Impact of end-of-life respiratory modalities on quality of dying and death and symptom relief in patients with interstitial lung disease: a multicenter descriptive cross-sectional study

doi:10.21203/rs.3.rs-885694/v1

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Impact of end-of-life respiratory modalities on quality of dying and death and symptom relief in patients with interstitial lung disease: a multicenter descriptive cross-sectional study

https://doi.org/10.21203/rs.3.rs-885694/v1

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published 04 Apr, 2022

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Background: Respiratory modalities that applied at end of life may affect burden of distressing symptoms and quality of dying and death (QODD) among patients with end-stage interstitial lung disease (ILD); however, there have been few studies into respiratory modalities applied to these patients near death. We hypothesized that high-flow nasal cannula (HFNC) may contribute to improved QODD and symptom relief in patients with end-stage ILD.

Objectives: This multicenter study examined the proportion of end-of-life respiratory modalities in a real-world setting and explored its impact on QODD and symptom relief among patients dying with ILD.

Methods: Consecutive patients with ILD who died in four participating institutions in Japan from 2015 to 2019 were identified and divided into four groups according to end-of-life respiratory modality: conventional oxygen therapy (COT), HFNC, non-invasive ventilation (NIV), and invasive mechanical ventilation (IMV). In addition, a mail survey was performed to quantify the QODD and symptom relief at their end of life from a bereaved family’s perspective. QODD and symptom relief were quantified using the Good Death Inventory (GDI) for patients with a completed bereavement survey. The impact of end-of-life respiratory modalities on QODD and symptom relief was measured by multivariable linear regression using COT as a reference.

Results: Among 177 patients analyzed for end-of-life respiratory modalities, 80 had a completed bereavement survey. The most common end-of-life respiratory modality was HFNC (n=76, 42.9%), followed by COT (n=62, 35.0%), NIV (n=27, 15.3%), and IMV (n=12, 6.8%). Regarding the place of death, 98.7% of patients treated with HFNC died outside the intensive care unit. Multivariable regression analyses revealed patients treated with HFNC had a higher GDI score for QODD [partial regression coefficient (B)=0.46, 95% CI: 0.07–0.86] and domain score related to symptom relief (B=1.37, 95% CI: 0.54–2.20) than those treated with COT.

Conclusion: HFNC was commonly used in patients with end-stage ILD in real-world setting and was associated with higher QODD and better symptom relief. HNFC may contribute to improved QODD and symptom relief in these patients.

Internal Medicine

General Practice

Nursing

Quality of life

Pulmonary fibrosis

Interstitial Lung Disease

Interstitial lung diseases (ILDs), including idiopathic pulmonary fibrosis (IPF), are progressive, incurable diseases with poor prognosis [1, 2]. They are associated with distressing symptoms such as dyspnea, intractable cough, and fatigue that limit activity and impair quality of life (QOL). Patients with ILD suffer from severe dyspnea, which is more common and serious at the end of life [3–5]. Breathing comfort is a high end-of-life priority for terminally ill patients [6] and the management of dyspnea is a serious unmet need in palliative care for ILD patients.

The choice of end-of-life respiratory modalities [7–9], which may affect the quality of dying and death (QODD) of patients with ILD, is important to address dyspnea and the other symptoms at the end of life. Options include conventional oxygen therapy (COT), high-flow nasal cannula (HFNC), non-invasive ventilation (NIV), and invasive mechanical ventilation (IMV). Non-invasive respiratory support, such as HFNC and NIV, are increasingly used in end-of-life settings for terminally ill patients due to their comfort and the availability of oxygen. In particular, HFNC has attracted increasing attention in recent years in palliative settings [10, 11]. However, there have been few studies on end-of-life respiratory modalities applied to terminally ill ILD patients in clinical practice, and its impact on QODD and symptom relief is not fully understood.

The present multicenter descriptive cross-sectional study examined the proportion of end-of-life respiratory modalities applied to patients with end-stage ILD in real-world practice and assessed its impact on QODD and symptom relief from the perspective of the bereaved family.

