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Original Research: Diffuse Lung Disease |

Palliative Care and Location of Death in Decedents With Idiopathic Pulmonary FibrosisPalliative Care in Idiopathic Pulmonary Fibrosis

Kathleen O. Lindell, PhD, RN; Zhan Liang, MSN, RN; Leslie A. Hoffman, PhD, RN; Margaret Q. Rosenzweig, PhD, FNP-BC, AOCNP; Melissa I. Saul, MS; Joseph M. Pilewski, MD; Kevin F. Gibson, MD; Naftali Kaminski, MD
Author and Funding Information

From The University of Pittsburgh Dorothy P. & Richard P. Simmons Center for Interstitial Lung Disease at UPMC (Drs Lindell and Gibson), Division of Pulmonary, Allergy, and Critical Care Medicine (Drs Lindell, Pilewski, and Gibson), School of Nursing (Drs Hoffman and Rosenzweig, and Ms Liang), and Department of Biomedical Informatics (Ms Saul), School of Medicine, Pittsburgh, PA; and Pulmonary, Critical Care and Sleep Medicine (Dr Kaminski), Yale School of Medicine, New Haven, CT.

CORRESPONDENCE TO: Kathleen O. Lindell, PhD, RN, Dorothy P. & Richard P. Simmons Center for Interstitial Lung Disease, UPMC, 3459 Fifth Ave, Pittsburgh, PA 15213; e-mail: lindellko@upmc.edu


Drs Gibson and Kaminski are senior authors of this article.

FUNDING/SUPPORT: This study was supported by the Dorothy P. and Richard P. Simmons endowed chair for Interstitial Lung Disease and the National Institutes of Health [Grant UL1TR000005].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2015;147(2):423-429. doi:10.1378/chest.14-1127
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BACKGROUND:  Palliative care, integrated early, may reduce symptom burden in patients with idiopathic pulmonary fibrosis (IPF). However, limited information exists on timing and clinical practice. The purpose of this study was to describe the time course of events prior to death in patients with IPF managed at a specialty center with a focus on location of death and timing of referral for palliative care.

METHODS:  Data were retrospectively extracted from the health system’s data repository and obituary listings. The sample included all decedents, excluding lung transplant recipients, who had their first visit to the center between 2000 and 2012.

RESULTS:  Median survival for 404 decedents was 3 years from diagnosis and 1 year from first center visit. Of 277 decedents whose location of death could be determined, > 50% died in the hospital (57%). Only 38 (13.7%) had a formal palliative care referral and the majority (71%) was referred within 1 month of their death. Decedents who died in the academic medical center ICU were significantly younger than those who died in a community hospital ward (P = .04) or hospice (P = .001).

CONCLUSIONS:  The majority of patients with IPF died in a hospital setting and only a minority received a formal palliative care referral. Referral to palliative care occurred late in the disease. These findings indicate the need to study adequacy of end-of-life management in IPF and promote earlier discussion and referral to palliative care.

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