Barriers to the Provision of Optimal Palliative Care in a Patient Awaiting Lung Transplantation

Faisal Ameer

doi:10.4172/2161-105x.1000151

Abstract

Idiopathic Pulmonary Fibrosis (IPF) is a chronic, progressive, fatal form of diffuse interstitial lung disease, which is associated with substantial mortality and morbidity. Lung transplantation has become one of the treatments of choice for patients with advanced IPF and has shown a 75% reduction in risk of death compared with patients who remained on the waiting list. Patients undergoing lung transplantation are required to participate in preoperative and postoperative pulmonary rehabilitation. This case report describes palliative and end of life care in a patient with end stage pulmonary fibrosis listed for lung transplantation and discusses the transition from curative restorative care and palliative care to end of life care. The goals of care of patients waiting for lung transplantation should be reviewed regularly and clarified as the clinical condition of the patient changes. End of life care should not only be considered in terminally ill patients or patients who do not fulfil the criteria for lung transplantation, but should also be raised with patients on the lung transplant waiting list. The goal of palliative care is to “enhance quality of life for patient and family, optimize function, and help with decision making” and thus it can be delivered concurrently with life prolonging care.

Highlights

Idiopathic Pulmonary Fibrosis (IPF) is a chronic, progressive, fatal form of diffuse interstitial lung disease, which is associated with substantial mortality and morbidity [1]
Patients with IPF are likely to be elderly with multiple medical co-morbidities that may preclude them from lung transplantation
Patients with IPF who received a lung transplant show a 75% reduction in risk of death compared with patients who remain on the waiting list [5]

Summary

Introduction

Idiopathic Pulmonary Fibrosis (IPF) is a chronic, progressive, fatal form of diffuse interstitial lung disease, which is associated with substantial mortality and morbidity [1]. She was referred to the palliative care service by the thoracic team two weeks into her final admission for assistance with complex multiple symptom management, and anticipating discharge, for access to community supports She was commenced on sustained release morphine (Kapanol) 10 mg daily, Morphine syrup 2-3 mg prn and clonazepam drops sublingually as required with reasonable improvement in subjective dyspnea. Hope appeared to be a strong persisting theme in her coping strategy – a hope for lung transplantation and resumption of a “normal life.” She denied any ongoing depressive and anxiety symptoms and continued to receive psychosocial and emotional support from the ward social worker and the palliative care team. She died peacefully in the hospital in the presence of her family and close friends within 24 hours

Findings

Discussion

Conclusion