Palliative care for people with non-malignant lung disease: Summary of current evidence and future direction
Environmental & Occupational Health
Source:2012 Journal Citation Reports® (Thomson Reuters, 2013)
- Jason Boland, Senior Lecturer and Honorary Consultant in Palliative Medicine, Hull York Medical School, University Of Hull, Hull HU6 7RX, UK. Email: Jason.Boland@hyms.ac.uk
Abstract
Background: The
physical and psychosocial needs of patients with chronic non-malignant
lung disease are comparable to those with lung
cancer. This article will focus on chronic
obstructive pulmonary disease, interstitial lung disease and cystic
fibrosis as
examples of life-limiting, non-curable and
non-malignant lung diseases.
The need for supportive and palliative care:
Recent national guidance has demanded that palliative care is inclusive
of all patients with life-limiting disease, irrespective
of diagnosis, and that specialist palliative
care teams are involved in the management of patients on a basis of need
rather
than prognosis.
What is known: Despite
medical therapy, most patients with moderate to severe chronic
obstructive pulmonary disease, interstitial lung disease
and cystic fibrosis experience pain, fatigue and
dyspnoea, with the majority not getting relief from dyspnoea towards
the
end of life. Furthermore, dyspnoea causes social
isolation and difficulty performing activities of daily living and
impairs
quality of life. There is an increasing evidence
base for the assessment of supportive and palliative care needs,
symptom
interventions, prognostication, models of
service delivery and implications of these for clinical practice and
research in
non-malignant lung diseases.
What is unknown:
Despite advances, much still remains unknown regarding assessment,
management and prognostication in individual chronic non-malignant
lung diseases. Although different service models
are being used in clinical practice, the optimal model(s) of service
delivery
remain unknown.
Implication for future research, policy and practice:
We describe key areas for further research, which include the need for
large, high-quality trials of pharmacological and
non-pharmacological interventions and their
combinations as well as evaluation of the efficacy and
cost-effectiveness of models
of care. As access to palliative care is poor
for these patients, the barriers to referral need to be understood and
reduced,
which along with effective working between
palliative care teams, with respiratory services backup, should optimise
delivery
of care in patients with life-limiting
non-malignant lung disease.
- Palliative care
- non-malignant lung disease
- chronic obstructive pulmonary disease
- cystic fibrosis
- interstitial lung disease
No comments:
Post a Comment