End-of-life Care in In-Patients Dying from Pulmonary Fibrosis

Background: Idiopathic Pulmonary Fibrosis has 3 year mean survival with many unmet palliative care needs (Bajwah et al, Lung 2012). Method: 2 year review of in-patient Pulmonary Fibrosis (PF) deaths. Results: 30 patients, 73% male, mean age at death 72.1(42-91). 4(13%) diagnosed PF during final admission. Remaining 24/26 known to Chest team. Mean diagnosis-death 19 months (excl. sarcoidosis > 10 yrs). Specialist Palliative Care involved pre-admission in 6(23%), initiated mean 3.5 months pre-death, & reviewed 7(23%) during admission. 14(47%) aware intent of treatment palliative, 2 aiming Lung Transplant. 22(73%) had in-patient Chest review. 2(7%) had failed resuscitation, remaining 28 were Not for Resuscitation. No recorded dialogue with 8(27%) patients/family during admission forewarning End-of-Life. Preferred Place of Death documented in 3(10%): 1 hospice, 2 home. In final 48 hrs opiates prescribed in 19(63%), 84% received, & benzodiazepines prescribed in 18(60%), 50% received. Discussion: Patients symptomatic at final admission with dyspnoea, agitation & anxiety, often enduring to death. Collaborative progress needed to palliate symptoms & initiate Advance Care Planning.