Settings and procedures

A secondary analysis was conducted using data from a multicenter observational study including clinical and QODD data from patients dying with ILD and lung cancer [5]. This multicenter study was conducted at four major acute general hospitals in the western part of the Shizuoka Prefecture, Japan: Hamamatsu University Hospital, Seirei Mikatahara Hospital, Seirei Hamamatsu Hospital, and Iwata City Hospital. The inclusion criteria of this secondary analysis were patients with fibrotic ILD who died in the participating institutes from October 2015 to March 2019, age > 20 years, and patients with family members aged > 20 years. Exclusion criteria were family members who lacked the capacity to complete the questionnaire (due to dementia, cognitive failure, psychiatric illness, language difficulty, or vision loss) and family members who had severe emotional distress, as determined by their primarily responsible physician.

The medical records of the consecutive patients were reviewed and information on baseline characteristics and medical interventions was collected. A cross-sectional bereavement survey was performed via mail to quantify the QODD from the bereaved family’s perspective between October and November 2019. The bereavement survey measurements were linked to the same patient’s information obtained from the medical records. This study was approved by the ethics board of Hamamatsu University School of Medicine and all participating institutions.

End-of-life respiratory modalities

The primary exposure of this secondary analysis was end-of-life respiratory modalities received by patients who died of ILD. The respiratory interface applied to patients at the time of death was defined as end-of-life respiratory modalities. Clinical data on respiratory modalities were obtained from the medical records by one of the investigators and patients were divided according to respiratory modality into four groups: HFNC, COT, NIV, and IMV.

Qodd

The outcome of interest was QODD, as rated using the Good Death Inventory (GDI), which is a validated and reliable tool for measuring QODD from the perspective of the bereaved family [12–14]. It was developed based on qualitative interviews and a quantitative study of bereaved family members of deceased patients with cancer and consists of 18 domains, including 10 core and eight optional domains. “Physical and psychological comfort” domain (related to symptom relief) is one of the core domains that consists of three questions: “Patient was free from pain,” “Patient was free from physical distress,” and “Patient was free from emotional distress.” Bereaved family members were asked to rate the patient’s QODD in their final place of care using a seven-point Likert-type scale. Higher values indicated higher QODD.

Statistical analysis

We first determined the proportion of end-of-life respiratory modalities among patients dying with ILD. The patients’ characteristics and medical interventions between each respiratory modality group were compared. Fisher’s exact test was used for categorical variables and one-way analysis of variance was used for quantitative variables. Summary statistics were calculated as numbers (with percentages), medians [with interquartile ranges (IQRs)], and means [with standard deviations (SDs)] as appropriate.

The impact of HFNC, NIV, and IMV (using COT as the reference group) on the outcome (i.e., GDI score for QODD) was calculated using univariable and multivariable linear regression analysis in patients with ILD whose bereaved families completed the questionnaire. COT was selected as the reference group as it has been widely prescribed for respiratory management of terminally ill patients for decades [15, 16], and we expected that this comparison would provide clinically interpretable insight. The primary outcome was calculated as the average score of 18 domains of the GDI and the secondary outcome was calculated as the score of “physical and psychological comfort” domain related to symptom relief. The choice of secondary outcome was based on the empirical finding that non-invasive respiratory support, such as HFNC and NIV, improved dyspnea in terminally ill patients and increased comfort [17, 18]. We expected that these respiratory modalities would have a beneficial impact on symptom relief. The following variables were selected as potential confounders based on findings from previous studies [19, 20] and the clinical perspective of the pulmonologist: patient’s age at death, patient’s sex, relationship between patient and family, cause of death (acute exacerbation or others), opioid use, and sustained sedation use.

A two-sided test was used to determine significant differences, with the significance level set at P < 0.05. All statistical analyses were performed using EZR version 1.52 (Saitama Medical Centre, Jichi Medical University, Saitama, Japan) software, which is a graphical user interface for R version 4.02 (The R Foundation for Statistical Computing, Vienna, Austria) [21].

Patients’ characteristics

A total of 177 consecutive patients died of ILD. The baseline characteristics of the patients are shown in Table 1. Patients with ILD included 137 men (77.4%) and 40 women (22.6%) with a mean age of 76 years. Overall, 92 patients (52.0%) used long-term oxygen therapy prior to final admission. ILD diagnoses included IPF (n = 78, 44.1%), idiopathic interstitial pneumonia excluding IPF (n = 58, 32.8%), interstitial pneumonia associated with connective tissue diseases (n = 36, 20.3%), chronic hypersensitivity pneumonitis (n = 3, 1.7%), and others (n = 2, 1.1%). Acute exacerbation was the most common cause of death (55.9%), followed by exacerbation of chronic respiratory failure (27.7%) and respiratory infection (8.5%). The median survival time from the time of diagnosis was 31 months (IQR, 6–61 months).

