S.Z.); (D.T.M.); (A.T.)
| | - Mihai Lucian Zabara
- Department of Surgery, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania;
- St. Spiridon Emergency Hospital, Clinic of Surgery (II), 700111 Iasi, Romania
| | - Ștefăniță Arcana
- Doctoral School of the Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (R.I.A.); (A.Z.-A.); (Ș.A.)
| | - Dragoș Traian Marcu
- Clinical Hospital of Pulmonary Diseases, 700115 Iasi, Romania; (R.A.C.-D.); (A.-S.Z.); (D.T.M.); (A.T.)
- Department of Medical Sciences I, Cardiology, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania
| | - Antigona Trofor
- Clinical Hospital of Pulmonary Diseases, 700115 Iasi, Romania; (R.A.C.-D.); (A.-S.Z.); (D.T.M.); (A.T.)
- Department of Medical Sciences III, Pulmonology, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania;
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van der Sar IG, Wijsenbeek MS, Braunstahl GJ, Loekabino JO, Dingemans AMC, In 't Veen JCCM, Moor CC. Differentiating interstitial lung diseases from other respiratory diseases using electronic nose technology. Respir Res 2023; 24:271. [PMID: 37932795 PMCID: PMC10626662 DOI: 10.1186/s12931-023-02575-3] [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: 08/25/2023] [Accepted: 10/22/2023] [Indexed: 11/08/2023] Open
Abstract
INTRODUCTION Interstitial lung disease (ILD) may be difficult to distinguish from other respiratory diseases due to overlapping clinical presentation. Recognition of ILD is often late, causing delay which has been associated with worse clinical outcome. Electronic nose (eNose) sensor technology profiles volatile organic compounds in exhaled breath and has potential to detect ILD non-invasively. We assessed the accuracy of differentiating breath profiles of patients with ILD from patients with asthma, chronic obstructive pulmonary disease (COPD), and lung cancer using eNose technology. METHODS Patients with ILD, asthma, COPD, and lung cancer, regardless of stage or treatment, were included in a cross-sectional study in two hospitals. Exhaled breath was analysed using an eNose (SpiroNose) and clinical data were collected. Datasets were split in training and test sets for independent validation of the model. Data were analyzed with partial least squares discriminant and receiver operating characteristic analyses. RESULTS 161 patients with ILD and 161 patients with asthma (n = 65), COPD (n = 50) or lung cancer (n = 46) were included. Breath profiles of patients with ILD differed from all other diseases with an area under the curve (AUC) of 0.99 (95% CI 0.97-1.00) in the test set. Moreover, breath profiles of patients with ILD could be accurately distinguished from the individual diseases with an AUC of 1.00 (95% CI 1.00-1.00) for asthma, AUC of 0.96 (95% CI 0.90-1.00) for COPD, and AUC of 0.98 (95% CI 0.94-1.00) for lung cancer in test sets. Results were similar after excluding patients who never smoked. CONCLUSIONS Exhaled breath of patients with ILD can be distinguished accurately from patients with other respiratory diseases using eNose technology. eNose has high potential as an easily accessible point-of-care medical test for identification of ILD amongst patients with respiratory symptoms, and could possibly facilitate earlier referral and diagnosis of patients suspected of ILD.
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Affiliation(s)
- Iris G van der Sar
- Department of Respiratory Medicine, Center of Excellence for Interstitial Lung Disease, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Marlies S Wijsenbeek
- Department of Respiratory Medicine, Center of Excellence for Interstitial Lung Disease, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Gert-Jan Braunstahl
- Department of Respiratory Medicine, Center of Excellence for Interstitial Lung Disease, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Respiratory Medicine, Franciscus Gasthuis & Vlietland, Center of Excellence for Asthma, COPD, and Respiratory Allergy, Rotterdam, The Netherlands
| | - Jason O Loekabino
- Department of Respiratory Medicine, Center of Excellence for Interstitial Lung Disease, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Anne-Marie C Dingemans
- Department of Respiratory Medicine, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands
| | - Johannes C C M In 't Veen
- Department of Respiratory Medicine, Center of Excellence for Interstitial Lung Disease, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Respiratory Medicine, Franciscus Gasthuis & Vlietland, Center of Excellence for Asthma, COPD, and Respiratory Allergy, Rotterdam, The Netherlands
| | - Catharina C Moor
- Department of Respiratory Medicine, Center of Excellence for Interstitial Lung Disease, Erasmus University Medical Center, Rotterdam, The Netherlands.
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Bramhill C, Langan D, Mulryan H, Eustace-Cook J, Russell AM, Brady AM. Exploration of the unmet needs of patients diagnosed with idiopathic pulmonary fibrosis: a scoping review protocol. BMJ Open 2023; 13:e070513. [PMID: 37130693 PMCID: PMC10163457 DOI: 10.1136/bmjopen-2022-070513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/04/2023] Open
Abstract
INTRODUCTION Interstitial lung diseases consist of a range of lung disorders, the most prevalent being idiopathic pulmonary fibrosis (IPF). IPF is a chronic, progressive disease, resulting in loss of lung function and potentially significant impacts on quality of life. There is an increasing need to address unmet needs in this population as there is evidence that unmet needs may impact quality of life and health outcomes. The key objective of this scoping review is to define the unmet needs of patients living with a diagnosis of IPF and to identify gaps in the literature relating to unmet needs. Findings will inform the development of services and the introduction of patient-centred clinical care guidelines for IPF. METHODS AND ANALYSIS This scoping review is guided by the methodological framework for conducting scoping reviews developed by the Joanna Briggs Institute. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist is used for guidance. The following databases will be searched: CINAHL, MEDLINE, PsycINFO, Web of Science, Embase and ASSIA and include a comprehensive grey literature search. The review will report on adult patients >18 with a diagnosis of IPF or pulmonary fibrosis and be limited to publications from 2011 onwards, with no language restrictions applied. Two independent reviewers will screen articles in consecutive stages for relevance against the inclusion and exclusion criteria. Data will be extracted using a predefined data extraction form and analysed using descriptive and thematic analysis. Findings will be presented in tabular form, coupled with a narrative summary of the evidence. ETHICS AND DISSEMINATION Ethics approval is not required for this scoping review protocol. We will disseminate our findings using traditional approaches that include open access peer-reviewed publications and scientific presentations.
