Palliative and Pulmonary Perspectives on Growing Collaborations in Interstitial Lung Disease.

Abstract

Interstitial lung diseases (ILDs) are often associated with significant morbidity and mortality. Patients with ILD benefit from palliative care consultation, although a standard recommendation of timing for referral has not yet been established. To inform future models of care for these patients, we aimed to assess pulmonary and palliative medical team members perspectives on care collaboration in ILD, as well as specialty specific knowledge gaps. We also wanted to explore if providing recommended criteria for inpatient palliative consultation would be perceived as beneficial for this patient population. An online survey was sent out to palliative and pulmonary medical teams. 64 medical team members responded to the survey (87.7% survey response rate). All respondents agreed that increased palliative care team presence for patients with ILD would be helpful for caring for the ILD population, and a majority agreed that a system in which patients with ILD receive a palliative care consultation per a set of recommended criteria would be helpful. Approximately half of pulmonary respondents independently addressed advance directives for patients with ILD (53.5%), and approximately a third felt comfortable initiating opioids for breathlessness (34.7%). Palliative respondents were unfamiliar with subtypes of ILD and how subtype impacts prognosis, as well as side effects of common treatments for ILD. Increased palliative involvement for patients with ILD is strongly endorsed by both palliative and pulmonary specialists, and recommended criteria for inpatient palliative consults were supported by a majority of responders.