Implementing a Palliative Care Trial in Advanced COPD: A Feasibility Assessment (The COPD IMPACT Study)

Horton, Robert; Rocker, Graeme; Dale, Andrea; Young, Joanne; Hernández, Paul; Sinuff, Tasnim

doi:10.1089/jpm.2012.0285

Cited by 52 publications

(86 citation statements)

References 39 publications

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“…Failure to achieve increased QOL scores as a result of home-based palliative services have been reported elsewhere in the literature [39]. Perhaps stabilization of scores was in itself a positive outcome in this population who are experiencing declining health.…”

Section: Discussionmentioning

confidence: 77%

Nurse-led navigation to provide early palliative care in rural areas: a pilot study

Pesut

Hooper²,

Jacobsen³

et al. 2017

BMC Palliat Care

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BackgroundFew services are available to support rural older adults living at home with advancing chronic illness. The objective of this project was to pilot a nurse-led navigation service to provide early palliative support for rural older adults and their families living at home with advancing chronic illness.MethodsTwenty-five older adults and 11 family members living with advancing chronic illness received bi-weekly home visits by a nurse navigator over a 2-year period. Navigation services included symptom management, education, advance care planning, advocacy, mobilization of resources, and psychosocial support. The nurse navigator collected longitudinal data on older adult and family needs, and older adult quality of life and healthcare utilization.ResultsSatisfaction with the service was high. There was no attrition over the 2-year period except through death, and few cancelled visits, indicating a high degree of acceptability of the intervention. The navigator addressed complex, multi-faceted needs through connecting health, social, and informal community resources. Participants who indicated a preferred place of death were able to die in that preferred place (n = 7). Emergency room use by participants was minimal and largely unpreventable by the nurse navigator. Longitudinal health-related quality of life scores for many participants were poor, lending further support to the need for more focused attention to this upstream palliative population.ConclusionsUsing a nurse navigator to facilitate early palliative care for rural older adults living with advanced chronic illness is a promising innovation for meeting the needs of this population. Further research is required to evaluate outcomes on a larger scale.

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Section: Discussionmentioning

confidence: 77%

Nurse-led navigation to provide early palliative care in rural areas: a pilot study

Pesut

Hooper²,

Jacobsen³

et al. 2017

BMC Palliat Care

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“…Another publication cited the patient's lack of understanding of their diagnosis and prognosis as being barriers to communication about COPD and palliative care [Gardiner et al 2010]. Horton and colleagues has done a good job of summarizing other common barriers to palliative care for those with COPD [Horton et al 2013]. These include the patient's limited comprehension of treatment options, failure to understand that COPD is a life-threatening disease, and limited ability to predict when supportive or palliative care services would be helpful and welcomed by the patient and family.…”

Section: Barriers To Palliative Carementioning

confidence: 99%

Improving end-of-life care for patients with chronic obstructive pulmonary disease

Sorenson

2013

Ther Adv Respir Dis

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Global chronic obstructive pulmonary disease care Worldwide, chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death [Mannino and Kiri, 2006], although individuals diagnosed with this disease around the globe do not always fare well in the medical community. An article from Japan states that patients with end-stage COPD have more deterioration in quality of life, more dyspnea, anxiety, appetite loss and general fatigue compared with patients with lung cancer [Katsura, 2003]. The article goes on to state that patients with COPD are also more likely to be treated aggressively with lifesustaining therapy, and receive inadequate symptom control [Katsura, 2003]. French authors reveal a similar lack of palliative care for patients with COPD. In 43% of patients with end-stage COPD, there was limited care [du Couedic et al. 2012]. Analysis of interviews showed that the subject of death was rarely or never discussed when the diagnosis was COPD [du Couedic et al. 2012]. Researchers in Australia also noted a lack of palliative care for individuals with COPD [Disler et al. 2012]. An integrated review to determine what approach was used to reduce symptoms at end of life revealed a range of palliative interventions. Although many components were present, there appeared to be limited evidence for health service coordination and active management of palliative care [Disler et al. 2012]. It is clear that medical institutions know how to deliver palliative care, just not always effectively for patients with end-stage COPD. Lack of understanding Palliative care is a term used liberally when discussing hospice and end-of-life care, but not always when addressing symptom control. Many healthcare professionals perceive palliative care to be only for the dying. Spence and colleagues did a qualitative study of professionals delivering palliative care to people with COPD. According to the participants, when treating patients with COPD the focus was on symptom management but predominately using an acute care model [Spence et al. 2009]. The delivery of palliative care was viewed as a specialist's role rather than an integral component of care. Patients with COPD have many bothersome symptoms; dyspnea is just one of them. These symptoms unfortunately exist long before the patient is deemed to have endstage disease. Nonhospice palliative care is a reality and can be offered at the same time as life-extending and curative therapies [Kelley and

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“…In a recent study of the feasibility of implementing a program of palliative care for patients with advanced COPD [29], we found that despite access to comprehensive medical support, which included individualized action plans and a er-hours physician response, Rocker & Cook. EOL Care for COPD some patients continued to turn repeatedly to the emergency room when symptoms escalated rapidly [29].…”

Section: Outreach For Patients With Advanced Copdmentioning

confidence: 99%

“…Success might be viewed through a di erent lens; whereby the dying begins at home but the death occurs in the hospital. Success might be considered in the light of averted visits to the emergency room, or through a short nal hospital admission without the intrusion of CPR as we have recently described [29].…”

Section: E Final Daysmentioning

confidence: 99%

'INSPIRED' Approaches to Better Care for Patients with Advanced COPD

Rocker¹,

Cook²

2013

CIM

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Chronic Obstructive Pulmonary Disease (COPD) is the most common cause of admission to acute care facilities in Canada. e burden of illness for patients, caregivers and the health care system is profound. Dyspnea in advanced COPD pervades all aspects of patients' lives. When increasing symptom burden limits patients to their homes, crucial primary care services become less accessible, and care of end-stage COPD becomes increasingly fragmented and reactive. Given the considerable physical and psychosocial consequences of advanced COPD, this phase can be devastating for patients and families. In this article we outline the need for clinical interventions and re-organized models of care designed for better continuity to achieve more favorable outcomes for these patients and their families. Outreach programs and use of personalized action plans that include advice on careful use of opioids can be remarkably e ective. e move toward an integrated approach to COPD management with more e ective advance care planning will help patients and their families make informed decisions throughout the illness trajectory. Intensive medical treatment focused on increasing survival can coexist with both holistic and palliative approaches to improve the quality of life of patients with severe end-stage COPD.

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Implementing a Palliative Care Trial in Advanced COPD: A Feasibility Assessment (The COPD IMPACT Study)

Cited by 52 publications

References 39 publications

Nurse-led navigation to provide early palliative care in rural areas: a pilot study

Nurse-led navigation to provide early palliative care in rural areas: a pilot study

Improving end-of-life care for patients with chronic obstructive pulmonary disease

'INSPIRED' Approaches to Better Care for Patients with Advanced COPD

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