Management of COPD in End-of-Life Care by Spanish Pulmonologists

Abstract

Chronic obstructive pulmonary disease is progressive and in its advanced stage is associated with major disability. Previous studies suggest that patients with this disease receive little palliative care, even in very advanced stages. Given this, our objectives were to describe the clinical practice of Spanish pulmonologists in the care of patients with end-stage chronic obstructive pulmonary disease, to identify potential barriers to implementing palliative care in these patients and to correlate these responses with doctor's years of experience. A link to an online survey was sent to pulmonologists on (a) symptom management, (b) structure of their department and collaboration with other services, (c) specialized medical training in palliative care, (d) communication with patients and their families, and (e) limiting barriers identified in the management of these patients. A total of 387 responses were received. The majority used opioids to treat dyspnea (52.9%) or pain (54.2%) and many treated anxiety/depression (41%). Around half of the respondents had no established routines in their departments to offer palliative care to patients with chronic obstructive pulmonary disease. There was little communication with end-of-life patients and their families on disease course, mainly associated with a lack of medical training (83% of cases) and changes in patient wishes regarding care through the disease course (81%). In our setting, communication with end-of-life patients with chronic obstructive pulmonary disease is poor. The key challenges identified are insufficient medical training and changing desires of patients. No substantial differences in attitude were found as a function of experience.

Ten Research Questions for Improving COPD Care in the Next Decade

“…A recent survey in Spain has revealed several deficiencies in the management of these cases and their support to the family [92]. Specifically, another neglected aspect of advanced COPD care is in relation with the evaluation of the social aspects of the disease, preventing the system to provide a comprehensive and efficient care if not considered [93].…”

An e-Delphi Study to Identify Priority Areas for Education on Advance Care Planning in COPD Management

“…In addition, guidance about who is responsible for initiating ACP is often lacking, and a lack of established protocols for who is responsible for initiating ACP has been identified as another barrier to implementing COPD into routine COPD management. 16,17,26 For patients, the key is having a well-informed health-care professional who is familiar with them and their history to carry out ACP discussions at an appropriate time. 3,27 For some, this may be a general practitioner, but, for others, it may be a hospital-based treating clinician.…”

“…A lack of training for health-care professionals has been identified as a barrier to implementing ACP into routine management. 16,17 To ensure that the topics of future educational interventions are relevant and meaningful to the target audience, the objective of this study was to identify gaps in health-care professionals' knowledge re-…”

Holistic services for people with advanced disease and chronic or refractory breathlessness: a mixed-methods evidence synthesis

“…53 Despite this, there remain few effective treatments for chronic breathlessness, making it a major challenge in improving palliative and end-of-life care. 18,[54][55][56][57] There are limited pharmacological treatments for chronic breathlessness 43,58 and there are currently no licensed medicines for the treatment of this symptom anywhere in the world. 2,59-62 Systematic reviews of effectiveness and clinical trials are available for opioids, oxygen and benzodiazepines.…”