End-of-life respiratory modalities

All patients included in the study were prescribed oxygen at the end of life. The most common end-of-life respiratory modality applied to patients with ILD was HFNC (n = 76, 42.9%), followed by COT (n = 62, 35.0%), NIV (n = 27, 15.3%), and IMV (n = 12, 6.8%) (Fig. 1). The ILD patients’ characteristics and medical interventions performed during the last hospitalization showed no significant differences between the groups in terms of age, sex, and type of ILD (Table 1). The COT group had a higher percentage of patients who died due to exacerbation of chronic respiratory failure compared with the other groups. Place of death was outside the intensive care unit (ICU) in 98.7% of patients treated with HFNC and 98.4% of those treated with COT. Patients treated with HFNC and IMV were more likely to be administered opioids than those treated with NIV and COT. Furthermore, 83% of patients treated with IMV received sustained sedation, while those treated with HFNC, COT, and NIV received lower levels of sedation.

Impact of respiratory modalities on QODD and symptom relief

Among 177 patients with ILD, 80 whose bereaved families completed the questionnaire were analyzed to determine the impact of end-of-life respiratory modalities on QODD and symptom relief. The median time interval between patient death and the relatives' completion of the questionnaire was 24 months (IQR: 17–34 months). There were no significant differences in the characteristics and interventions between patients who responded to the questionnaire and those who did not (online Supplemental Table E1). The baseline characteristics of patients, medical interventions, and the characteristics of bereaved family members in QODD analysis population are shown in online Supplemental Table E2. The patient characteristics and interventions for each group in this study population were similar to those in the whole population and there were no significant differences between the groups in terms of the characteristics of the bereaved family members and time interval between patient death and the relatives' completion of the questionnaire.

The average score of 18 domains of the GDI and the scores of each domain are presented in online Supplemental Table E3, and the average score of the GDI and the “physical and psychological comfort” domain score (the main study outcome) are shown in Fig. 2. The average score of 18 domains of the GDI for QODD was the highest for HFNC group (4.58 ± 0.67), followed by the NIV (4.38 ± 0.71), COT (4.09 ± 0.96), and IMV (3.96 ± 0.75) groups (Fig. 2A). Similarly, the score of the “physical and psychological comfort” domain was the highest for the HFNC group (4.55 ± 1.43), followed by the NIV (4.19 ± 1.63), COT (3.34 ± 1.70), and IMV (3.17 ± 1.47) groups (Fig. 2B). The mean GDI and “physical and psychological comfort” domain scores in patients treated with HFNC were significantly higher than those in patients treated with COT were.

Multivariable regression analyses were performed to investigate the impact of end-of-life respiratory modalities on QODD and symptom relief (Table 2). The results revealed that the QODD (average score of the 18 GDI domains) was significantly higher in patients treated with HFNC than in those treated with COT [partial regression coefficient (B) = 0.49, 95% CI: 0.09–0.88, P = 0.02]. Additionally, the “physical and psychological comfort” domain score (related to symptom relief) was also significantly higher in patients treated with HFNC than those in patients treated with COT was (B = 1.43, 95% CI: 0.59–2.26, P = 0.001). Meanwhile, patients in the NIV and IMV groups showed no significant differences in the average score of 18 domains and the “physical and psychological comfort” domain score compared with those in the COT group.

The present multicenter study revealed that HFNC was the most commonly used end-of-life respiratory modality for patients with end-stage ILD in a real-world setting in Japan. Additionally, use of HFNC at the end of life was associated with higher bereaved family ratings of QODD and higher ratings of symptom relief than use of COT. To the best of our knowledge, this study is the first to explore the proportion of end-of-life respiratory modalities and the impact of end-of-life respiratory modalities on QODD and symptom relief in patients dying with ILD. These findings suggest that HFNC may contribute to improved QODD and symptom relief in these patients.

