title: Referral to Palliative Care Infrequent in Patients with Idiopathic Pulmonary Fibrosis Admitted to an Intensive Care Unit.
abstract: Palliative care has been recommended as a means to assist patients with idiopathic pulmonary fibrosis (IPF) in managing symptom burden and advanced care planning. Timing of referral is important because although most patients display a gradually progressive course, a minority experience acute deterioration, an outcome associated with high mortality.
  
  
  
  To describe characteristics of IPF patients referred to a specialty lung disease center over a 10-year period who experienced acute deterioration and subsequent intensive care unit (ICU) admission, including frequency and timing of referral to palliative care.
  
  
  
  Retrospective review.
  
  
  
  We identified 106 patients admitted to the ICU with acute deterioration due to a respiratory or nonrespiratory cause. Variables examined included demographics, date of first center visit, forced vital capacity, diffusing capacity of the lung for carbon monoxide (DLCO), and palliative care referral.
  
  
  
  ICU admission occurred early (median 9.5 months) and, for 34%, within four months of their first center visit. For nearly one-half of these patients, ICU admission occurred before their third clinic visit. Only 4 (3.8%) patients received a palliative care referral before ICU admission. The majority (77%) died during ICU admission. With exception of the relationship between DLCO% predicted at first visit and time to ICU admission (r = 0.32, p = 0.005), no variables identified those most likely to experience acute deterioration.
  
  
  
  Due to high mortality associated with ICU admission, patients and families should be informed about palliative care early following diagnosis of IPF.
authors.affiliation: 1 University of South Florida College of Nursing , Tampa, Florida.
authors.forename: Zhan
authors.initials: Z
authors.lastname: Liang
authors.affiliation: 2 University of Pittsburgh School of Nursing , Pittsburgh, Pennsylvania.
authors.forename: Leslie A
authors.initials: LA
authors.lastname: Hoffman
authors.affiliation: 3 Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh , Pittsburgh, Pennsylvania.|4 The University of Pittsburgh Dorothy P. and Richard P. Simmons Center for Interstitial Lung Disease at UPMC , Pittsburgh, Pennsylvania.
authors.forename: Mehdi
authors.initials: M
authors.lastname: Nouraie
authors.affiliation: 3 Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh , Pittsburgh, Pennsylvania.|4 The University of Pittsburgh Dorothy P. and Richard P. Simmons Center for Interstitial Lung Disease at UPMC , Pittsburgh, Pennsylvania.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Kass
authors.affiliation: 3 Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh , Pittsburgh, Pennsylvania.|5 Department of Medicine, University of Pittsburgh , Pittsburgh, Pennsylvania.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Donahoe
authors.affiliation: 3 Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh , Pittsburgh, Pennsylvania.|4 The University of Pittsburgh Dorothy P. and Richard P. Simmons Center for Interstitial Lung Disease at UPMC , Pittsburgh, Pennsylvania.
authors.forename: Kevin F
authors.initials: KF
authors.lastname: Gibson
authors.affiliation: 5 Department of Medicine, University of Pittsburgh , Pittsburgh, Pennsylvania.
authors.forename: Melissa I
authors.initials: MI
authors.lastname: Saul
authors.affiliation: 3 Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh , Pittsburgh, Pennsylvania.|4 The University of Pittsburgh Dorothy P. and Richard P. Simmons Center for Interstitial Lung Disease at UPMC , Pittsburgh, Pennsylvania.
authors.forename: Kathleen O
authors.initials: KO
authors.lastname: Lindell
mesh_terms: D000368:Aged; D005260:Female; D006760:Hospitalization; D006801:Humans; D054990:Idiopathic Pulmonary Fibrosis; D007362:Intensive Care Units; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D010166:Palliative Care; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012189:Retrospective Studies
keywords: advanced care planning; idiopathic pulmonary fibrosis; intensive care unit; palliative care