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Best Practices from the UPMC Expert Team: A Holistic Approach to the Patient with IPF

Pulmonary Disease
Credits:
1.25 AMA PRA Category 1 Credit(s) ™
Launch Date:
August 02, 2018
Expiration Date:
The accreditation for this activity has expired.

Primary Audience:

ILD center core care teams; including pulmonologists; clinic coordinators; social workers; nurse specialists; respiratory therapists; and research coordinators

Relevant Terms:

Idiopathic pulmonary fibrosis; palliative care; symptom management; supportive care

Kathleen O. Lindell, PhD, RN

Kathleen O. Lindell, PhD, RN
Associate Professor of Medicine
Clinical Nurse Specialist
Dorothy P. and Richard P. Simmons Center for Interstitial Lung Disease
University of Pittsburgh Medical Center
Pittsburgh, PA

Kathleen O. Lindell, PhD, RN, is Associate Professor of Medicine and a Clinical Nurse Specialist at the Dorothy P. and Richard P. Simmons Center for Interstitial Lung Disease at the University of Pittsburgh Medical Center. Dr Lindell earned a BSN, an MSN in Pulmonary Nursing, and a PhD in Nursing at the University of Pittsburgh School of Nursing. 
 
Earlier in her career, she worked at the Penn Lung Center at the University of Pennsylvania Medical Center where she participated in developing evidence-based programs to reduce hospitalizations for patients with asthma and to incorporate transfer of care for young adults with cystic fibrosis to an adult CF center. She also developed and coordinated the PENN Quit Smoking Program, which became the tobacco cessation program for the University of Pennsylvania Health System. From 2001-2012, she served as Clinical Nurse Specialist and Nurse Manager of the Simmons Center at the University of Pittsburgh Medical Center.
 
Her research is directed toward improving the quality of life for patients with advanced lung disease, specifically idiopathic pulmonary fibrosis, and their family caregivers. Her research focus developed from her experience working to improve support available to patients with IPF and their caregivers, assuring patients and caregivers were aware of the most recent education available, and engaging in advocacy to increase awareness of this disease. Her research has provided seminal findings about the need for earlier provision of palliative care and earlier initiation of discussion about end-of-life planning for patients with IPF.

Jared Chiarchiaro, MD, MS

Jared Chiarchiaro, MD, MS
Assistant Professor of Medicine
Division of Pulmonary, Allergy, and Critical Care Medicine
University of Pittsburgh
Pittsburgh, PA

Jared Chiarchiaro, MD, MS, is Assistant Professor of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine at the University of Pittsburgh. Dr. Chiarchiaro is a medical educator with a special focus on teaching high-stakes communication skills. Through high-fidelity simulation utilizing highly skilled medical actors, he helps physicians develop and practice crucial skills to navigate difficult conversations with patients and their families about end-of-life care and advance care planning. His clinical focus is in interstitial lung disease.

Dr. Chiarchiaro received his medical degree with honors from the University of Texas Medical Branch and completed his internal medicine residency at Duke University. He completed his Pulmonary and Critical Care Fellowship and earned an MS in Clinical Research at the University of Pittsburgh.

Kevin F. Gibson, MD

Kevin F. Gibson, MD
Professor of Medicine
Medical Director
Dorothy P. and Richard P. Simmons Center for Interstitial Lung Disease
University of Pittsburgh Medical Center
Pittsburgh, PA

Kevin F. Gibson, MD, is Professor of Medicine and Medical Director of the Dorothy P. and Richard P. Simmons Center for Interstitial Lung Disease at the University of Pittsburgh Medical Center. He is responsible for all clinical research in the center and is the principal investigator on several pharmaceutical trials of novel therapeutics. His research interests focus on interstitial lung diseases, including idiopathic pulmonary fibrosis, autoimmune lung disease, and sarcoidosis, and on translational studies to identify unique biomarkers of disease activity in idiopathic pulmonary fibrosis and other interstitial lung diseases. He is also engaged in studies of gene expression profiling in lung and peripheral blood in idiopathic pulmonary fibrosis.
 