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Affiliation(s)
- Carita Bramhill
- Trinity Centre for Practice and Healthcare Innovation, School of Nursing & Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Donna Langan
- Department of Respiratory, Galway University Hospital, Galway, Ireland
| | - Helen Mulryan
- Department of Respiratory, Galway University Hospital, Galway, Ireland
| | | | | | - Anne-Marie Brady
- Trinity Centre for Practice and Healthcare Innovation, School of Nursing & Midwifery, Trinity College Dublin, Dublin, Ireland
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Hoffman TW, van Es HW, Biesma DH, Grutters JC. Potential interstitial lung abnormalities on chest X-rays prior to symptoms of idiopathic pulmonary fibrosis. BMC Pulm Med 2022; 22:329. [PMID: 36038862 PMCID: PMC9426013 DOI: 10.1186/s12890-022-02122-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 08/22/2022] [Indexed: 11/11/2022] Open
Abstract
Background Idiopathic pulmonary fibrosis (IPF) often has significant diagnostic delay. At present it is not well-known what factors associate with time to diagnosis and if this is associated with survival after the diagnosis. There has also been increasing attention for interstitial lung abnormalities on chest CT-scans. In this study we assessed what factors associate with time to diagnosis in patients with IPF, and whether early stages of pulmonary fibrosis can be seen on chest X-rays prior to the start of symptoms. Methods In this retrospective study, 409 Dutch patients with IPF were included. Clinical characteristics, including patient demographics, medical history, time of start of symptoms, time of first visit to pulmonologist, and any previous radiographic imaging reports were collected from patient records. Results In 96 patients (23%) a chest X-ray was available that had been made prior to the start of symptoms (median of 50.5 months (IQR 26.3–83.3 months)), and this showed potential interstitial lung abnormalities in 56 patients (58%). The median time from the start of symptoms to the final diagnosis was 24.0 months (interquartile range 9.0–48.0 months). In a multivariate model that corrected for diffusion capacity of the lung for carbon monoxide, forced vital capacity, sex, and age at diagnosis, time to diagnosis did not associate with survival (hazard ratio 1.051 (95% CI 0.800–1.380; p = 0.72)). Conclusions There is a significant diagnostic delay for patients with IPF, but longer time to diagnosis did not associate with survival. Interstitial lung abnormalities were seen in more than half of the patients in whom a chest X-ray had been made prior to the start of symptoms. This illustrates that a computed tomography scan should be strongly considered for analysis of unexplained abnormalities on a chest X-ray. This could facilitate early detection and possibly prevention of disease progression for patients with pulmonary fibrosis. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-022-02122-8.
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Affiliation(s)
- T W Hoffman
- Interstitial Lung Diseases Center of Excellence, Department of Pulmonology, St. Antonius Hospital, Koekoekslaan 1, 3435 CM, Nieuwegein, The Netherlands.
| | - H W van Es
- Department of Radiology, St. Antonius Hospital, Nieuwegein/Utrecht, The Netherlands
| | - D H Biesma
- Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - J C Grutters
- Interstitial Lung Diseases Center of Excellence, Department of Pulmonology, St. Antonius Hospital, Koekoekslaan 1, 3435 CM, Nieuwegein, The Netherlands.,Division of Heart and Lungs, University Medical Center, Utrecht, The Netherlands
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Igai Y, Porter SE. Development and applicability of a dignity-centred palliative care programme for people with idiopathic pulmonary fibrosis: A qualitative-driven mixed methods study. Nurs Open 2022; 10:8-23. [PMID: 35726124 PMCID: PMC9748069 DOI: 10.1002/nop2.1274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 05/18/2022] [Accepted: 05/20/2022] [Indexed: 01/04/2023] Open
Abstract
AIMS This study evaluated the acceptability of a dignity-centred palliative care programme for people with idiopathic pulmonary fibrosis by converging perceptions of living with idiopathic pulmonary fibrosis qualitative data and quantitative data. DESIGN The qualitative-driven mixed methods research addressed the study aim by using a convergent design. This single arm, non-randomized study used purposive sampling. METHODS Interviews with 12 stable outpatients with IPF provided qualitative data. Their quantitative data were from six scales: self-esteem, health-related quality of life, anxiety, depression, dyspnoea, cough and programme satisfaction. Intervention was three educational modules: symptom management, enhancing daily activities and life reviews. RESULTS Semi-structured interviews yielded eight categories. Self-esteem was not statistically significantly changed. Dyspnoea symptoms improved significantly. Participants (n = 9) holding positive attitudes for living with idiopathic pulmonary fibrosis, had improved lifestyle behaviour and improved or maintained self-esteem. The meta-inference regarding idiopathic pulmonary fibrosis perceptions were related to changes in self-esteem.
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Affiliation(s)
- Yasuko Igai
- Graduate School of Nursing ScienceSt. Luke's International UniversityTokyoJapan
| | - Sarah E. Porter
- Graduate School of Nursing ScienceSt. Luke's International UniversityTokyoJapan,Oregon Health & Science University School of NursingPortlandUSA
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