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Palliative care for people with non-malignant lung disease: summary of current evidence and future direction

Ross, Joy R; Wells, Athol U.; Boland, Jason; Martin, Jonathan; Wells, Athol U; Ross, Joy R.

Authors

Joy R Ross

Athol U. Wells

Jason Boland

Jonathan Martin

Athol U Wells

Joy R. Ross

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.

Publication Date 2013-09
Journal Palliative medicine
Print ISSN 0269-2163
Electronic ISSN 1477-030X
Publisher SAGE Publications
Peer Reviewed Peer Reviewed
Volume 27
Issue 9
Pages 811-816
Institution Citation Boland, J., Martin, J., & Wells, A. U. (2013). Palliative care for people with non-malignant lung disease: summary of current evidence and future direction. Palliative medicine, 27(9), 811-816. https://doi.org/10.1177/0269216313493467
DOI https://doi.org/10.1177/0269216313493467
Keywords Anesthesiology and Pain Medicine; General Medicine
Publisher URL http://pmj.sagepub.com/content/27/9/811
Additional Information Author's accepted manuscript of article published in: Palliative medicine, 2013, v.27, issue 9

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