Dr Gibson earned his medical degree at the New Jersey Medical School at Rutgers University. He completed an internship and residency at Emory University and had fellowships in clinical research and in pulmonary and critical care at the University of Pittsburgh School of Medicine.
 

Deborah Gillman, PhD

Deborah Gillman, PhD
Clinical Psychologist
Comprehensive Lung Center
UPMC Presbyterian
Pittsburgh, PA

Dr. Deborah Gillman is a clinical psychologist practicing at the outpatient Comprehensive Lung Center at UPMC Presbyterian since 2010. There, she established a mental health treatment service for patients with chronic and severe respiratory health issues and their caregivers. She employs a range of psychotherapeutic modalities to address aspects of diagnosis, living with illness, and end-of-life concerns. She has advanced training in cognitive behavioral therapy for insomnia, and behavioral sleep treatment is an additional focus of her practice.
 
Dr. Gillman has a PhD in clinical psychology from the City University of New York. She trained as both an intern and fellow at St. Luke's-Roosevelt Hospital Center in New York. She has also worked in the field of addiction treatment at the Center for Motivation and Change which specializes in evidence-based therapies for addictive and compulsive disorders.
 

Daniel J. Kass, MD

Daniel J. Kass, MD
Associate Professor of Medicine
Director 
Dorothy P. and Richard P. Simmons Center for Interstitial Lung Disease
University of Pittsburgh Medical Center
Pittsburgh, PA

Daniel J. Kass, MD, is Associate Professor of Medicine and Director of the Dorothy P. and Richard P. Simmons Center for Interstitial Lung Disease at the University of Pittsburgh Medical Center. His research focuses on idiopathic pulmonary fibrosis, a disease characterized by the unremitting accumulation of fibroblasts. Dr Kass and his lab have discovered that the receptor for the hormone relaxin, RXFP1, is decreased in IPF. IPF patients with the lowest expression of RXFP1 have the most compromised pulmonary function and may be relatively insensitive to the anti-fibrotic effects of relaxin-based therapies. Dr Kass has also focused on the role of fibroblasts as regulators of the degree and extent of inflammation in the lung, particularly on the role of twist1, a transcription factor with enriched expression in IPF.
 
Dr Kass earned his medical degree at New York University School of Medicine and did a residency in medicine and a fellowship in pulmonary and critical care at Columbia University Medical Center.
 

Laura Tycon Moreines, MSN, CRNP

Laura Tycon Moreines, MSN, CRNP
Nurse Practitioner
University of Pittsburgh Medical Center
Pittsburgh, PA

Laura Tycon Moreines, MSN, CRNP, was until recently a nurse practitioner at the University of Pittsburgh Medical Center (UPMC Presbyterian). She ran an outpatient palliative care clinic for patients with advanced cardiopulmonary disease. In this role she offered patients support, symptom management, and early advanced care planning sessions. She is now with the Geriatrics Department at Yale New Haven Hospital.
 
Ms. Moreines holds a BSN in nursing from Case Western Reserve University and her MSN from the University of Pennsylvania where she minored in palliative care. She has a special interest in patients who are pre-lung/heart transplant and has been researching models on how to best integrate palliative care into nonmalignant disease processes such as heart failure, cystic fibrosis, idiopathic pulmonary fibrosis and pulmonary hypertension. Mrs. Moreines presented at AAHPM/HPNA Annual Assembly in 2017 about the transition to practice for new Advanced Practice Registered Nurses.
 

Melissa M. Priore, RN

Melissa M. Priore, RN
Outpatient Nurse Coordinator
Dorothy P. and Richard P. Simmons Center for Interstitial Lung Disease
University of Pittsburgh Medical Center
Pittsburgh, PA

Melissa M. Priore, RN, currently specializes in interstitial lung disease. She has been the outpatient nurse coordinator at the Dorothy P. and Richard P. Simmons Center for Interstitial Lung Disease since 2015. Before that, she worked with inpatients on a medical surgical cardiopulmonary unit for 14 years, specializing primarily in cystic fibrosis. She earned an Associate in Science Nursing degree at the Community College of Allegheny County.


