End-of-life care for patients with advanced lung cancer and chronic obstructive pulmonary disease – survey among Polish pulmonologists

Abstract

INTRODUCTION There is evidence that people with nonmalignant disease receive poorer end-of-life (EOL) care compared with people with cancer. OBJECTIVES The aim of the study was to assess the selected aspects of symptomatic treatment and communication between physicians and patients diagnosed with either advanced chronic obstructive pulmonary disease (COPD) or lung cancer. METHODS A questionnaire survey was conducted online among members of the Polish Respiratory Society. RESULTS Properly completed questionnaires were returned by 174 respondents (27.2% of those proved to be contacted by email). In COPD, 32% of respondents always or often used opioids in chronic breathlessness and 18.3% always or often referred patients to a palliative care (PC) specialist. Nearly 80% of the respondents claimed that bedside discussions on EOL issues with people with COPD are essential, although only 20% would always or often initiate them. In people with lung cancer, opioids were routinely used for relief of chronic breathlessness by 80% of physicians; 81.7% referred patients to a PC specialist. More than half of the respondents always or often discussed EOL issues only with the patient's caregivers or relatives. Younger physicians, those at an earlier stage of their career, those caring for higher numbers of patients with lung cancer, and those who were better acquainted with Polish Respiratory Society recommendations for PC in chronic lung diseases seemed to provide better EOL care for COPD patients. CONCLUSIONS Patients with COPD, as compared with patients with lung cancer, were less frequently treated with opioids to relieve chronic breathlessness or referred for a PC consultation. Discussing the EOL issues with a patient was generally found challenging by physicians, and most often pursued with caregivers instead. The COPD recommendations on PC may prove helpful in providing better EOL care by pulmonologists.

Professionals’, patients’ and families’ views on the use of opioids for chronic breathlessness: A systematic review using the framework method and pillar process

“…Positive changes in attitudes in response to more recent knowledge about the safety and potential benefits of opioids may mean that younger clinicians are more open to using opioids. 24 However, the study which reported this finding only received an MMAT total of 1 and had limitations in terms of response rate and sampling strategy. Support from a palliative care team increased clinician willingness to prescribe opioids, particularly collaboration, communication and information sharing between palliative specialists and non-palliative specialists.…”

“…Several studies, one of which has a MMAT total of 5, 37 highlighted the need to improve clinician knowledge and education on opioid use for breathlessness, particularly regarding prescribing and application. 24,37,40…”

“…Comparing and contrasting study findings (see Supplemental File 3) in relation to MMAT scores showed similar findings across the studies, regardless of score. For example, the barrier clinician and patient fear of opioids was identified in several studies with lower MMAT totals 24,25 and several with higher MMAT totals. 26,27 This was the case across the barrier and enabler findings.…”

“…Several studies, one of which has a MMAT total of 5, 37 highlighted the need to improve clinician knowledge and education on opioid use for breathlessness, particularly regarding prescribing and application. 24,37,40 'I guess the thing is I don't have enough experience in doing that yet [opioid use for advanced COPD] and there hasn't been enough studies out, enough physicians that are on board with it yet'. Respiratory Therapist 37 One study suggested that information about dosing was needed and provision of guidelines.…”

Do guidelines influence breathlessness management in advanced lung diseases? A multinational survey of respiratory medicine and palliative care physicians

“…Recent multinational and national surveys have highlighted considerable variation in treatment approaches for breathlessness between respiratory medicine (RM) and palliative care (PC) physicians [ 14 ], and in the approach to breathlessness management in malignant versus non-malignant disease [ 15 ]. Barriers to effective management include lack of clinician knowledge and experience [ 16 – 18 ].…”