Patients Through Decisions in IPF: The Respiratory …This activity was intended for respiratory therapists and other clinicians involved in the management of patients with IPF. Release/Expiration:

Guiding Patients Through Decisions in IPF: The Respiratory Therapists’ Role

Highlights from AARC Congress 2016 Symposium

Final Outcomes Report

Boehringer Ingelheim Grant ID: ME201621300

This activity is supported by an independent educational grant from Boehringer Ingelheim Pharmaceuticals, Inc.

Program Information

Overview: This enduring webcast shared highlights from a live presentation at AARC Congress 2016, which took place in San Antonio, TX on October 16th, 2016. Joyce Lee, MD and Trina Limberg, RRT, discussed the spectrum of IPF, changing treatment paradigms for IPF patients and how respiratory therapists can better assist IPF patients and their caregivers.

Intended Audience:This activity was intended for respiratory therapists and other clinicians involved in the management of patients with IPF.

Release/Expiration: January 1, 2017 – December 31, 2017

Credit: 1.0 hours of Continuing Respiratory Care Education (CRCE)Course number: 147782000

Sponsored By: The Academy for Continued Healthcare Learning

Funding: Supported by an educational grant from Boehringer Ingelheim Pharmaceuticals, Inc.

Executive Summary

Impact1,798 Learners (500 Guaranteed – guarantee exceeded)

888 Certificates

Profession1,762 Respiratory Therapists!

Target Audience reached!

Icon made by FreePik from www.flaticon.com

Patient ImpactBetween 1,424 – 4,531 IPF patients will be impacted per month

Executive Summary

SatisfactionAll faculty were very highly rated with an average rating of 3.81/4

Learning Objectives98% of participants agree or strongly agree that they are better able

to meet the learning objectives after completing the activity


Impact• 72% of learners will change their practice based on this activity, of those

• 41% will incorporate disease‐specific education in their clinical practice

• 44% will include family and caregivers in their care plan for patients with IPF

• 85% average increase in learners’ knowledge related to the use of HRCT in making a diagnosis and components of comprehensive case plansincluding therapy and supportive care.

Executive Summary

Strategies for educating and counseling IPF patients on their care plans

Information on available therapies, including benefits and potential side

effects, to educate IPF patients and their caregivers

The role and benefits of pulmonary rehabilitation in the care of IPF patients

Future Educational Opportunities


Faculty

Joyce Lee, MD, MASAssistant ProfessorPulmonary/Critical CareUniversity of Colorado DenverAurora, CO

Trina Limberg, BS, RRT, FAARC, MAACVPRDirector, Pulmonary Rehabilitation ServicesUC San Diego Health SystemSan Diego, CA

Level 1: Participation

Total Participants Certificates Awarded

1798 888

98%

1% 1%

Clinician Type

Respiratory Therapists

Other

No response

Compared with the live symposium, there were more RT learners in the enduring activity (98% vs. 85%). This difference in learners may account for differences in baseline knowledge between the two

activities as noted in this report.

Level 2: Learning Objectives

Please indicate if the following learning objectives were achieved:• Outline the prevalence, signs and symptoms, and diagnostic criteria for IPF• Compare and contrast available therapies for IPF• Formulate strategies for comprehensive management of symptoms• Effectively counsel IPF patients on available therapies and supportive care• Identify patients with IPF who may benefit from intensification of therapy

N=888

70%

28%

2% 0%0%

20%

40%

60%

80%

StronglyAgree

Agree Neutral Disagree StronglyDisagree

98% of learners strongly agree or agree that all learning objectives were met.

Level 2: Faculty

79%

20%

1%

80%

19%

1%0%

20%

40%

60%

80%

100%

Excellent Good Fair Poor

Joyce Lee Trina Limberg

Both faculty were highly rated across all areas, with an average rating of 3.81/4.

