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. 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). 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. 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.

中文翻译：

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肺移植转诊实践模式：囊性纤维化医师和普通肺科医生的调查

许多患有囊性纤维化（CF）的人死于呼吸衰竭，而没有转介进行肺移植。可能会加速，延误或阻止转诊的内科医生实践知之甚少。通过电子邮件将两个并行的，基于网络的平行调查，重点放在肺移植的转诊触发因素和障碍以及转诊前评估，通过电子邮件发送给在新英格兰地区执业的肺病学家。一份问卷发送给CF提供者（n = 61），第二份问卷发送给在同一机构执业的普通肺部提供者（n = 61）。CF提供者调查有43（70％）个回应，而普通肺部（'non-CF'）提供者调查有25（41％）个回应。CF提供者转诊患者的主要原因包括：肺功能迅速下降（91％）和1 s内的强制呼气量（FEV1）低于预期的30％（74％）。CF和非CF提供者转介的最大障碍包括积极使用烟草（分别为65％和96％，不会推荐），积极使用酒精或其他物质或依赖性（63％和80％）。此外，如果预计将采用三联疗法或其他有希望的新的，针对疾病的疗法，则多达42％的CF提供者可能会延迟其转诊。通常，非CF提供者进行更强健的转诊前医学检查，而CF提供者完成较高数量的社会心理评估。在两组中，据报道与肺移植计划的沟通都不充分。存在医师级障碍，无法及时进行肺移植转诊，需要解决。肺移植计划与肺提供者之间加强沟通可以减少这些障碍。