C36-17 Patients With End-stage Lung Diseases Have Lower In-hospital Death Rates When Referred to Palliative Care

Abstract Rationale Chronic respiratory disease is a leading cause of death in the United States. The unpredictable clinical trajectory of these diseases and inherent challenges in prognostication complicate timely palliative care referral and integration. Despite recommendations from organizations such as the American Thoracic Society and Global Initiative for Chronic Obstructive Lung Disease, which advocate for patient-centered palliative care guided by refractory symptoms and individual preferences rather than prognosis alone, palliative care remains underutilized in these patients. This leaves a vast unmet need for chronic lung disease patients who are referred to palliative care and hospice less compared with other life-limiting conditions. High symptom burden including dyspnea, fatigue, and anxiety, which are often inadequately controlled by disease-modifying therapies alone, plus unmet psychosocial needs lead to frequent hospitalizations and, subsequently, in-hospital deaths rather than at home or in a hospice facility. As palliative care and hospice remain under-utilized in patients with advanced lung disease, we sought to further understand if increasing palliative care referrals would impact the number of out-of-hospital deaths for these patients. Methods We reviewed the charts of all patients referred to our Pulmonary Palliative Care Clinic at a suburban, tertiary, academic medical center from September 2024 to October 2025. We included patients with a primary or secondary diagnosis of chronic obstructive pulmonary disease (COPD), interstitial lung disease (ILD), or other significant lung disease history (cystic fibrosis/bronchiectasis, lung transplantation, etc.). Among patients referred, we examined the number of hospice enrollments and location of death during the year following their establishment with palliative care. Results Between September 2024 to October 2025, 67 patients with end-stage lung disease established care in a dedicated Palliative Care Clinic for patients with advanced lung disease. Of those patients, there were 34 with COPD, 25 with ILD, 5 were status post lung transplant complicated by chronic lung allograft dysfunction (CLAD), and 3 patients had “other” lung diseases. Of those patients, 28 (41.8%) were referred to hospice. Among the patients on hospice, 23 have died, all either at home or in a hospice facility (34.3% of all patients). One patient (1.5%) deferred hospice enrollment and passed in the hospital. Conclusion When patients with advanced lung disease are referred to palliative care, there are high rates of hospice referrals (41.8% in our group), which may subsequently increase non-hospital death rates (34.3% of our total group). Increased access to palliative care in this population may aid in more out-of-hospital deaths. This abstract is funded by: None