Fibrotic ILDs, represented by IPF, have a poor prognosis and are associated with dyspnea, cough, fatigue, anxiety, and depression. Among these symptoms, dyspnea is particularly distressing to patients with ILD [22], and high levels of dyspnea are associated with poor QOL [23]. Unfortunately, the frequency and severity of hypoxemia and dyspnea frequently increase near the end of life. Ahmadi et al. reported a higher prevalence of dyspnea in patients with oxygen-dependent ILD at the end of life, which was more refractory to treatment than that in patients with lung cancer [4]. Similarly, our multicenter observational study showed that the prevalence of very severe breathlessness was more than twofold greater in patients with ILD than patients with lung cancer (55.8% vs. 26.7%) [5]. These findings suggest that difficulties managing breathlessness and relief of dyspnea is an unmet need in the palliative care of patients with end-stage ILD. The pharmacological treatment of dyspnea is not well understood, and non-pharmacological approaches, including choice of respiratory modalities, have become a great concern [9]. Respiratory modalities at the end of life should be designed to improve patient comfort and maintain their communication abilities. An interface to provide a higher fraction of inspiratory oxygen is required to improve very severe hypoxemia in patients with end-stage ILD, and HFNC may be useful in the palliative care of patients with end-stage ILD; however, there is little evidence to support its use in this setting.

HFNC is a relatively new respiratory modality that can deliver high flow rates of 30–60 L/min of heated humidified gas at controlled oxygen concentrations via a large caliber nasal cannula [24]. HFNC is associated with lower or equivalent intubation and mortality rates than COT and NIV among patients with acute hypoxemic respiratory failure [25, 26], and the use of HFNC for these patients has been strongly recommended by a working group of the European Society of Intensive Care Medicine [27]. HFNC has several characteristics that would greatly contribute to maintaining a better QOL for patients with end-stage ILD. First, it can relieve dyspnea caused by hypoxia since it allows the administration of a high flow and high concentration of oxygen. The FLORALI study reported a significantly better rate of improvement of dyspnea in the HFNC group compared with the NIV and COT groups [17], which is consistent with the results of the present study. Second, HFNC may contribute to improved QODD by avoiding patient admission to the ICU. ICU admission near the end of life is an indicator of poor quality of care and high intensity of end-of-life treatment [28, 29]. Jackson et al. demonstrated the feasibility of using HFNC safely outside the ICU [30], and most patients treated with HFNC in this study also died outside the ICU. Third, HFNC has advantages, such as superior facial comfort, less skin breakdown, and less interference with eating and talking, over NIV and IMV. We previously reported that patients treated with HFNC had lower discontinuation and an adverse event rate and better oral intake and ability to converse until just before death compared with those treated with NIV among patients with ILD with a do-not-intubate order [31]. While some issues, such as the cost-effectiveness of use of HFNC in palliative care settings, remain to be examined, the results of the present study as well as previous studies highlight the use of HFNC as a reasonable and feasible palliative care treatment in patients with end-stage ILD.

The present study has several limitations. First, this study was conducted in a limited area of Japan. However, the participating hospitals were regarded as representative of the region as they are four of the six general hospitals with ≥ 500 beds and a respiratory department within this geographical area. Thus, we believe the findings of this study have a degree of external validity. Second, the number of patients treated with NIV or IMV was small. Studies that include a larger number of patients are required to evaluate the impact of these respiratory modalities. Third, we did not examine the sequence of respiratory management, the settings of each respiratory device, and adverse events. The association between these concerns and QODD needs to be studied in future. Fourth, the period between the patient's death and the relatives' completion of the questionnaire was longer because ILDs are relatively rare diseases. Therefore, the concern about recall bias exists. In addition, there was a selection and proxy bias in the bereavement survey; therefore, careful interpretation is required after integrating other results.

In conclusion, the present study showed that HFNC was the most commonly used end-of-life respiratory modality in patients with end-stage ILD in a real-world setting in Japan. HFNC application at the end of life was associated with higher bereaved family ratings of QODD than COT, as well as higher ratings of domain related to symptom relief. While prospective interventional studies are required to determine the optimal end-of-life respiratory modality, our findings indicate that HFNC may contribute to improved QODD and relief of distressing symptoms in patients with end-stage ILD.

QODD, quality of dying and death; QOL. Quality of life; HFNC, high-flow nasal cannula; COT, conventional oxygen therapy; NIV, non-invasive ventilation; IMV, invasive mechanical ventilation; ILD, interstitial lung disease; IPF, idiopathic pulmonary fibrosis.

Ethics approval and consent to participate

The study was approved by the ethics board of Hamamatsu University School of Medicine (approval number: 18-296), Seirei Hamamatsu Hospital (approval number: 3025), Seirei Mikatahara Hospital (approval number: 18-72) and Iwata City Hospital (approval number: 2019-001). The study procedures were carried out in accordance with the tenets of the Declaration of Helsinki.

Acknowledgement

The authors would like to thank all the participants who participated in this study. The authors would like to thank Enago (www.enago.jp) for the English language review.

Consent for publication

Not applicable.

Funding

No financial support was provided for this study.

Availability of data and materials

Participants of this study did not agree for their data to be shared publicly, so supporting data are not available.

Author contributions

T.K. Conception and design, Data collection, Data analysis and interpretation, and Manuscript writing. Y.S. Conception and design, Data analysis and interpretation, Manuscript writing, and Final approval of the manuscript, K.S., H.H., M.K., K.F., T.F., N.E., Y.N., N.I., K.Y., S.I., H.N., Data collection, and Data analysis and interpretation, T.M. Conception and design, Data analysis and interpretation, and Manuscript writing, T.S. Manuscript writing, Final approval of the manuscript and administrative support.

Competing interests: All authors declare no actual or potential conflicts of interest.

1. Raghu G, Collard HR, Egan JJ, Martinez FJ, Behr J, Brown KK, Colby T V., Cordier JF, Flaherty KR, Lasky JA, Lynch DA, Ryu JH, Swigris JJ, Wells AU, Ancochea J, Bouros D, Carvalho C, Costabel U, Ebina M, Hansell DM, Johkoh T, Kim DS, King TE, Kondoh Y, Myers J, Müller NL, Nicholson AG, Richeldi L, Selman M, Dudden RF, et al. An Official ATS/ERS/JRS/ALAT Statement: Idiopathic pulmonary fibrosis: Evidence-based guidelines for diagnosis and management. Am. J. Respir. Crit. Care Med. 2011; 183: 788–824.

2. Cottin V, Hirani NA, Hotchkin DL, Nambiar AM, Ogura T, Otaola M, Skowasch D, Park JS, Poonyagariyagorn HK, Wuyts W, Wells AU. Presentation, diagnosis and clinical course of the spectrum of progressive-fibrosing interstitial lung diseases. Eur. Respir. Rev. 2018; 27(150):180076. .

3. Kreuter M, Bendstrup E, Russell AM, Bajwah S, Lindell K, Adir Y, Brown CE, Calligaro G, Cassidy N, Corte TJ, Geissler K, Hassan AA, Johannson KA, Kairalla R, Kolb M, Kondoh Y, Quadrelli S, Swigris J, Udwadia Z, Wells A, Wijsenbeek M. Palliative care in interstitial lung disease: living well. Lancet Respir. Med. 2017; 5: 968–980.

4. Ahmadi Z, Wysham NG, Lundström S, Janson C, Currow DC, Ekström M. End-of-life care in oxygen-dependent ILD compared with lung cancer: A national population-based study. Thorax. 2016; 71: 510–516.

5. Koyauchi T, Suzuki Y, Sato K, Hozumi H, Karayama M, Furuhashi K, Fujisawa T, Enomoto N, Nakamura Y, Inui N, Yokomura K, Imokawa S, Nakamura H, Morita T, Suda T. Quality of dying and death in patients with interstitial lung disease compared with lung cancer: an observational study. Thorax. 2021; 76: 248–255.

6. Downey L, Engelberg RA, Curtis JR, Lafferty WE, Patrick DL. Shared priorities for the end-of-life period. J. Pain Symptom Manage. 2009; 37: 175–188.

7. Ben-Aharon I, Gafter-Gvili A, Paul M, Leibovici L, Stemmer SM. Interventions for alleviating cancer-related dyspnea: A systematic review. J. Clin. Oncol. 2008; 26: 2396–2404.

8. Uronis HE, Currow DC, McCrory DC, Samsa GP, Abernethy AP. Oxygen for relief of dyspnoea in mildly- or non-hypoxaemic patients with cancer: A systematic review and meta-analysis. Br. J. Cancer. 2008; 98: 294–299.

9. Davies JD. Noninvasive respiratory support at the end of life. Respir. Care. 2019; 64: 701–711.

10. Ruangsomboon O, Dorongthom T, Chakorn T, Monsomboon A, Praphruetkit N, Limsuwat C, Surabenjawong U, Riyapan S, Nakornchai T, Chaisirin W. High-Flow Nasal Cannula Versus Conventional Oxygen Therapy in Relieving Dyspnea in Emergency Palliative Patients With Do-Not-Intubate Status: A Randomized Crossover Study. Ann. Emerg. Med. 2020; 75: 615–626.