N=888

84%

16%

83%

17%

0%0%

20%

40%

60%

80%

100%

Excellent Good Fair Poor

Please rate each faculty member on their expertise on the subject matter:

Joyce Lee Trina Limberg

Please rate each faculty member on their ability to effectively convey the subject matter:

Level 2: Objectivity & Bias

73%

24%

3%0%

20%

40%

60%

80%

100%

StronglyAgree

Agree Neutral Disagree StronglyDisagree

Activity was perceived as objective, balanced, and non‐biased.

N=888

The content of this course was presented without bias of any commercial product or drug.

Question Topic Pre Post % Change

1 Diagnosis 57% 87% 53%

2 Application of Therapies 37% 68% 84%

3 Symptom Management 19% 47% 147%

4 Pulmonary Rehabilitation 19% 42% 121%

Level 3‐4: Pretest vs. Posttest

Overview of correct responses:

Average pre and post test scores were 33% and 61%, respectively, demonstrating an increase in learners’ knowledge regarding the diagnosis of IPF and comprehensive care plans including therapy and supportive care. Baseline knowledge in the enduring activity was slightly lower than the live

symposium with greater improvements observed.

101%


1. DG, a 67‐year old man, who has a history of heavy smoking, presents with complaints of shortness of breath and a dry cough for 6 months’ duration with increasing severity. In addition to a thorough medical history, what test should be ordered to differentiate IPF from other interstitial lung diseases?

A. Surgical lung biopsyB. Chest x‐rayC. High‐resolution computed tomographyD. Thoracoscopy

Learner knowledge of testing for IPF increased from 57% to 87% after participating in the activity, indicating that RTs have an increased understanding of the tools used when making a differential

diagnosis of IPF.

14%26%

57%

3%7% 5%

87%

1%0%

25%

50%

75%

100%

A B C D

Pre (N=1748) Post (N=844)


2. Which of the following is a difference between nintedanib and pirfenidone?

A. Dosing frequencyB. Route of administrationC. Effectiveness on forced vital capacityD. Guideline recommendation for use

As a result of their participation, learners demonstrated increased awareness regarding the difference in dosage frequency among the two available therapies. However, additional education may be warranted to ensure that RTs can accurately counsel patients and respond to questions related to therapy. The baseline knowledge on this question was lower in enduring participants compared with participants in the live

meeting.

37%22% 17% 24%

68%

5%16%

11%

0%

25%

50%

75%

100%

A B C D

Pre (N=1735) Post (N=876)


3. SJ, a 71‐year old man, has elected to initiate therapy with one of the approved agents. SJ asks whether therapy will improve his cough. How would you counsel SJ on available data?

A. The efficacy of nintedanib and pirfenidone on cough are unknown

B. Clinical trials indicate that the approved agents have no effect on measures of cough

C. Clinical trials indicate that both agents decrease cough frequency

D. His cough will improve as his lung function improves

While there was an increased understanding among learners that the impact of available therapies on cough are unknown, these data indicate that further education is needed surrounding the efficacy of

IPF therapies and symptom management.

19% 15%

35% 31%47%

23%16% 14%

0%

25%

50%

75%

100%

A B C D

Pre (N=1731) Post (N=876)


4. DB, a 63‐year old woman with a low baseline 6‐minute walk distance is initiating pulmonary rehabilitation (PR). Her low baseline score suggests that her level of improvement after PR may be:

A. Minimal due to severe baseline impairmentB. Comparable to patients with higher baselines

scoresC. Greater than a patient with a higher

baseline scoreD. Unpredictable

Despite an increase in correct answer responses from 19% to 42% after participation in the activity, these data indicate a need for additional education on the benefits of pulmonary rehabilitation across

diverse IPF patients.

37%

14% 19%30%

20% 19%

42%

19%

0%

25%

50%

75%

100%

A B C D

Pre (N=1735) Post (N=882)

Level 3‐4: Posttest

5. A study of Medicare beneficiaries revealed that the prevalence of IPF is:

A. IncreasingB. Decreasing C. StableD. Too difficult to assess

96%

1% 1%0%

25%

50%

75%

100%

A B C D

Post (N=1423)

6. The average survival of IPF is:

A. <1 yearB. 2‐3 yearsC. 5‐6 yearsD. 7‐10 years

85%

12%3%

0%

25%

50%

75%

100%

A B C D

Post (N=1399)

Learner knowledge of these facts related to the incidence and prognosis of IPF was high after participation in the activity.

