Barriers to the provision of optimal palliative care in a patient awaiting lung transplantation

Abstract

Idiopathic Pulmonary Fibrosis (IPF) is a chronic, progressive, fatal form of diffuse interstitial lung disease, which is associated with substantial mortality and morbidity. Lung transplantation has become one of the treatments of choice for patients with advanced IPF and has shown a 75% reduction in risk of death compared with patients who remained on the waiting list. Patients undergoing lung transplantation are required to participate in preoperative and postoperative pulmonary rehabilitation. This case report describes palliative and end of life care in a patient with end stage pulmonary fibrosis listed for lung transplantation and discusses the transition from curative restorative care and palliative care to end of life care. The goals of care of patients waiting for lung transplantation should be reviewed regularly and clarified as the clinical condition of the patient changes. End of life care should not only be considered in terminally ill patients or patients who do not fulfil the criteria for lung transplantation, but should also be raised with patients on the lung transplant waiting list. The goal of palliative care is to “enhance quality of life for patient and family, optimize function, and help with decision making” and thus it can be delivered concurrently with life prolonging care.