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Brown CE, Steiner JM, Leary PJ, Curtis JR, Engelberg RA. A World of Maximalist Medicine: Physician Perspectives on Palliative Care and End-of-life for Patients With Pulmonary Arterial Hypertension. J Pain Symptom Manage 2023; 65:e329-e335. [PMID: 36521765 PMCID: PMC10023342 DOI: 10.1016/j.jpainsymman.2022.11.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 11/22/2022] [Accepted: 11/29/2022] [Indexed: 12/15/2022]
Abstract
CONTEXT Physicians who specialize in pulmonary arterial hypertension (PAH) care for patients facing a serious, life-limiting illness. Palliative care is underutilized in patients with PAH, and little is known about how best to provide palliative care to this patient population. OBJECTIVES Using a qualitative approach, assess physicians' perspectives on barriers and facilitators to the use of palliative care in PAH. METHODS Participants were board-certified pulmonologists and cardiologists recruited from the Pulmonary Hypertension Association's list of physician specialists and academic center websites. We performed one-on-one semi-structured interviews that were recorded, transcribed, and analyzed using thematic analysis. RESULTS Twelve physicians participated in the study, with a median age of 48.5 years and 20.5 years of clinical experience caring for patients with PAH. We identified the following themes and associated barriers and facilitators to effective implementation of palliative care for patients with PAH: a tailored approach to the individual patient; a PAH-specialist-led culture of care; effective collaboration with palliative care clinicians; and limitations imposed by health systems. CONCLUSION PAH physicians are open to palliative care for their patients and are willing to partner with palliative care clinicians to implement this effectively and in the right setting. Areas for targeted improvement in enhancing palliative care for patients with PAH exist, especially enhancing collaboration between PAH physicians and palliative care specialists and navigating barriers in health systems.
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Affiliation(s)
- Crystal E Brown
- Division of Pulmonary, Critical Care, and Sleep Medicine (C.E.B., J.M.S., P.J.L., J.R.C., R.A.E.), University of Washington Seattle, WA, USA; Cambia Palliative Care Center of Excellence at UW Medicine (C.E.B., J.M.S., J.R.C., R.A.E.), Seattle, WA, USA; Department of Bioethics and Humanities (C.E.B.), University of Washington, Seattle, WA, USA.
| | - Jill M Steiner
- Cambia Palliative Care Center of Excellence at UW Medicine (C.E.B., J.M.S., J.R.C., R.A.E.), Seattle, WA, USA; Division of Cardiology (C.E.B., J.M.S., P.J.L., J.R.C., R.A.E.), University of Washington, Seattle, WA, USA
| | - Peter J Leary
- Division of Pulmonary, Critical Care, and Sleep Medicine (C.E.B., J.M.S., P.J.L., J.R.C., R.A.E.), University of Washington Seattle, WA, USA; Department of Epidemiology (P.J.L.), University of Washington, Seattle, WA, USA
| | - J Randall Curtis
- Division of Pulmonary, Critical Care, and Sleep Medicine (C.E.B., J.M.S., P.J.L., J.R.C., R.A.E.), University of Washington Seattle, WA, USA; Cambia Palliative Care Center of Excellence at UW Medicine (C.E.B., J.M.S., J.R.C., R.A.E.), Seattle, WA, USA
| | - Ruth A Engelberg
- Division of Pulmonary, Critical Care, and Sleep Medicine (C.E.B., J.M.S., P.J.L., J.R.C., R.A.E.), University of Washington Seattle, WA, USA; Cambia Palliative Care Center of Excellence at UW Medicine (C.E.B., J.M.S., J.R.C., R.A.E.), Seattle, WA, USA
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