Diffuse Lung Disease |

Idiopathic Pulmonary Fibrosis (IPF): The Pulmonologist’s Journey FREE TO VIEW

Craig Conoscenti, MD; Eben Rubin, MD; Nadia Sapiro
Author and Funding Information

Boehringer Ingelheim Pharmaceuticals Inc, Ridgefield, CT

Chest. 2013;144(4_MeetingAbstracts):477A. doi:10.1378/chest.1702731
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SESSION TITLE: Interstitial Lung Disease Posters

SESSION TYPE: Poster Presentations

PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM

PURPOSE: Idiopathic pulmonary fibrosis (IPF) is a progressive fibrosing interstitial pneumonia with a highly variable disease course and a median survival time of 2-3 years from diagnosis. No pharmacologic treatments for IPF are licensed in the US, and the only curative treatment, a lung transplant, is unavailable to most patients. This qualitative study explored the journey that pulmonologists go through when treating patients with IPF.

METHODS: The experiences of US pulmonologists from community (n=12), academic (n=11) and IPFnet (n=5) settings were collected using semi-structured interviews, essays and journal exercises. Data were analyzed for emerging themes using a grounded theory approach to construct development.

RESULTS: For pulmonologists, the IPF journey involves transition from a ‘healer’ to a ‘supporter’ role. In the ‘separation’ phase, the pulmonologist may feel unprepared for the emotional challenge of delivering such a poor prognosis to the patient. The pulmonologist educates the patient according to their expertise. In the ‘transition’ phase, the pulmonologist adjusts to managing IPF but may experience feelings of inadequacy due to the lack of effective treatments. In the ‘reincorporation’ phase, the pulmonologist becomes reconciled with their ‘supporter’ role and focuses on providing emotional support and minimizing suffering at the end of the patient’s life. Two typologies emerged as adaptive reactions to treating patients with IPF. Pulmonologists with a ‘sustained optimism’ typology spent longer explaining the prognosis and treatment options to the patient and actively considered clinical trials and lung transplants. Pulmonologists with a ‘pragmatic acceptance’ typology lacked faith in trials and transplants and focused on managing symptoms. Pulmonologists with this typology may fail to build an appropriate relationship with the patient, leaving them unprepared for the end of life journey.

CONCLUSIONS: The unpredictable disease course and lack of effective treatments present unique challenges to pulmonologists treating patients with IPF. Their attitude can affect the relationship they build with IPF patients.

CLINICAL IMPLICATIONS: A positive patient-pulmonologist relationship can help patients to cope with IPF.

DISCLOSURE: Craig Conoscenti: Employee: Employee of Boehringer Ingelheim Eben Rubin: Employee: Employee of Boehringer Ingelheim Nadia Sapiro: Employee: Employee of in sync, which has received money from Boehringer Ingelheim

No Product/Research Disclosure Information




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