Specialist palliative care is more than drugs: a retrospective study of ILD patients

Abstract

Background: This study aimed to assess the palliative care needs of progressive idiopathic fibrotic interstitial lung disease (PIF-ILD) populations in two London ILD centres.

Methods: Patients' records from Royal Brompton Hospital (RBH) and King's College Hospital (KCH) were extracted to assess palliative care needs, use of palliative treatments, and whether end-of-life preferences were documented and achieved.

Results: Forty-five PIF-ILD patients were identified (26 RBH, 19 KCH). Patients at RBH were younger (37-81 years, median = 61 years) and predominantly white British (23/26) compared to KCH's older, more racially diverse population (70-99 years, median = 82 years, 6/19 nonwhite). Seventeen of 45 patients had specialist palliative care team involvement. Nearly all patients (42/45) experienced breathlessness in their last year of life. Additional symptoms included cough, fatigue, depression/anxiety, and chest pain. All patients given opioids (22/45) or benzodiazepines (8/45) had documented benefit. Nonpharmacological treatments were rarely used. Few patients had preferred place of care (8/45) or preferred place of death (6/45) documented.

Conclusions: Despite demographic variation, the patient populations at the two hospitals experienced similar symptoms. There was use of standard pharmacological treatments with symptom benefit. Nonpharmacological interventions were seldom used and documentation of preferred place of care and preferred place of death was poor.