S42 Where do individuals with idiopathic pulmonary fibrosis (IPF) die

Introduction Median survival in IPF is 2–3 years from diagnosis. A majority of individuals with a variety of terminal illnesses express a preference to die at home1. Those with IPF may have different needs which affect actual and preferred place of death, and the unpredictable trajectory in IPF can make it difficult to identify appropriate timing to refer to palliative and supportive care, and discuss advance care planning (ACP). Methods We wanted to better understand the experience of those with IPF, where they die and opportunities to discuss ACP. We retrospectively examined records of 81 individuals with IPF who had most recently died. These were identified prior to introduction of process for individuals with IPF to be reviewed in our MDT clinic, where they are seen by ILD CNS, respiratory and palliative care consultants one one occasion. The opinion of those seen were sought to address whether early ACP discussions were helpful. Results 32/81 (39.5%) had some form of ACP recorded, but in most cases (78.1%), this was during an inpatient admission. Discussions about preferred place of death were not recorded in outpatient clinic for any patients. Of the 35 individuals local to the tertiary centre, 28 patients had been admitted to hospital at least once in their final year of life. For those 35 individuals, place of death is shown in table 1. Discussion A significant proportion of patients with IPF die in an acute hospital setting. While preferences for their place of death are not known, high oxygen requirements, unpredictable disease trajectory and lack of directed specialist palliative care services may contribute to why this proportion is higher than expected for other cardiorespiratory conditions with a limited prognosis. We anticipate the introduction of early ACP discussions at annual review will provide opportunities to ensure individual wishes are known, with a view to avoid distressing admissions with unwanted and burdensome interventions at the end of life.