Characteristics, Trends, and Predictors of Specialty Palliative Care Utilization after Lung Transplantation

Eric P. Nolley, Rebecca Desensi, Mehdi Nouraie, Yael Schenker, Matthew R. Morrell

Research output: Contribution to journalArticle

Abstract

Background: Lung transplant recipients who experience serious illness could benefit from specialty palliative care (SPC), but evidence suggests that referral has been rare. Objective: Examine the characteristics of post-transplant SPC encounters, utilization trends, and patient characteristics associated with SPC at a center with established SPC services. Design: Retrospective cohort study of SPC utilization by 597 lung transplant recipients transplanted between 2010 and 2015. We collected data on pretransplant demographics and post-transplant SPC encounters, including timing, location, and referral reasons. Cumulative incidence of SPC and patient characteristics associated with SPC were examined by competing risks methods. Utilization in the first two post-transplant years was compared between subcohorts defined by year of transplantation. Results: SPC cumulative incidence was 27% and 43% at one and five years. More than 60% of encounters occurred in the first post-transplant year including 34% during the index transplant hospitalization. Over 90% of encounters occurred in the inpatient setting. The majority of consults were for symptom management. From 2010 to 2015 inpatient utilization in the first two post-transplant years increased from 23% to 42%, and outpatient utilization increased from 2% to 16%. Accounting for increasing utilization, pretransplant SPC and double-lung transplantation were associated with greater incidence of post-transplant SPC. Conclusions: Lung transplant recipients may have palliative care needs early after transplantation. Increasing utilization suggests greater awareness of or changing attitudes about the utility of SPC for lung transplant recipients. Understanding transplant recipients' palliative care needs and transplant physicians' views of SPC is critical to improving the provision of SPC in lung transplantation.

Original languageEnglish (US)
Pages (from-to)1092-1098
Number of pages7
JournalJournal of palliative medicine
Volume22
Issue number9
DOIs
StatePublished - Sep 2019
Externally publishedYes

Fingerprint

Lung Transplantation
Palliative Care
Transplants
Lung
Inpatients
Incidence
Referral and Consultation
Transplantation

Keywords

  • competing risks
  • lung transplant recipients
  • lung transplantation
  • solid organ transplantation
  • specialty palliative care

ASJC Scopus subject areas

  • Nursing(all)
  • Anesthesiology and Pain Medicine

Cite this

Characteristics, Trends, and Predictors of Specialty Palliative Care Utilization after Lung Transplantation. / Nolley, Eric P.; Desensi, Rebecca; Nouraie, Mehdi; Schenker, Yael; Morrell, Matthew R.

In: Journal of palliative medicine, Vol. 22, No. 9, 09.2019, p. 1092-1098.

Research output: Contribution to journalArticle

Nolley, Eric P. ; Desensi, Rebecca ; Nouraie, Mehdi ; Schenker, Yael ; Morrell, Matthew R. / Characteristics, Trends, and Predictors of Specialty Palliative Care Utilization after Lung Transplantation. In: Journal of palliative medicine. 2019 ; Vol. 22, No. 9. pp. 1092-1098.
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