THE IMPACT OF ADVANCE CARE PLANNING IN INTERSTITIAL LUNG DISEASE (ILD)

Abstract

SESSION TITLE: Palliative Care and End-of-Life Issues SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/10/2018 01:00 PM - 02:00 PM PURPOSE: We advocate advanced care planning (ACP) as a solution to poor acute end of life care. In 2012, we developed a multidisciplinary collaborative care model with an early integrated palliative approach to better document ACP and facilitate Idiopathic Pulmonary Fibrosis (IPF) patient wishes with respect to their care and death. We reviewed our clinic data to study the impact of ACP in IPF on the preferred location of death and on health resource utilization. METHODS: We identified 38 deceased IPF patients. Extracted data from the EMR included: demographics, duration of clinic enrollment, ACP documentation including goals of care, preferred place of care and death, dyspnea management (opiate use), actual place of death and number of hospitalizations. RESULTS: The ACP-IPF model was implemented in 100% of deceased patients, with a median follow-up period of 17.5 months. Preferred place of death was home in 74% and hospice in 13%. Actual place of death was home or hospice in 74% with a concordance rate of 85%. On average, 163 days were spent at home 6 months preceding death. 42% did not use acute care and only 16% needed 2 or more admissions. Opioids were initiated in 82% of patients, an average of 150 days preceding death. CONCLUSIONS: End of life care in IPF is marked by inadequate palliative care and increased acute care. We show that embedded within a multidisciplinary collaborative care model, ACP can be successfully implemented concurrently with routine clinical care to meet patient goals. The care design included early symptom self-management and timely coordination of needed multidisciplinary services to facilitate patient’s preferences. This is the first study to show that ACP as part of routine IPF care can improve end of life care by allowing greater adherence to patient choices, early institution of symptom treatments and decreasing acute care utilization in IPF. CLINICAL IMPLICATIONS: ACP was identified as a National Priority by the IOM 2014 report titled ‘Dying in America’, yet most IPF patients have no ACP, die in hospitals including ICUs and receive costly and inappropriate care at end of life. This the first study to our knowledge to describe the feasibility of early initiation and successful implementation of ACP in routine outpatient ILD care. It allowed mobilization of community and clinic resources and implementation of ‘dyspnea crisis plans’ within our patient centered care model, facilitating home or hospice deaths to achieve a concordance rate of 85%. Our work demonstrates improvement in end of life care by allowing greater adherence to patient choices, early institution of symptom treatments and decreasing acute care utilization in IPF. This further supports the need for wider and early ACP application in IPF and other debilitating chronic illnesses. DISCLOSURES: No relevant relationships by alia daoud, source=Web Response Speaker/Speaker's Bureau relationship with BI, ROCHE Please note: $5001 - $20000 Added 03/02/2018 by Meena Kalluri, source=Web Response, value=Consulting fee Grant relationship with Roche Please note: $5001 - $20000 Added 03/02/2018 by Meena Kalluri, source=Web Response, value=Grant/Research Consultant relationship with Boehringer Ingelheim Please note: $1001 - $5000 Added 03/03/2018 by Janice Richman-Eisenstat, source=Web Response, value=Consulting fee