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Palliative Care and End of Life Issues |

Impact of Collaborative, Multidisciplinary Care on Place of Death in Patients in Fibrotic Lung Diseases

Meena Kalluri, MD; Janice Richman-Eisenstat, MD
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University of Alberta, Edmonton, AB, Canada


Chest. 2015;148(4_MeetingAbstracts):772A. doi:10.1378/chest.2260205
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Abstract

SESSION TITLE: Palliative Care and End of Life Issues Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: Majority of IPF patients (>50%) die in a hospital based setting, only 13.7% of them receive palliative care, mostly in the last month of their lives. This results in poor quality of life and death in IPF. While there is agreement on the need for early, integrated palliative care for IPF patients, there are no guidelines on care methods. We describe the impact of our collaborative, multidisciplinary model of patient centered care with early and integrated symptom control on end of life management in patients with fibrotic lung diseases.

METHODS: Retrospective chart review was performed. All deceased patients with fibrotic lung diseases who received multidisciplinary care (2012-current) were identified. Following data was collected: age, gender, diagnosis, place of death, start time of symptomatic therapy, home care consultation, medication use, oxygen use and functional status at the time of death.

RESULTS: There were 11 deaths over 30 months. 10 patients had IPF and 1 had asbestosis. Median age 70 years(52-86 yrs); 67% were males. Seven patients died at home(63.3%), 3 in hospice (27%) and only one patient died in a hospital.Preferred place of care and death was home or hospice in all cases. Symptom based therapy was commenced 8 months(median) prior to death (range1-21 months). Action plans for dyspnea, cough, chest infection, heart failure and hemoptysis were developed at the outset and escalated to meet patient needs. All patients had home care team involved early, 8 months(median) prior to death. All patients were on a combination of opiates for dyspnea and cough (morphine, fentanyl and hydromorphone). Benzodiazepines (Lorazepam, clonazepam) were prescribed for anxiety and olanzapine or methotrimeprazine for agitation. The range of supplemental oxygen flow rate at the time of death was 25-30LPM. Two patients were bed bound and others were still ambulating bed to chair with assistance on the day of death.

CONCLUSIONS: A multidisciplinary care approach with early, integrated palliative care allows patients to manage symptoms and pass away at home. The presence of supportive care givers, experienced home care team,clinicians well versed with palliative care and readily available to respond are integral to the success of this model.

CLINICAL IMPLICATIONS: Collaborative, multidisciplinary team assessments and use of individualized actions plans can lead to better symptom control, thereby improve quality of life, decrease acute care utilization and may potentially decrease IPF mortality.

DISCLOSURE: The following authors have nothing to disclose: Meena Kalluri, Janice Richman-Eisenstat

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