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The impact of palliative care on quality of life, anxiety, and depression in idiopathic pulmonary fibrosis: a randomized controlled pilot study

Authors
  • Janssen, Katherine1
  • Rosielle, Drew2
  • Wang, Qi3
  • Kim, Hyun Joo1
  • 1 University of Minnesota Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, MMC 276, 420 Delaware Street SE, Minneapolis, MN, 55455, USA , Minneapolis (United States)
  • 2 University of Minnesota Palliative Care, MMC 603 Mayo, 8603A, 420 Delaware Street SE, Minneapolis, MN, 55455, USA , Minneapolis (United States)
  • 3 University of Minnesota Biostatistical Design and Support Center, Clinical Translational Science Institute, Room 223, 1932D, 717 Delaware St SE, Minneapolis, MN, 55414, USA , Minneapolis (United States)
Type
Published Article
Journal
Respiratory Research
Publisher
BioMed Central
Publication Date
Jan 03, 2020
Volume
21
Issue
1
Identifiers
DOI: 10.1186/s12931-019-1266-9
Source
Springer Nature
Keywords
License
Green

Abstract

BackgroundIdiopathic pulmonary fibrosis (IPF) is a fatal disease that results in poor quality of life due to progressive respiratory symptoms, anxiety, and depression. Palliative care improves quality of life and survival in other progressive diseases. No randomized controlled trials have investigated the impact of palliative care on quality of life, anxiety, or depression in IPF.MethodsWe conducted a randomized, controlled, pilot study to assess the feasibility of measuring the effect of a palliative care clinic referral on quality of life, anxiety, and depression in IPF. Patients were randomized to usual care (UC) or usual care + palliative care (UC + PC) with routine pulmonary follow up at 3 and 6 months. The UC + PC group received a minimum of one PC clinic visit. Primary outcome was change from baseline in quality of life, anxiety, and depression as measured by the St. George’s Respiratory Questionnaire (SGRQ), the Hospital Anxiety and Depression Index (HADS), and the Patient Health Questionnaire (PHQ-9) at 6 months.ResultsTwenty-two patients were randomized between September 2017 through July 2018; 11 to UC and 11 to UC + PC. There was no difference in the change in SGRQ score at 3 months or 6 months, however, the symptom score trended towards a significant worsening for UC + PC at both 3 and 6 months (mean change at 3 months for UC and UC + PC was − 7.8 and + 10.7, respectively, p = 0.066; mean change at 6 months for UC and UC + PC was − 6.0 and + 4.6, respectively, p = 0.055). There was no difference in the change in HADS anxiety or depression scores. There was a significant transient worsening in PHQ-9 scores for UC + PC at 3 months (UC: -1.6, UC + PC: + 0.9, p = 0.008); this effect did not persist at 6 months.ConclusionThis pilot study demonstrated that a randomized controlled trial of palliative care in idiopathic pulmonary fibrosis patients is feasible. Receiving palliative care did not lead to improved quality of life, anxiety, or depression compared to usual care after 6 months. Patients in the UC + PC group trended towards worsening symptoms and a small but statistically significant transient worsening in depression. These findings should be interpreted with caution, and need to be evaluated in adequately powered clinical trials. NCT03981406, June 10, 2019, retrospectively registered.

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