62 Barriers to Optimal Palliative Care of Lung Transplant Candidates

Purpose Provision of palliative and end-of-life care is of special importance for patients awaiting lung transplantation. However, lung transplant program practices may be at odds with palliative care principles. We examined perceived barriers to delivery of palliative care to lung transplant candidates and sought strategies to improve such care. Methods and Materials An anonymized e-mail questionnaire was sent to all members of the American College of Chest Physicians Transplant NetWork and of the Pulmonary Council of the ISHLT. It included demographic and practice-related questions, questions about barriers to palliative care of lung transplant candidates, availability of services and utility of strategies to improve palliative care. Transplant program practitioners were eligible for this study. Results There were 158 eligible responses. Respondents were in practice 11.3 (±9) years. 70% were pulmonologists, 17% surgeons and 13% other care providers, including coordinators and nurse practitioners. Barriers that were considered at least moderate by >50% of respondents were classified as significant. These included unrealistic patient/family expectations about survival until and after transplant, patient/family unwillingness to plan end-of-life care, patient concerns about inappropriate care or abandonment after enrollment in a palliative care program and family disagreements about care goals. Among program policy barriers, the requirement for weight loss or gain was identified. Clinician barriers included competing time demands and seemingly contradictory goals of transplantation and palliative care. Helpful strategies included routine advanced care planning assistance for listed patients, access to palliative care consultants, training of transplant physicians in symptom management and regular meetings between transplant physicians, nurses, patients and families. Conclusions Clinicians providing care to lung transplant candidates perceive important barriers to the delivery and acceptance of palliative care and believe that there are specific strategies that may improve such care.