Specialist palliative care, psychology, interstitial lung disease (ILD) multidisciplinary team meeting: a novel model to address palliative care needs.

INTRODUCTION: Patients with progressive idiopathic fibrotic interstitial lung disease (ILD), such as those with idiopathic pulmonary fibrosis (IPF), can have an aggressive disease course, with a median survival of only 3-5 years from diagnosis. The palliative care needs of these patients are often unmet. There are calls for new models of care, whereby the patient's usual respiratory clinician remains central to the integration of palliative care principles and practices into their patient's management, but the optimal model of service delivery has yet to be determined. METHODS: We developed a novel, collaborative, multidisciplinary team (MDT) meeting between our palliative care, psychology and ILD teams with the principal aim of integrating specialist care to ensure the needs of persons with ILD, and their caregivers were identified and met by referral to the appropriate service. The objective of this study was to assess the effectiveness of this novel MDT meeting on the assessment of a patient's palliative care needs. RESULTS: Significant increases in advance care planning discussions were observed, in conjunction with increased referrals to community courses and teams, following introduction of this novel MDT. CONCLUSIONS: Our results suggest that our collaborative MDT is an effective platform to address patients' unmet palliative care needs. Further work is required to explore the effect of our model on achieving the preferred place of death and reductions in unplanned hospital admissions.

Development of tools to facilitate palliative and supportive care referral for patients with idiopathic pulmonary fibrosis.

OBJECTIVES: Palliative care is underused in non-malignant respiratory diseases, including interstitial lung diseases (ILDs). We investigated current practices around palliative and supportive care and explored the impact of a supportive care decision aid tool. METHODS: This was a single centre study in a UK ILD centre. Retrospective analysis of hospice referrals and patients with idiopathic pulmonary fibrosis (IPF) under the Bristol ILD (BILD) service were used to identify unmet palliative and supportive care needs. Using quality improvement methodology, we explored the impact of a supportive care decision aid on clinician behaviours for patients with ILD. RESULTS: 108 patients with ILD were referred for hospice care between 2010 and 2015, representing 0.15% of all referrals, compared with a population prevalence of IPF of 0.9%. The median interval between referral and death was 124 days.Records were reviewed for 64 deceased and 89 living patients with IPF seen on July-December 2014. The decision aid was prospectively assessed with 73 patients. The deceased patients had greater markers of severity. There were no other differences between the groups.After introduction, the decision aid tool was completed for 49.3% of patients and resulted in significant increases in documented discussion of referral to palliative care (11.2%vs53.6%, p<0.01) and end-of-life discussions (15.7%vs91.8%, p<0.01). Tool completion led to an increase in referral for palliative care (2.7%vs16.7%, p<0.01). CONCLUSION: Palliative care services are underused in ILD and a supportive care decision aid can prompt consideration of palliative and supportive care needs.

Comparison of short-term psychological outcomes of respiratory failure treated by either invasive or non-invasive ventilation.

BACKGROUND: There is now widespread recognition of the development of symptoms of posttraumatic stress disorder (PTSD) in individuals subjected to treatment in the hospital intensive care unit (ICU). OBJECTIVE: The authors sought to investigate traumatic aspects of the ICU hospitalization experience. METHOD: A group of 20 adult pulmonary patients requiring ventilation in the ICU were compared with 20 patients treated without ventilation. Subjects completed a semistructured interview about their hospital experience and were given self-report measures to assess PTSD and coping style. RESULTS: Subjects requiring invasive ventilation were significantly more likely to endorse symptoms of PTSD. There was a strong correlation between symptoms of PTSD and recall of memories of traumatic medical events. Symptoms of PTSD were positively associated with habitual experiences of distress and negatively associated with the use of denial of distress. CONCLUSION: Specific traumatic aspects of a patient's treatment, in this case the experience of intubation and mechanical ventilation, may be an additive risk factor for the development of PTSD.