Posttest data only


7. Overall, the clinical course of IPF is:

A. Unpredictable and variableB. Rapid progressionC. Cyclical with acute exacerbationsD. Stable over time

Learner response to this question suggests a need for additional education on the IPF

disease course.

62%

25%11%

2%0%

25%

50%

75%

100%

A B C D

Post (N=1424)

8. Which of the following best describes the effects of nintedanib and pirfenidone in IPF?

A. They improve measures of lung functionB. They reduce the decline in lung functionC. They prevent the occurrence of acute

exacerbationsD. They increase survival

14%

72%

9% 5%0%

25%

50%

75%

100%

A B C D

Post (N=1417)

One‐quarter of learners incorrectly identified the effects of nintedanib and pirfenidone,

indicating a knowledge gap.Posttest data only


9. The most common side effect observed in clinical trials with nintedanib was:

A. RashB. SomnolenceC. DiarrheaD. Dry mouth

Learner knowledge of this side effect associated with nintedanib was high

after the activity.

5% 3%

85%

7%

0%

25%

50%

75%

100%

A B C D

Post (N=1427)

10. Recommendations from the ATS/ERS/JRS/ALAT indicate that:

A. All patients with IPF should be treated with pulmonary rehabilitation

B. The majority of patients with IPF should be treated with pulmonary rehabilitation

C. A minority of IPF patients will benefit from pulmonary rehabilitation

D. Patients with sever dyspnea should be treated with pulmonary rehabilitation

31%

61%

4% 4%0%

25%

50%

75%

100%

A B C D

Post (N=1422)

Learner responses on this question suggest a need for additional education on the role of pulmonary rehabilitation in IPF patients.

Posttest data only

Level 4: How Will You Change Your Practice?

16%

28%

44%

41%

Other changes. Please specify:

This activity validated my current practice, no changes

Include family and caregivers in my care of IPF patients.

Include disease‐specific education.

(Select all that apply)

N=888

72% of learners will change their practice – to include family and caregivers in decision making, to provide more disease‐specific education to patients, and other changes as indicated in the following slides.

Please identify how you will change your practice as a result of participating in this activity:

Include family and caregivers in my care of IPF patients. Please specify:

• Always ask family members for input• Always include family members when possible• Answer any questions family may have on IPF• Attempt to schedule mutually convenient family meeting

times• Be sure to inquire about the patients’ desires with

regards to inclusion of family or caregivers in conversations

• Better understanding of how to explain IPF to family.• Catch family members away from the pt to identify

symptoms the pt himself may not be recognizing.• Discuss the disease in a compassionate informative

manner.• Educate all involved, patient/family/friends• Encourage dialogue with CMS and RTs with primary

caregivers• Encourage families to attend the Evaluation process and

education classes• Encourage patients to bring family members at follow up

appointments• Ensure pt family is with the patient and utilize the teach

back method• Everyone can be on the same page and will know what to

expect from the situation.

• Family is key in helping patients to understand what is expected of them.

• Family, should be aware of what they are up against and what to except to happen too.

• Giving family and caregivers the knowledge and education so the pt can make informed decisions and they can help the pt in their journey of this disease process.

• Help to locate data they need to manage disease and be supportive.

• I liked how Trina discussed it being a journey and the family knowing more information

• I see the importance in the pt including the family and caregivers in their care and preparation for the disease progression

• I will try to make sure each person (in the room) associated with the patient has a better understanding of how the disease process works, how the meds taken can help & what else can be done

• important patient and family understand the dx state and consequences.

• In order to understand pt's symptoms, treatments and outlooks for future. caregiver should be educated as much as the pt


Include family and caregivers in my care of IPF patients. Please specify:

• Include family more when educating regarding IPF.• Including family and caregivers will help with anxiety

and depression issues as well as adherence to prescribed rehab

• Including the family is a big part for the pt. I believe if the pts. family is involved the pt. will be more proactive about engaging in PR.