11. Hui D, Mahler DA, Larsson L, Wu J, Thomas S, Harrison CA, Hess K, Lopez-Mattei J, Thompson K, Gomez D, Jeter M, Lin S, Basen-Engquist K, Bruera E. High-Flow Nasal Cannula Therapy for Exertional Dyspnea in Patients with Cancer: A Pilot Randomized Clinical Trial. Oncologist; 2020 Dec 2. doi: 10.1002/onco.13624. Epub ahead of print.

12. Miyashita M, Sanjo M, Morita T, Hirai K, Uchitomi Y. Good death in cancer care: A nationwide quantitative study. Ann. Oncol. 2007; 18: 1090–1097.

13. Miyashita M, Morita T, Sato K, Hirai K, Shima Y, Uchitomi Y. Good Death Inventory: A Measure for Evaluating Good Death from the Bereaved Family Member’s Perspective. J. Pain Symptom Manage. 2008; 35: 486–498.

14. Hirai K, Miyashita M, Morita T, Sanjo M, Uchitomi Y. Good death in Japanese cancer care: A qualitative study. J. Pain Symptom Manage. 2006; 31: 140–147.

15. Booth S, Anderson H, Swannick M, Wade R, Kite S, Johnson M. The use of oxygen in the palliation of breathlessness. A report of the expert working group of the scientific committee of the association of palliative medicine. Respir. Med. 2004; 98: 66–77.

16. O’Driscoll BR, Howard LS, Earis J, Mak V, Bajwah S, Beasley R, Curtis K, Davison A, Dorward A, Dyer C, Evans A, Falconer L, Fitzpatrick C, Gibbs S, Hinshaw K, Howard R, Kane B, Keep J, Kelly C, Khachi H, Khan MAI, Kishen R, Mansfield L, Martin B, Moore F, Powrie D, Restrick L, Roffe C, Singer M, Soar J, et al. BTS guideline for oxygen use in adults in healthcare and emergency settings. Thorax. 2017; 72(Suppl 1): ii1–ii90.

17. Frat J-P, Thille AW, Mercat A, Girault C, Ragot S, Perbet S, Prat G, Boulain T, Morawiec E, Cottereau A, Devaquet J, Nseir S, Razazi K, Mira J-P, Argaud L, Chakarian J-C, Ricard J-D, Wittebole X, Chevalier S, Herbland A, Fartoukh M, Constantin J-M, Tonnelier J-M, Pierrot M, Mathonnet A, Béduneau G, Delétage-Métreau C, Richard J-CM, Brochard L, Robert R. High-Flow Oxygen through Nasal Cannula in Acute Hypoxemic Respiratory Failure. N. Engl. J. Med. 2015; 372: 2185–2196.

18. Nava S, Ferrer M, Esquinas A, Scala R, Groff P, Cosentini R, Guido D, Lin CH, Cuomo AM, Grassi M. Palliative use of non-invasive ventilation in end-of-life patients with solid tumours: A randomised feasibility trial. Lancet Oncol. 2013; 14: 219–227.

19. Sanjo M, Miyashita M, Morita T, Hirai K, Kawa M, Akechi T, Uchitomi Y. Preferences regarding end-of-life cancer care and associations with good-death concepts: A population-based survey in Japan. Ann. Oncol. 2007; 18: 1539–1547.

20. Miyashita M, Morita T, Sato K, Hirai K, Shima Y, Uchitomi Y. Factors contributing to evaluation of a good death from the bereaved family member’s perspective. Psychooncology. 2008; 17: 612–620.

21. Kanda Y. Investigation of the freely available easy-to-use software “EZR” for medical statistics. Bone Marrow Transplant. 2013; 48: 452–458.

22. Wijsenbeek MS, Holland AE, Swigris JJ, Renzoni EA. Comprehensive supportive care for patients with fibrosing interstitial lung disease. Am. J. Respir. Crit. Care Med. 2019; 200: 152–159.

23. Glaspole IN, Chapman SA, Cooper WA, Ellis SJ, Goh NS, Hopkins PM, Macansh S, Mahar A, Moodley YP, Paul E, Reynolds PN, Walters EH, Zappala CJ, Corte TJ. Health-related quality of life in idiopathic pulmonary fibrosis: Data from the Australian IPF Registry. Respirology. 2017; 22: 950–956.

