Feasibility and efficacy of a multidisciplinary palliative approach in patients with advanced interstitial lung disease. A pilot randomised controlled trial
I. Bassi,
A. Guerrieri,
M. Carpano,
A. Gardini,
I. Prediletto,
M. Polastri,
J. Randall Curtis,
S. Nava
Affiliations
I. Bassi
Department of Clinical, Integrated and Experimental Medicine (DIMES), Alma Mater University, Bologna, 40138, Italy; Respiratory and Critical Care Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138, Italy
A. Guerrieri
Department of Clinical, Integrated and Experimental Medicine (DIMES), Alma Mater University, Bologna, 40138, Italy; Respiratory and Critical Care Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138, Italy
M. Carpano
Department of Clinical, Integrated and Experimental Medicine (DIMES), Alma Mater University, Bologna, 40138, Italy; Respiratory and Critical Care Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138, Italy
A. Gardini
Department of Statistical Sciences “P. Fortunati”, Alma Mater University, Bologna, 40138, Italy
I. Prediletto
Department of Clinical, Integrated and Experimental Medicine (DIMES), Alma Mater University, Bologna, 40138, Italy; Respiratory and Critical Care Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138, Italy
M. Polastri
Department of Continuity of Care and Disability, Physical Medicine and Rehabilitation, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138, Italy.
J. Randall Curtis
Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle WA, 98195, United States; Cambia Palliative Care Center of Excellence, UW Medicine, University of Washington, Seattle WA, 98195, United States
S. Nava
Department of Clinical, Integrated and Experimental Medicine (DIMES), Alma Mater University, Bologna, 40138, Italy; Respiratory and Critical Care Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138, Italy; Corresponding author at: via Massarenti 9, Bologna (40138), BO, Italy.
Introduction and Objectives: Interstitial lung diseases (ILDs) encompass a heterogeneous group of parenchymal lung disorders which have a significant burden on quality of life and exercise. The primary purpose of this randomised pilot trial performed in advanced ILD was to determine the feasibility and efficacy of a multidisciplinary palliative care approach (including physiotherapist, psychologist, pulmonologists, and palliative care doctors) to relieve patients’ symptoms of dyspnoea, depression measured with the Center for Epidemiological Studies-Depression (CES-D) scale and quality-of-life (QoL) at 6 and 12 months. Matherials and Methods: Fifty patients with confirmed interstitial lung disease at computed tomography (CT) scan and advanced disease were enrolled at our clinic. Patients were randomised to usual care group vs intervention group; in the intervention group, patients were scheduled to meet a physiotherapist, a psychologist, a palliative care doctor, and a pulmonologist specialized in ILD care. Data on dyspnoea, cough, quality of life and depression were recorded; patients in the intervention group were also tested to assess lower body flexibility and strength. Results: Both groups showed a worsening in dyspnoea during the time course of the trial, but the Borg scale was less in the intervention group at 6 and 12 months. A similar trend was observed also for the CES-D scale. No differences were observed for the other scales. Conclusions: A multi-disciplinary palliative care intervention in patients with advanced fibrosing interstitial lung disease is feasible and effective. Trial registration: NCT02929966 on ClinGovTrial.
