How well do we care for patients with end stage chronic obstructive pulmonary disease (COPD)? A comparison of palliative care and quality of life in COPD and lung cancer

Gore, Justin; Brophy, C.; Greenstone, M A

doi:10.1136/thorax.55.12.1000

Cited by 565 publications

(552 citation statements)

References 24 publications

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“…In fact, SUPPORT found that patients with lung cancer and patients with COPD were equally likely to prefer not to be intubated and not to receive cardiopulmonary resuscitation (CPR), yet patients with COPD were much more likely to receive these therapies [11]. A study in the UK also found that patients with COPD are much less likely to die at home and to receive palliative care services than patients with lung cancer [12]. Additional studies have documented the poor quality of palliative care and significant burden of symptoms among patients with COPD [13].…”

Section: Poor Palliative Care In Copd and The Link To Poor Communicationmentioning

confidence: 94%

“…Patients dying of progressive COPD are less likely to be offered the opportunity to benefit from hospice services when compared with patients with cancer [12]. The illness trajectory among patients with COPD is more likely to be a gradual slow decline interspersed with unpredictable acute exacerbations, which are often followed by an improvement back towards, but not quite reaching, their pre-exacerbation baseline [9].…”

Section: Care Of the Patient Dying From Copd And The Role Of The Hospicementioning

confidence: 99%

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Palliative and end-of-life care for patients with severe COPD

2007

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Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. For many patients, maximal therapy for COPD produces only modest or incomplete relief of disabling symptoms and these symptoms result in a significantly reduced quality of life.Despite the high morbidity and mortality associated with severe COPD, many patients receive inadequate palliative care. There are several reasons for this. First, patient-physician communication about palliative and end-of-life care is infrequent and often of poor quality. Secondly, the uncertainty in predicting prognosis for patients with COPD makes communication about end-oflife care more difficult. Consequently, patients and their families frequently do not understand that severe COPD is often a progressive and terminal illness.The purpose of the present review is to summarise recent research regarding palliative and end-of-life care for patients with COPD. Recent studies provide insight and guidance into ways to improve communication about end-of-life care and thereby improve the quality of palliative and end-of-life care the patients receive. Two areas that may influence the quality of care are also highlighted: 1) the role of anxiety and depression, common problems for patients with COPD; and 2) the importance of advance care planning.Improving communication represents an important opportunity for the improvement of the quality of palliative and end-of-life care received by these patients.

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Section: Poor Palliative Care In Copd and The Link To Poor Communicationmentioning

confidence: 94%

Section: Care Of the Patient Dying From Copd And The Role Of The Hospicementioning

confidence: 99%

Palliative and end-of-life care for patients with severe COPD

2007

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“…This recognition demonstrates a shift in focus from the "cure versus no cure" mind-set toward acknowledging the importance of assessing and addressing symptom burden, diminished quality of life, and social isolation that patients with chronic lung disease experience (3,(23)(24)(25)(26)(27)(28). Studies outside the ICU setting demonstrate that patients with chronic lung disease experience a high burden of diverse symptoms that impact their quality Bold values indicate significance set at P < 0.05.…”

Section: Discussionmentioning

confidence: 99%

Palliative Care for Patients Dying in the Intensive Care Unit with Chronic Lung Disease Compared with Metastatic Cancer

et al. 2016

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Rationale: Palliative care has been focused largely on patients with cancer, and yet patients with chronic lung diseases also have high morbidity and mortality. The majority of deaths in intensive care units (ICUs) follow decisions to withhold or withdraw life-sustaining treatments, suggesting that palliative care is critically important in this setting.Objectives: We explored differences in receipt of elements of palliative care among patients with interstitial lung disease (ILD) and chronic obstructive pulmonary disease (COPD) who die in ICUs compared with patients with cancer.Methods: We identified patients with COPD, ILD, or metastatic cancer who died in the ICUs of 15 Seattle-area hospitals between 2003 and 2008. We used robust multivariable logistic and linear regression to compare differences in receipt of elements of palliative care and length of stay. Measurements and Main Results:Compared with patients with cancer, patients with COPD were more likely to receive cardiopulmonary resuscitation before death and patients with ILD were less likely to have documentation of pain assessment in the last day of life. Patients with ILD and COPD were less likely to have a do-not-resuscitate order in place at the time of death and less likely to have documentation of discussions about prognosis than patients with cancer. Patients with COPD had longer hospital lengths of stay, and patients with COPD and ILD had longer ICU lengths of stay. Conclusions:Among patients who die in the ICU, patients with ILD and COPD receive fewer elements of palliative care and have longer lengths of stay than patients with cancer. These findings identify areas for improvement in caring for patients with chronic lung diseases.Clinical trial registered with www.clinicaltrials.gov (NCT00685893).

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“…193 Despite disabling symptoms (especially breathlessness), complex co-morbidity and social isolation, [194][195][196][197][198] the needs of people with very severe COPD are rarely addressed adequately. 194,199 Although 'markers' of a poor prognosis in COPD are well recognised, 200 the outcome for any individual is unpredictable, 201 leading to 'prognostic paralysis' on the part of clinicians. 202,203 Primary care clinicians have an important role in orchestrating proactive supportive care.…”

Section: Research Questionsmentioning

confidence: 99%