24. Vella MA, Pascual-Lopez J, Kaplan LJ. High-Flow nasal cannula system not just another nasal cannula. JAMA Surg. 2018; 153:854–855.

25. Monro-Somerville T, Sim M, Ruddy J, Vilas M, Gillies MA. The Effect of High-Flow Nasal Cannula Oxygen Therapy on Mortality and Intubation Rate in Acute Respiratory Failure: A Systematic Review and Meta-Analysis. Crit. Care Med. 2017; 45: e449–e456.

26. Lee CC, Mankodi D, Shaharyar S, Ravindranathan S, Danckers M, Herscovici P, Moor M, Ferrer G. High flow nasal cannula versus conventional oxygen therapy and non-invasive ventilation in adults with acute hypoxemic respiratory failure: A systematic review. Respir. Med. 2016; 121: 100–108.

27. Rochwerg B, Einav S, Chaudhuri D, Mancebo J, Mauri T, Helviz Y, Goligher EC, Jaber S, Ricard JD, Rittayamai N. The role for high flow nasal cannula as a respiratory support strategy in adults : a clinical practice guideline. Intensive Care Med. 2020; 46: 2226–2237.

28. Earle CC, Park ER, Lai B, Weeks JC, Ayanian JZ, Block S. Identifying potential indicators of the quality of end-of-life cancer care from administrative data. J. Clin. Oncol. 2003; 21: 1133–1138.

29. Barnato AE, Farrell MH, Chang C-CH, Lave JR, Roberts MS, Angus DC. Development and validation of hospital “end-of-life” treatment intensity measures. Med. Care. 2009; 47: 1098–1105.

30. Jackson JA, Spilman SK, Kingery LK, Oetting TW, Taylor MJ, Pruett WM, Omerza CR, Branick KA, Ganapathiraju I, Hamilton MY, Nerland DA, Taber PS, McCann DA, Pelaez CA, Trump MW. Implementation of High-Flow Nasal Cannula Therapy Outside the Intensive Care Setting. Respir. Care. 2021; 66: 357–365.

31. Koyauchi T, Hasegawa H, Kanata K, Kakutani T, Amano Y, Ozawa Y, Matsui T, Yokomura K, Suda T. Efficacy and Tolerability of High-Flow Nasal Cannula Oxygen Therapy for Hypoxemic Respiratory Failure in Patients with Interstitial Lung Disease with Do-Not-Intubate Orders: A Retrospective Single-Center Study. Respiration. 2018; 96: 323–329.

Table 1. Patients’ characteristics and medical interventions at end of life

Categorical variables were expressed as numbers (percentage). Quantitative variables were expressed as mean (SD). Fisher's exact test was used to analyze categorical variables, and one-way analysis of variance was used to analyze quantitative variables.

HFNC, high-flow nasal cannula; COT, conventional oxygen therapy; NIV, non-invasive ventilation; IMV, invasive mechanical ventilation; LTOT, long-term oxygen therapy; IPF, idiopathic pulmonary fibrosis; Non-IPF IIP, idiopathic interstitial pneumonia excluding idiopathic pulmonary fibrosis; CTD-IP, connective tissue disease-related interstitial pneumonia; CHP, chronic hypersensitivity pneumonitis; ICU, intensive care unit; SD, standard deviation.

Table 2. Results of multivariate regression analyses of scores of the Good death inventory for quality of dying and death for ILD patients treated with HFNC, NIV, or IMV, compared with those with COT (reference group)

The scores of GDI for QODD for patients treated with HFNC, NIV, or IMV were tested using a multivariate linear regression model with those treated with COT as the reference group. All models were adjusted for the patient’s age at death, patient’s sex, the relationship between the patient and the family, cause of death (i.e., acute exacerbation or others), opioid use, and sustained sedation use.

B, partial regression coefficient; GDI, Good death inventory; HFNC, high-flow nasal cannula; COT, conventional oxygen therapy; NIV, non-invasive ventilation; IMV, invasive mechanical ventilation.

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Impact of end-of-life respiratory modalities on quality of dying and death and symptom relief in patients with interstitial lung disease: a multicenter descriptive cross-sectional study

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Introduction

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End-of-life respiratory modalities

Qodd

Statistical analysis

Results

Patients’ characteristics

End-of-life respiratory modalities

Impact of respiratory modalities on QODD and symptom relief

Discussion

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