Format

Send to

Choose Destination
See comment in PubMed Commons below
Chest. 2013 Mar;143(3):736-743. doi: 10.1378/chest.12-0830.

Barriers to optimal palliative care of lung transplant candidates.

Author information

1
Division of Respirology, Department of Medicine, University of Toronto, Toronto, ON, Canada.
2
Division of Pulmonary and Critical Care Medicine, Harborview Medical Center, University of Washington, Seattle, WA.
3
Division of Pulmonary, Critical Care, and Sleep Medicine and the Hertzberg Palliative Care Institute, New York, NY.
4
Department of Medicine, South Nassau Communities Hospital, Oceanside, NY.
5
Division of Pulmonary and Critical Care Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA.
6
Division of Pulmonary and Critical Care Medicine and CT Surgery, University of Texas Heath Center, San Antonio, TX.
7
Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI.
8
Department of Medicine, Mount Sinai School of Medicine, New York, NY.
9
Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Chicago, Chicago IL.
10
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI.
11
Division of Respirology, Department of Medicine, University of Toronto, Toronto, ON, Canada; Toronto Lung Transplant Program, University Health Network, Toronto, ON, Canada. Electronic address: lianne.singer@uhn.ca.

Abstract

BACKGROUND:

The provision of effective palliative care is of great importance to patients awaiting lung transplantation. Although the prospect of lung transplantation provides hope to patients and their families, these patients are usually very symptomatic from their underlying disease.

METHODS:

An e-mail questionnaire was sent to members of the American College of Chest Physicians' Transplant NetWork and the Pulmonary Council of the International Society for Heart and Lung Transplantation (ISHLT). The survey included questions about barriers to providing palliative care, the availability of palliative care services, and recommended strategies to improve palliative care for lung transplant candidates.

RESULTS:

The 158 respondents represented approximately 65% of transplant programs in the ISHLT registry. Respondents were in practice a mean of 11.3 (± 9) years, 70% were pulmonologists, 17% were surgeons, and 13% were other care providers. Barriers were classified into domains including patient factors, family factors, physician factors, and institutional/transplant program/lung allocation system factors. Significant patient/family barriers included unrealistic patient/family expectations about survival, unwillingness to plan end-of-life care, concerns about abandonment or inappropriate care after enrollment in a palliative care program, and family disagreements about care goals. For institutional/program/allocation system barriers, only the requirement for weight loss or gain to meet program-specific BMI requirements was identified. Significant physician barriers included competing time demands and the seemingly contradictory goals of transplant vs palliative care. Strategies recommended to improve palliative care included routine advance care planning for patients awaiting transplantation, access to palliative care specialists, training of transplant physicians in symptom management, and regular meetings among transplant physicians, nurses, patients, and families.

CONCLUSIONS:

Physicians providing care to lung transplant candidates reported considerable barriers to the delivery and acceptance of palliative care and identified specific strategies to improve palliative care for lung transplant candidates.

PMID:
22922517
PMCID:
PMC4694081
DOI:
10.1378/chest.12-0830
[Indexed for MEDLINE]
Free PMC Article
PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for Elsevier Science Icon for PubMed Central
    Loading ...
    Support Center