Much within existing services works well for people with chronic obstructive pulmonary disease, but opportunities to enhance palliative care for this underserved group remain. Future research might focus on prospectively evaluating the impact of key components of palliative care on core patient-centred outcomes. Additionally, work must be done to raise awareness of the benefits of specialist palliative care for non-cancer patients, as negative associations can form a barrier to access.

BackgroundPrognostic estimates are used to support decision-making in advance care planning. NICE Quality Standards (2011) advocate that ‘people approaching the end of life are identified in a timely way’. Estimations are often inaccurate, with non-specialist medical professionals being accurate only 20% of the time.1 2Prognostication scores exist to help inform estimations, but most medical professionals use a combination of personal experience, the patient's disease burden and momentum of functional decline.AimTo determine prognostic accuracy of a specialist palliative care multi-disciplinary team (MDT).MethodsPrognostic estimates were recorded by a specialist palliative care MDT bi-weekly for hospice inpatients over a six month period. Patients were placed in to one of four prognostic categories: ‘last six months’, ‘last six weeks’, last two weeks', and ‘last 48 hours’. Data was collected retrospectively.Results182 prognostic estimates were recorded for 122 patients over six months. 96.8% of patients had a diagnosis of malignant disease. In the ‘last six months’ category, median survival was 42 days, with a prognostic accuracy of 48.6% (i.e. 48.6% of patients in this category died within six months and survived longer than six weeks). In the ‘last six weeks’ category, median survival was 21 days, with an accuracy of 43%. In the ‘last two weeks’ category, median survival was 8 days, with an accuracy of 50%. In the ‘last 48 hours’ category, median survival was 60 hours, with an accuracy of 52%.ConclusionsThe specialist palliative care MDT is more accurate at estimating prognosis than non-specialist medical professionals, with an average accuracy over all prognostic categories of 48.4%. Accuracy improves the closer the patient is to death. Overestimation of prognosis is the more common error, contrary to media reports that suggest medical professionals can underestimate prognosis and deny patients treatment towards the end of life.

Background Patients with end-stage chronic obstructive pulmonary disease (COPD) experience health-related quality of life comparable to, or worse than that of people with advanced non-small cell lung cancer. Access to specialist palliative care is poor for those with COPD, and comparisons with lung cancer patients demonstrate inequalities. National COPD guidelines state that patients ‘should have access to the full range of services offered by multidisciplinary palliative care teams’. Services are being developed to address this inequality, but it is not known whether current models of specialist palliative care are appropriate to the needs of COPD patients. Aim To understand the experience of patients with COPD who access specialist palliative care. Methods Eight patients accessing any service for one month (outpatient) or one week (inpatient) undertook semistructured interviews (mean duration 34 min). Recordings were transcribed verbatim and analysed using hermeneutic phenomenology. Results Perceived benefits of specialist palliative care included reduced frequency of hospital admission, improved physical symptoms, reduced social isolation and a broadened physical environment in which participants could function. Improvements in psychological wellbeing (including improved mood, confidence and self-worth) were also described. Patients were aware of their poor prognosis, but some were initially distressed at the prospect of palliative care referral, mainly due to prior associations between palliative care and death. Perceptions changed following engagement with services, with fear of discharge becoming problematic. Conclusions There is much within existing services that works well for people with COPD, but some features of care could be modified, such as patterns of service provision and discharge policy. In contrast with previous literature, participants were aware of their poor prognosis. However, work is needed to dispel negative perceptions of specialist palliative care among COPD patients, as they may form a barrier to access.

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