 
 
1. Recognize the barriers that prevent the timely and effective use of palliative care for patients with long-term progressive diseases, such as IPF.
2. Develop strategies for early communication and implementation of an effective plan for supportive care.

Program overview
Idiopathic pulmonary fibrosis is a life-threatening disease characterized by the accumulation of fibroblasts which deposit extracellular matrix, causing progressive scarring of the alveolar parenchyma and eventual respiratory failure and death. The median survival is about 3 years from diagnosis. Although treatment can slow disease progression, there is no cure.
 
Patients with IPF can benefit from palliative care. Palliative care refers to any supportive care outside of direct disease treatment. In the case of IPF, it includes symptom management, oxygen supplementation, pulmonary rehabilitation, and psychosocial treatment, as well as advance care planning. Many patients, however, associate the term palliative care with end-of-life care and refuse it. Many clinicians do not offer it to their patients or they do not offer it until patients are near the end of life. Studies show that many patients with IPF are not receiving palliative care and, as a result, are experiencing a decreased quality of life. Clinicians should assess patient symptoms soon after diagnosis and provide the continuing supportive care their patients need.
 
In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine and Global Academy for Medical Education.  Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
 
Physician Continuing Medical Education
The Postgraduate Institute for Medicine designates this enduring material for a maximum of 1.25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
 
Continuing Nursing Education
The maximum number of hours awarded for this Continuing Nursing Education activity is 1.2 contact hours.
 
Interprofessional Continuing Education
This activity was planned by and for the healthcare team, and learners will receive 1.25 Interprofessional Continuing Education (IPCE) credit for learning and change.
 
Term of Offering
This activity was released on July 31, 2018 and is valid for one year. Requests for credit must be made no later than July 31, 2019.
  
Instructions for Obtaining Credit
In order to receive credit, participants must complete the online evaluation and post-test at the end of this program. Participants must also score at least a 70% on the post-test. Statements of credit will be issued upon completion of the evaluation and post-test. 

Fee Information & Refund/Cancellation Policy
There is no fee for this educational activity.
 
Disclosure Declarations
Postgraduate Institute for Medicine (PIM) requires instructors, planners, managers and other individuals and their spouse/life partner who are in a position to control the content of this activity to disclose any real or apparent conflict of interest they may have as related to the content of this activity. All identified conflicts of interest are thoroughly vetted and resolved according to PIM policy. PIM is committed to providing its learners with high-quality CME/CE activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of a commercial interest.
  
The faculty reported the following financial relationships or relationships to products or devices they or their spouse/life partner have with commercial interests related to the content of this CME activity:
 
Name of Faculty or Presenter
Reported Financial Relationship
Jared Chiarchiaro, MD
Has nothing to disclose.
Kevin Gibson, MD
Consultant: Bayer Pharmaceuticals
Deborah Gillman, PhD
Spouse, Consultant: Sanofi Regeneron Pharmaceuticals
Daniel Kass, MD
Consultant: Sanofi Regeneron Pharmaceuticals
Kathleen O. Lindell,PhD, RN
Has nothing to disclose.
Melissa Priore, RN
Has nothing to disclose.
Laura Moreines, MSN, CRNP
Has nothing to disclose.
 
The planners and managers reported the following financial relationships or relationships to products or devices they or their spouse/life partner have with commercial interests related to the content of this CME/CE activity:
 
Name of Planner or Manager
Reported Financial Relationship
Global Academy for Medical Education, LLC planners and managers
Nothing to disclose
 
The Postgraduate Institute for Medicine planners and managers
Nothing to disclose.
 
Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the US Food and Drug Administration. The planners of this activity do not recommend the use of any agent outside of the labeled indications. 
 
The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of any organization associated with this activity. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
 
Disclaimer
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed in this activity should not be used by clinicians without evaluation of patient conditions and possible contraindications on dangers in use, review of any applicable manufacturer's product information, and comparison with recommendations of other authorities.

Commercial Support Statement
This activity is supported by an independent educational grant from Boehringer Ingelheim Pharmaceuticals, Inc.
 
Contact Information
The Postgraduate Institute for Medicine can be accessed at at www.pimed.com.
 
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