• IPF is a very quick death sentence for people diagnosed later in disease progression, it’s important to have all the support and help from family to help them live the best they can for whatever time left they have to do it.

• It is important for family members to realize the degree of help that is needed for their loved one

• It is important for family to encourage patient in use of Oxygen Therapy and Rehab.

• Make sure all are extending invitation to family and caregivers to attend initial intake and subsequent educational offerings.

• My patients haven't asked for them to be included but it might be because I haven't asked them so I will start asking them.

• Patient's need all the support they can get so helping their family understand how to help them and support them will only benefit the patient.

• Share the education with family‐‐it is essential to patient overall success.

• Support can never be overrated • Tell them about the risk factors about smoking and the

environment• They may have a different perspective about how the

patient is coping with their disease• To assist medication, nutrition, encouragement, rest.• Try to have family members present when reviewing

education materials.• We encourage family to come to rehab and attend

classes and see the exercises patients are doing• We have always encouraged family to attend education.

Although will stress the importance and ask per session for family to attend

• will ask patients to include family and caregiver to assessment and treatment plan for comprehensive management and improve planning


Include disease‐specific education. Please specify:

• Avoid lumping all diseases into COPD or Restrictive• Be mindful when teaching IPF pt. vs. COPD pt.• Being able to know more about the medications

recommended and their side effects• Being honest and compassionate regarding disease

progression• Better understanding of how to approach IPF patient for

rehab.• Breathing techniques• Clinical data exclusive to the dx and tx of IPF.• Concentrate more on 02 therapy• Depression and palliative care• Develop education materials and interventions specific

to patients with IPF• Differentiate between pulmonary ailments• Discuss disease process and treatment modalities; refer

to resources.• Discuss treatment options for IPF, side effects, limitations

of medications.• Educate family and patient• Educate patient on the drugs and pulmonary rehab• Educating and encouraging pT to wear oxygen when

doing ADL's, and having them do the activity with RT to evaluate flow of oxygen for pt

• Educating the patient and family regarding this disease process and other info relevant to the patient's care and expected course of this disease.

• Emphasize importance of pulmonary rehab• End‐of‐life decisions• Ensuring accurate PFT's and teaching to include

techniques to overcome some of the limitations• I need to review the patient's needs and address them to

their disease progression• I will pass this information on to my students• Include a walking test prior to D/C to make sure they are

on the right kind of portable oxygen• Include only IPF education for those patients, we usually

have them sit together.• Knowledge is a powerful treatment tool for the RT and

patient.• Look for educational tools that are simple to understand• Many patients are given too much generic lung disease

information.• Medications can slow the process. PH may be difficult

but beneficial• More frequent one‐on‐session with this population,

especially with medications.• Oxygen therapy and walk testing• PAH, Lung Transplants


Include disease‐specific education. Please specify:

• Re‐enforce with all educators the importance of being disease specific and inclusive of other than COPD diagnoses.

• Recommend PR, encourage HRCT• Research patient friendly education materials• Speak more to IPF pts about medications• Spend time teaching IPF pts about dx• Stress even more the need for early intervention for

exacerbations• Take care to focus on IPF and not other chronic lung

diseases.• Talk to patient how meds help slow decline in lung

function, how PR may benefit them• The clinic I work in just started our pulmonary rehab

program and find this very beneficial. I will start implementing.

• The differences between Pulm fibrosis and COPD• There are now medications to slow the disease progress.• When working with IPF patients I will be able to be

thorough with this disease education.• Will allow me to give better education and pt

assessment• Will ask follow‐up questions for patients with IPF.• Will include more direct education to Fibrosis patient's• Will use info to help better educate patient on their dx.• Work with Medical directors to develop and establish a

good process


Other changes. Please specify:

• Additional services could be helpful like psychologist for depression• Ask administration to start a pulmonary rehab program at our hospital.• Better understanding of diagnosis of IPF versus other types of fibrosis. Also will encourage PR• Consider adding some aspect of end of life planning to our POLST/advance directives lecture• Definitely stress showering is an exercise along with other ADL to be treated as exercise.• Differential Diagnosis• Explore ability to include psychologist• Get recommendations on how to care more for the increased psychosocial needs• I will be more aware of the differences in IPF and will look at each patient on more of an individual level• I work in Home Care and it is important to be aware of a 10 Liter Concentrator that may be needed.• Incorporate the GAP and ILD‐GAP index scores• Increase patient's knowledge of current disease and investigate EMR of patient for administration of pirfenidone or

nintedanib• Liked the idea to suggest pt return to MD office for 6MW after getting ambulatory O2 device. Some are not open to my

suggestion that O2 device not adequate for ADL..• Offer greater patient and Family Support• Recommend evidence‐based, individualized treatment goals.• See if there is more pulmonary rehab that I can do as an RT for these patients that I work with.• Speak as to the differences in IPF and other diseases such as rapid change necessitating support.• This course has allowed me to share valuable general data about IPF with my patients.• Try to modify the interactions we have with our patients.• Will adjust exercise or activity accordingly• Will be better able to participate in IDG patient care meetings with new knowledge• Will have different educators available


Level 4: Impact of Changes on Patient Care

N=888

Changes will impact between 1,424 – 4,531 IPF patients each month. This assumes data in chart above is representative of all participating healthcare professionals (1,798), who indicated they would change their

practice as a result of this activity (72%).

40%

52%

6% 2%0

1‐5

6‐10

11‐15

>15

Please identify the number of patients with IPF seen per month:

Level 4: When Will You Change Your Practice?

N=888

74% of the learners indicated they will immediately implement changes to their clinical practice as a result of their participation.

74%

9%

7%

10%

Immediately

In one month

In three months

In six months

How soon do you intend to incorporate changes into your clinical practice as a result of this CE activity?

ACHL Contact Information

• For questions, please contact:

Brittany PusterDirector, Education DevelopmentAcademy for Continued Healthcare Learning (ACHL)

E: [email protected]: 773‐714‐0705 ext. 134

Please share any additional comments

• Appreciate the free CEUs• Course was very informative! Thank you• Dr. Lee was exceptional.• Enjoyed this lecture • Everything was great!• Excellent course• Great course. Very informative• Great information I'm excited to implement some

changes in our PR program• Great information. I teach Pulm Rehab and find

these patients particularly difficult.• Great presentation. Especially the CT, and lab

examples, of what ILD/IPF looks like.• Great speakers, and very informative presentation. I

feel like this gave me a lot of insight with information that is relatable to my practice.

• I greatly appreciate the online CEUs ‐ I would have liked to be able to get the slideshow of this course ‐a lot is covered and I could then share with my peers ‐thank you

• I have seen these same results in my work in Pulmonary Rehab and am very glad to see the validation of our efforts.

• I would love more on alternative oxygen use for desaturation during exercise, (High flow, Helium etc)

• I'm a Respiratory Therapy student and I found it very fascinating.

• It helped improve my understanding of this disease.• It is important for the RT in the Hospital and Rehab to learn

what is available in Portable Oxygen and what is not.• Loads of info, well presented• The AARC material was so helpful for all respiratory

practitioners and I highly recommend for all• The presentation was very good, it was informative to Doctors

and Pulmonary rehab therapists. Need more information on acute inpatient care and potentially home care.

• The topic was well presented.• This is the best lecture that has appeared on this site great job.• This was a wonderful presentation. Very informative. We have

had IPF pts in our PR for last 7 yrs. Confirmed much of what we have seen. Now see less % COPD, more restrictive pts.

• This was so interesting! Great speakers. Useful tool for active members since the courses are current evidence based practice

• Well y'all knocked it out of the park with this one. EXCELLENT!!! Thank you. You gave me confidence and support to continue with some of the practices we've implemented based on experience and instinct.

• Will encourage staff to join AARC.• Wonderful marvelous stupendous job

General Comments

Documents

Patients Through Decisions in IPF: The Respiratory …This activity was intended for respiratory therapists and other clinicians involved in the management of patients with IPF. Release/Expiration: