Journal of palliative medicine
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Observational Study
Impact of Early Referral to Palliative Care in Patients with Interstitial Lung Disease.
Background: Interstitial lung diseases (ILDs) have a major impact on survival and quality of life but only a small percentage of patients are referred for palliative care (PC). Objective: To assess the impact of early PC referral on hospital admissions, emergency department visits, and place of death in the last year of life. Design: This is a single-center retrospective observational study. ⋯ Results: Of the 51 included patients, 45% received early PC referral. Logistic regression indicated that early PC referral was independently associated with a lower risk of hospital admissions in the last year of life (OR = 0.16; 95% CI 0.03-0.75; p = 0.02) and a lower risk of dying in hospital (OR = 0.11; 95% CI 0.02-0.5; p = 0.009). Conclusion: Early PC referral reduces the need for hospitalization and enables domiciliary death.
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Medical interpreters are the primary facilitators of effective communication between clinical providers and patients with limited English proficiency. They can assist in managing complex meetings in which patients, families, and clinicians decide on next steps in care. ⋯ Rather than using an interpreter as a language tool, this article encourages PC clinicians to cultivate a partnership with the interpreter as a team member. We describe 10 tips for effective partnering with interpreters: the importance of including the interpreters in preencounter huddles and post-encounter debriefs, agreeing on strategies for interpreting "untranslatable" words and managing the encounters, using the "teach back" method to ensure understanding, acknowledging interpreters as cultural mediators, understanding the potential emotional impact of family meetings on interpreters, and enhancing follow-up with the PC team by providing contact information for PC staff to patients.