End-of-Life Care in Cystic Fibrosis: Comparing Provider Practices Based on Lung Transplant Candidacy

Allison V. Lange, Ali Rueschhoff, Stephanie Terauchi, Leah Allison Cohen, Joan Reisch, Raksha Jain, James D. Finklea

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Background: The optimal timing to introduce palliative care (PC) and end-of-life (EOL) conversations into the lives of people with cystic fibrosis (CF) has not been established. Objective: Compare EOL care practices for people with CF who died without a lung transplant (LT), are living without an LT, and those who received an LT. Design: Retrospective chart review. Setting/Subjects: People with CF who received care from 2012 to 2017 at the University of Texas Southwestern Medical Center. Measurements: Primary outcomes were (1) EOL discussion with a pulmonologist, (2) time of EOL discussion before death or LT, (3) evaluation by PC, and (4) documentation of advanced directive or medical power of attorney. Results: Twenty-three patients died without LT, 40 patients received an LT, and 222 were living without an LT. Among LT recipients, 10% had EOL conversations compared with 74% of deceased patients and 5% of living patients without LT (p = 0.001). Among deceased patients, 39% had EOL conversations more than six months before death, while 5% of transplanted patients had EOL conversation more than six months before LT (p < 0.001). Deceased patients were more likely to have seen PC (57%) than either patients who received LT (2%) or those living without LT (3%, p = 0.0001). Conclusions: Patients who died without LT were more likely to have seen PC and had an EOL conversation than patients who received LT or who are living without LT. Further research should explore the optimal timing to discuss EOL care and the best timing to involve PC.

Original languageEnglish (US)
Pages (from-to)1606-1612
Number of pages7
JournalJournal of palliative medicine
Volume23
Issue number12
DOIs
StatePublished - Dec 1 2020

Keywords

  • cystic fibrosis
  • end of life
  • lung transplant

ASJC Scopus subject areas

  • Nursing(all)
  • Anesthesiology and Pain Medicine

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