Palliative care in chronic obstructive pulmonary disease

Lilly, Evan; Senderovich, Helen

doi:10.1016/j.jcrc.2016.05.019

Cited by 23 publications

(32 citation statements)

References 52 publications

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“…The prevalence of COPD is increasing worldwide [ 32 ]. Its incurable nature and unpredictable course, with resulting intense symptom distress and poor QOL, have led to recognition of the potential of palliative care to mitigate the challenges patients and families face [ 33 ]. COPD, including emphysema and bronchitis, is a disease of airflow obstruction that makes breathing and activity difficult.…”

Section: Palliative Care and Copdmentioning

confidence: 99%

The potential of palliative care for patients with respiratory diseases

Narsavage¹,

Chen²,

Korn³

et al. 2017

Breathe

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Based on the demonstrated effectiveness of palliative care in the alleviation of symptoms and enhancement of life quality, it is important to incorporate palliative care early in the respiratory disease trajectory. Quality palliative care addresses eight domains that are all patient and family centred. Palliative care interventions in respiratory conditions include management of symptoms such as dyspnoea, cough, haemoptysis, sputum production, fatigue and respiratory secretion management, especially as the end-of-life nears. A practical checklist of activities based on the domains of palliative care can assist clinicians to integrate palliative care into their practice. Clinical management of patients receiving palliative care requires consideration of human factors and related organisational characteristics that involve cultural, educational and motivational aspects of the patient/family and clinicians.Educational aimsTo explain the basic domains of palliative care applicable to chronic respiratory diseases.To review palliative care interventions for patients with chronic respiratory diseases.To outline a checklist for clinicians to use in practice, based on the domains of palliative care.To propose recommendations for clinical management of patients receiving palliative care for chronic respiratory diseases.

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Section: Palliative Care and Copdmentioning

confidence: 99%

The potential of palliative care for patients with respiratory diseases

Narsavage¹,

Chen²,

Korn³

et al. 2017

Breathe

View full text Add to dashboard Cite

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“…Globally, chronic obstructive pulmonary disease (COPD) prevalence is on the rise and is the only disease that continues to have an increasing age-adjusted mortality rate [ 1 ]. In the UK, 5.2% of all deaths are secondary to COPD, which is approaching the proportion (6.2%) of deaths that are due to lung cancer [ 2 , 3 ].…”

Section: Introductionmentioning

confidence: 99%

“…However, compared with patients with lung cancer who suffer from a similar burden of disabling symptoms and psychological distress, small studies or studies using select COPD cohorts have found over the past decade that COPD patients often have limited access to palliative care services [ 9 – 13 ], even when compared with patients with other chronic terminal diseases [ 14 ]. It is likely that a major reason for this is the difficulty in predicting when to initiate PCS; current recommendations are to deliver PCS during the last year of life, but prognosticating the life expectancy of individuals with COPD has proven to be extremely difficult [ 1 , 15 , 16 ]. Consequentially, there is no commonly accepted definition of “end-stage COPD”.…”

Section: Introductionmentioning

confidence: 99%

Low uptake of palliative care for COPD patients within primary care in the UK

et al. 2018

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Mortality and symptom burden from chronic obstructive pulmonary disease (COPD) and lung cancer are similar but there is thought to be an inequality in palliative care support (PCS) between diseases. This nationally representative study assessed PCS for COPD patients within primary care in the UK.This was a cohort study using electronic healthcare records (2004–2015). Factors associated with receiving PCS were assessed using logistic regression for the whole cohort and deceased patients.There were 92 365 eligible COPD patients, of which 26 135 died. Only 7.8% of the whole cohort and 21.4% of deceased patients received PCS. Lung cancer had a strong association with PCS compared with other patient characteristics, including Global Initiative for Chronic Obstructive Lung Disease stage and Medical Research Council Dyspnoea score (whole cohort, lung cancer: OR 14.1, 95% CI 13.1–15; deceased patients, lung cancer: OR 6.5, 95% CI 6–7). Only 16.7% of deceased COPD patients without lung cancer received PCS compared with 56.5% of deceased patients with lung cancer. In patients that received PCS, lung cancer co-diagnosis significantly increased the chances of receiving PCS before the last month of life (1–6 versus ≤1 month pre-death: risk ratio 1.4, 95% CI 1.3–1.7).Provision of PCS for COPD patients in the UK is inadequate. Lung cancer, not COPD, was the dominant driver for COPD patients to receive PCS.

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“…Patients with advanced COPD benefit equally from palliative care compared to patients with malignant diseases [17]. Despite of this, palliative care in a specialized unit is offered to patients with COPD to a lesser extend than to patients with a malignant disease [15,18]. Few existing studies evaluate the effect of palliative care outside a specialized unit directed at patients with COPD [12,15,19–22].…”

Section: Introductionmentioning

confidence: 99%

Is the high intensity symptoms experienced by patients admitted with chronic obstructive pulmonary disease documented by health professionals? - a prospective survey with comparison of patient reported outcomes and medical records

Bech

Bové

Marsaa

et al. 2018

European Clinical Respiratory Journal

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Context: Patients with chronic obstructive pulmonary disease (COPD) have a high symptom burden and reduced quality of life. There is an increasing attention on palliation for patients with COPD. Recognition of symptoms is a prerequisite for palliation. Objectives: We aim to investigate the extent to which symptoms in patients with COPD are recognized in the documentation of the health professionals, indicated in ‘Doctors Symptom Recognition Rate’ (DSR), ‘Nurses Symptom Recognition Rate’ (NSR) or ‘Doctors and/or Nurses Symptom Recognition rates ’(DNSR) as a team, respectively. Methods: Patients with COPD (n = 40) admitted in two respiratory units, responded within 48 h on two symptom-screening-tools that access quality of life; COPD assessment test (CAT) used for the treatment of COPD and EORTC-QLQ-C15-PAL used for palliation in patients with cancer. Patient-described symptomatology was compared to the symptoms as recognized in the documentation of doctors and/or nurses. Results: There was a significant discrepancy between the symptomatology indicated by patients with COPD on CAT and EORTC-QLQ-C15-PAL, and the degree by which it was recognized in the medical records indicated in DSR or NSR. In 30 out of 44 items DSR or NSR were < 70%. There was a significant difference between DNSR versus DSR or NSR, respectively, in 19 out of 22 items. Conclusion: A team-based symptom recognition DNSR is superior when compared to DSR or NSR.Team-based systematic screening is suggested as a pathway to increase symptom recognition in patients with COPD. Increased rates of symptom recognition may improve symptom alleviation and thus palliation.

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Palliative care in chronic obstructive pulmonary disease

Cited by 23 publications

References 52 publications

The potential of palliative care for patients with respiratory diseases

The potential of palliative care for patients with respiratory diseases

Low uptake of palliative care for COPD patients within primary care in the UK

Is the high intensity symptoms experienced by patients admitted with chronic obstructive pulmonary disease documented by health professionals? - a prospective survey with comparison of patient reported outcomes and medical records

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