Implementing a Palliative Care Protocol in a Pulmonary Fibrosis Unit

The Fibrosis and other progressive fibrosing clinical phenotypes, called progressive pulmonary fibrosis (PPF), are characterized by decreased lung function, worsening symptoms and quality of life, and premature death despite optimal medical treatment. Survival of these patients is around 5-8 years. When the disease progresses despite the correct treatment, we should consider incorporating palliative care into the clinical management of patients. Palliative care (PC) is a multidisciplinary approach, early intervention improves symptom control and the approach from all physical, emotional, intellectual and spiritual spheres. Early referral to PC units in pulmonary fibrosis patients is associated with better end of life planning, less need for hospital care and less need for emergency room visits. Objective: Identification of outpatients diagnosed with pulmonary fibrosis with disease progression and poor symptomatic control in order to early integrate palliative care. We propose a series of referral criteria to help us identify early on those patients who may be in need of palliative care. Criteria: High symptom burden, Functional loss, Prognostic criteria for advanced disease, Disease trajectory, Presence of comorbidities, Demand for palliative care, Psycho-emotional situation, Social vulnerability. First joint introductory visit: in this visit the Pneumology specialist will introduce the Hospital Palliative Care Hospital Support Team to the patient and their relatives. Follow-up will be carried out by the Primary Care Team in coordination with the Palliative Home Care Unit. A continuous assessment of the situation will be carried out, taking into account the needs of the patient and their family. The process of planning end-of-life care requires a longitudinal communication process in which trust is built in order to explore the values, preferences and concerns of the patient, and their affective environment, that relate to the end of life. Advanced Decision Planning is associated with improved end-of-life treatments and quality of life.