<p>Palliative Care Initiation in Chronic Obstructive Pulmonary Disease: Prognosis-Based, Symptoms-Based or Needs-Based?</p>

Abstract

The absence or late initiation of palliative care (PC) in chronic obstructive pulmonary disease (COPD) is multidimensional. To provide palliative care from the moment of COPD diagnosis remains utopic. Even the advanced forms or the end-oflife stages benefit late or never from these services. In this context, the research questions for the present systematic review were focused on the prognosis variables or multicomponent indices in COPD patients alongside the symptoms and unmet needs, which may be useful for the palliative care initiation. The aim was to help clinicians to identify not only the tools reliable to predict poor survival in COPD patients but also to identify the criteria for appropriateness for early palliative care onset. The search included systematic reviews and reviews published in English in the PUBMED database from Jan 1, 2015 to Jan 6, 2020. From a total of 202 findings, after applying filters, using additional sources, and eliminating duplicates, the search strategy screened 16 articles, out of which 10 were selected and included. A Preferred Reporting Items for Systematic Review and Meta-analysis Protocols (PRISMA-P) flow diagram was constructed. The main domains identified as barriers in providing palliative care in COPD patients were complex: from the prognosis difficulties to the prognostic variables and scores proposed for initiating PC; from the troublesome symptoms or the unidimensional symptom tools to the unmet needs of COPD patients. The review concluded that none of the existing prognostic variables and multicomponent indices are reliable enough to exclusively predict poor survival in COPD patients and the decision to initiate PC should be rather based on the presence of refractory symptoms and patients' unmet needs and preferences. Despite the current advances, the ideal model to initiate palliative care from the moment COPD is diagnosed is a goal for clinicians trained in, and capable of providing palliative care in any COPD patient.

Perceptions of healthcare professionals towards palliative care in internal medicine wards: a cross-sectional survey

“…However, effective utilisation of palliative care services continues to be undermined by gaps in knowledge, prognostication and communication. These gaps appear to stem from unfamiliarity with palliative care’s shift from a prognosis-based model to a needs-based model and failure to appreciate its merits in supporting patients with non-cancer diagnoses and chronic life-limiting conditions [ 27 ]. Indeed, this study reveals that misconceptions on the role of prognosis as an entry criteria inhibit up to 60% of physician initiated referrals to palliative care.…”

Pulmonary referrals to specialist palliative medicine: a survey

“…Palliative care was borne out of the needs and trajectory of patients with cancer,36 such that current models of palliative care may not consider the specific needs and unique trajectories of patients with non-malignant diseases. For example, the referral to palliative care services in community and hospice settings may require an estimation of prognosis, which is difficult among patients with chronic respiratory disease 37. SPC referral based on needs rather than on prognosis would be more compatible with the disease trajectory of patients with chronic respiratory disease 37…”

“…For example, the referral to palliative care services in community and hospice settings may require an estimation of prognosis, which is difficult among patients with chronic respiratory disease 37. SPC referral based on needs rather than on prognosis would be more compatible with the disease trajectory of patients with chronic respiratory disease 37…”

Can Ultrasound Therapy Be an Environmental-Friendly Alternative to Non-Steroidal Anti-Inflammatory Drugs in Knee Osteoarthritis Treatment?

“…Patients may also experience movement decreasing, deformity, swelling, and crepitus. When pain persists, patients develop pain-related psychological distress [ 7 ] and are exposed to addictive behaviors and poor evolution of their comorbidities [ 8 , 9 , 10 , 11 ]. The OA symptoms are caused by a complex pathology of whole joint, generated by inflammation; oxidative stress; and metabolic, endocrine, and genetic factors.…”