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

Abstract

IntroductionPatients 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.MethodsWe 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.ResultsSignificant increases in advance care planning discussions were observed, in conjunction with increased referrals to community courses and teams, following introduction of this novel MDT.ConclusionsOur 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.

Care programs and their components for patients with idiopathic pulmonary fibrosis: a systematic review

“…Only two of the 13 changes reported the use of a theoretical framework (i.e., the Medical Research Council guidance (MRC) on developing complex interventions) or a theoretical model (i.e., the stress-coping model) [ 31 , 32 ]. Furthermore, two of the 13 changes used a stepwise process, such as the PDCA cycles or the DMAIC method, of which the first step was the analysis of local practice patterns and needs to inform the content of the change [ 33 – 35 ]. Three changes were developed based on existing interventions or tools from other research fields [ 31 , 34 , 36 ].…”

“…The first involved a new multidisciplinary collaborative care model for addressing the palliative care needs of patients and their caregivers with a specific emphasis on patient-centredness [ 38 , 44 ]. The second change comprised of a tool to support care providers in addressing palliative care needs of patients in routine care and the practice was subsequently extended with a multidisciplinary meeting in which tailored referrals were implemented for patients identified with the tool [ 33 , 34 ].…”

ERS Scientific Working Group 09.04, “Psychologists and behavioural scientists”: the next step towards multidisciplinary respiratory care

“…This chronic care management is an essential but highly complex practice, especially in the era of personalised treatments [1,4,11]. Alongside the "classical" medical and therapeutic components, support preferably involves further important elements, such as guided self-management, psychosocial interventions and behaviour change techniques, supported by a multidisciplinary team [2,9,12,[17][18][19]. However, psychosocial and behavioural factors are still considerably under-recognised in chronic respiratory care and research, thus limiting the availability of comprehensive, integrated and holistic treatments and preventing optimal treatment effects [4,11,20].…”

Contemporary Concise Review 2018: Interstitial lung disease

“…The role of palliative care (PC) should not be underestimated in ILD due to their impact on quality of life, especially in IPF . A collaborative MDD may represent an effective platform to address subject’s PC needs by integrating the PC specialist to the multidisciplinary team discussion to reduce unplanned hospital admissions. Safety of benzodiazepines (BDZ) and opioids in ILD has been investigated in a prospective study .…”