CHEST Guidelines-Response_chest

Response_chest_26

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The correspondence letter in CHEST by Dr. Kathleen O. Lindell and colleagues responds to Dr. Wijsenbeek's contributions regarding the care of patients with idiopathic pulmonary fibrosis (IPF) and emphasizes palliative care's importance. The letter highlights that the majority of patients with IPF die in hospitals, with 59% and 57% in European and the authors' studies, respectively. Both findings accentuate the need to reassess end-of-life care arrangements.<br /><br />A significant divergence noted is the percentage of hospital deaths occurring in the ICU: 33% in the authors' cohort versus just 7% in Dr. Wijsenbeek's. This difference likely stems from variations in ICU bed availability and practices between countries such as the U.S., which has a notably higher number of ICU beds and lower admission thresholds compared to the UK.<br /><br />The high ICU mortality rates in the U.S. might partly be due to affiliated active transplant programs, where IPF patients often receive transplants either during or following ICU admission. Critical care in such circumstances might be more routinely offered.<br /><br />Dr. Wijsenbeek's notable achievement is reducing hospital death rates to 28% through a dedicated palliative care program, underscoring the potential benefits of this approach. The letter supports the notion that systematic palliative care can improve symptom management, end-of-life care quality, and respect patients' and families' preferences.<br /><br />Conclusively, the authors call for the integration of palliative care discussions at diagnosis and advocate a paradigm shift to make palliative care a foundational element in managing IPF. They also highlight the need for continuous studies to improve patient education and assess patient and family preferences for symptom management and palliative care. A reconsideration of when and how palliative care is implemented in the IPF treatment continuum is deemed necessary.

Keywords

idiopathic pulmonary fibrosis

palliative care

ICU mortality rates

hospital deaths

end-of-life care

patient education

symptom management

transplant programs

care paradigm shift

patient preferences