Lung transplant referral practice patterns: a survey of cystic fibrosis physicians and general pulmonologists
Abstract Background Many individuals with cystic fibrosis (CF) die from respiratory failure without referral for lung transplant. Physician practices that may expedite, delay, or preclude referral, are poorly understood. Methods Two parallel, web-based surveys focusing on lung transplant referral tr...
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doaj-49bdb292fdce485abdd30764bd38a7602020-11-25T02:25:00ZengBMCBMC Pulmonary Medicine1471-24662020-03-012011910.1186/s12890-020-1067-4Lung transplant referral practice patterns: a survey of cystic fibrosis physicians and general pulmonologistsBethany L. Bartley0Carolyn E. Schwartz1Roland B. Stark2Anna M. Georgiopoulos3Deborah Friedman4Christopher J. Richards5Henry L. Dorkin6T. Bernard Kinane7Isabel P. Neuringer8Lael M. Yonker9Department of Pediatrics, Division of Pulmonology, Massachusetts General HospitalDepartment of Pediatrics, Division of Pulmonology, Massachusetts General HospitalDeltaQuest Foundation, Inc.Department of Psychiatry, Massachusetts General HospitalDepartment of Psychiatry, Massachusetts General HospitalDepartment of Medicine, Division of Pulmonology, Massachusetts General HospitalDepartment of Pediatrics, Division of Pulmonology, Boston Children’s HospitalDepartment of Pediatrics, Division of Pulmonology, Massachusetts General HospitalDepartment of Medicine, Division of Pulmonology, Massachusetts General HospitalDepartment of Pediatrics, Division of Pulmonology, Massachusetts General HospitalAbstract Background Many individuals with cystic fibrosis (CF) die from respiratory failure without referral for lung transplant. Physician practices that may expedite, delay, or preclude referral, are poorly understood. Methods Two parallel, web-based surveys focusing on lung transplant referral triggers and barriers, as well as pre-referral evaluation, were emailed to pulmonologists practicing in the New England region. One questionnaire was sent to CF providers (n = 61), and the second to general pulmonary providers practicing at the same institutions (n = 61). Results There were 43 (70%) responses to the CF provider survey, and 25 (41%) responses to the general pulmonary (‘non-CF’) provider survey. Primary reasons for CF providers to refer their patients included: rapidly declining lung function (91%) and a forced expiratory volume in 1 s (FEV1) below 30% predicted (74%). The greatest barriers to referral for both CF and non-CF providers included active tobacco use (65 and 96%, respectively, would not refer), and active alcohol or other substance use or dependence (63 and 80%). Furthermore, up to 42% of CF providers would potentially delay their referral if triple-combination therapy or other promising new, disease-specific therapy were anticipated. In general, non-CF providers perform a more robust pre-referral medical work-up, while CF providers complete a psychosocial evaluation in higher numbers. Across both groups, communication with lung transplant programs was reported to be inadequate. Conclusions Physician-level barriers to timely lung transplant referral exist and need to be addressed. Enhanced communication between lung transplant programs and pulmonary providers may reduce these barriers.http://link.springer.com/article/10.1186/s12890-020-1067-4Cystic fibrosisLung transplantationReferralPhysician survey |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Bethany L. Bartley Carolyn E. Schwartz Roland B. Stark Anna M. Georgiopoulos Deborah Friedman Christopher J. Richards Henry L. Dorkin T. Bernard Kinane Isabel P. Neuringer Lael M. Yonker |
spellingShingle |
Bethany L. Bartley Carolyn E. Schwartz Roland B. Stark Anna M. Georgiopoulos Deborah Friedman Christopher J. Richards Henry L. Dorkin T. Bernard Kinane Isabel P. Neuringer Lael M. Yonker Lung transplant referral practice patterns: a survey of cystic fibrosis physicians and general pulmonologists BMC Pulmonary Medicine Cystic fibrosis Lung transplantation Referral Physician survey |
author_facet |
Bethany L. Bartley Carolyn E. Schwartz Roland B. Stark Anna M. Georgiopoulos Deborah Friedman Christopher J. Richards Henry L. Dorkin T. Bernard Kinane Isabel P. Neuringer Lael M. Yonker |
author_sort |
Bethany L. Bartley |
title |
Lung transplant referral practice patterns: a survey of cystic fibrosis physicians and general pulmonologists |
title_short |
Lung transplant referral practice patterns: a survey of cystic fibrosis physicians and general pulmonologists |
title_full |
Lung transplant referral practice patterns: a survey of cystic fibrosis physicians and general pulmonologists |
title_fullStr |
Lung transplant referral practice patterns: a survey of cystic fibrosis physicians and general pulmonologists |
title_full_unstemmed |
Lung transplant referral practice patterns: a survey of cystic fibrosis physicians and general pulmonologists |
title_sort |
lung transplant referral practice patterns: a survey of cystic fibrosis physicians and general pulmonologists |
publisher |
BMC |
series |
BMC Pulmonary Medicine |
issn |
1471-2466 |
publishDate |
2020-03-01 |
description |
Abstract Background Many individuals with cystic fibrosis (CF) die from respiratory failure without referral for lung transplant. Physician practices that may expedite, delay, or preclude referral, are poorly understood. Methods Two parallel, web-based surveys focusing on lung transplant referral triggers and barriers, as well as pre-referral evaluation, were emailed to pulmonologists practicing in the New England region. One questionnaire was sent to CF providers (n = 61), and the second to general pulmonary providers practicing at the same institutions (n = 61). Results There were 43 (70%) responses to the CF provider survey, and 25 (41%) responses to the general pulmonary (‘non-CF’) provider survey. Primary reasons for CF providers to refer their patients included: rapidly declining lung function (91%) and a forced expiratory volume in 1 s (FEV1) below 30% predicted (74%). The greatest barriers to referral for both CF and non-CF providers included active tobacco use (65 and 96%, respectively, would not refer), and active alcohol or other substance use or dependence (63 and 80%). Furthermore, up to 42% of CF providers would potentially delay their referral if triple-combination therapy or other promising new, disease-specific therapy were anticipated. In general, non-CF providers perform a more robust pre-referral medical work-up, while CF providers complete a psychosocial evaluation in higher numbers. Across both groups, communication with lung transplant programs was reported to be inadequate. Conclusions Physician-level barriers to timely lung transplant referral exist and need to be addressed. Enhanced communication between lung transplant programs and pulmonary providers may reduce these barriers. |
topic |
Cystic fibrosis Lung transplantation Referral Physician survey |
url |
http://link.springer.com/article/10.1186/s12890-020-1067-4 |
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