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Interstitial lung disease care: A good death?

First, off the blocks, I would like to say that the title of this article would perhaps be more suitable to the wording of “Interstitial lung disease: A good life until death?”, but I considered this to lack something of the panache or cliché that might draw you here. However, is this not the aim of palliative care in medicine – to maintain a high, happy quality of life until the end; not to wind down to death; not to relinquish control to the prospect, but to relish all remaining opportunities? This is the objective, at least in my opinion, that any patient at the end of their life should be encouraged to achieve. I think that palliative treatment is one of the most important care sectors in modern medicine, yet it is one given very little public attention, despite its importance to every single one of us at some point in our twilight years. This is, perhaps, because it lacks the flair, the modernity and the fascinating qualities that can be found in medical news. Take, for example, new CRISPR genome editing, “printing” of new organs for transplant, surgical tools, or perhaps stem cell treatments. When compared with these modern wonders, it is no surprise that the more consistent field of palliative care takes a backseat. I, therefore, write this article to raise a little awareness for the importance of this patient management.

Idiopathic pulmonary fibrosis, with features as shown on this HRCT scan, is the most common type of interstitial lung disease

When one thinks of end of life care, cancer care is often the type of disease that springs to mind and, although I do not contest that this is equally important for cancer patients, palliative management is often neglected in other diseases. In particular, I would like to address palliative care in interstitial lung disease, which encompasses most common lung diseases affecting the interstitium of the lungs. The reason for this topic lies in my summer. While many of my colleagues may have spent theirs on the beach in Spain, Italy, or some other exotic location, I spent most of mine in a hospital. More specifically, I spent four weeks on placement at the North Bristol Trust researching the effectiveness of a new initiative introduced in the interstitial lung disease sector of the Respiratory Department. This initiative was a new type of multidisciplinary team (MDT) meeting of respiratory, palliative and psychology professionals who discussed each relevant individual patient in the department nearing the end of their life, their needs and how these needs could be addressed with maximum comfort and content. These needs included DNACPR orders (more commonly known as DNRs), secondary palliative care team input, matrons and nursing, fitness to fly, supportive care register listings and breathlessness courses (for lung rehabilitation). This initiative was introduced with the aim of better following the NICE guidance that “people approaching the end of life are offered comprehensive holistic assessments”1.

To outline this project simply for you, we examined records of patients who passed away before the introduction of the MDT meeting and compared their end of life management with those who were discussed in the MDT meeting, which was introduced in January 2016. I will skip straight to the crux of this article, with the results of this project. Though I do not know whether I am permitted reveal statistics and, therefore, will not do so, I can certainly tell you the basic conclusions we made. These observations were beyond what certainly I had expected to see.

Firstly, the percentage of patients with these treatment elements discussed (with this discussion documented) showed a huge increase since the MDT’s introduction. This is definitely the most important thing to note from this project, showing more comprehensive deliberation. Furthermore, it was conclusive that the action upon these points of discussion had also increased significantly, though to a slightly lesser extent than the discussion.

It is clear to conclude from this research that this MDT meeting is highly effective, and makes a great positive difference on not only an administrative level, with easier documentation, but more importantly on an individual patient basis. The initiative has, and will continue to, make a real difference to the quality of life of interstitial lung disease patients. I think that this is far and away the most important thing, and it is a wonderful feeling to have made a difference. I would really recommend dipping your toe into the sector of research. Who knows, you may find yourself being sucked into it…

 


I would like to give a short note of special thanks to Southmead Hospital and the North Bristol NHS Trust for this opportunity to complete a placement. In particular, I would like to thank the interstitial lung disease team, who made my time on placement so interesting and always kept me busy. Special thanks go to my overseeing consultant, whom I found to be an inspirational model exemplifying all that a medical professional should be.


  1. NICE, End of life care for adultsQuality statement 3, March 2017