Palliative and end of life care conversations in COPD - a systematic literature review

Abstract

Chronic obstructive pulmonary disease (COPD) is a chronic life-limiting disorder characterised by persistent airflow obstruction and progressive breathlessness. Discussions/conversations between patients and clinicians ensure palliative care plans are grounded in patients' preferences. This systematic review aimed to explore what is known about palliative care conversations between clinicians and COPD patients.A comprehensive search of all major healthcare-related databases and websites was performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies were quality assessed, employing widely used quality-assessment tools, with only papers scoring moderate-tohigh quality included. All relevant data were extracted. A narrative synthesis was used to analyse, process and present the final data.The findings indicated that the frequency and quality of palliative care conversations is generally poor. Patients and physicians identified many barriers and important topics were not discussed. Patients and clinicians reported tension between remaining hopeful and the reality of the patients' condition. When discussions did happen, they often occurred at an advanced stage of illness and in respiratory wards and intensive care units.In conclusion, current care practices do not facilitate satisfactory conversations about palliative care between COPD patients and clinicians. This impacts upon the fulfilment of patients' preferences at the end of life. @ERSpublications Conversations about palliative care in COPD http://ow.ly/NlKt307jgRs

How do hospital-based nurses and physicians identify the palliative phase in their patients and what difficulties exist? A qualitative interview study

“…It also seems that the patients' voice within the assessment of treatment-trade-off is not always taken into account. This finding is not surprising, barriers to starting conversation about the end of life are numerous and divers [31,40]. One specific barrier described by our respondents is that they did not believe to be the right person to discuss the end of life with patients.…”

Observational cohort study of outcomes in patients admitted to the intensive care unit for acute exacerbation of chronic obstructive pulmonary disease

“…The degree to which palliative care consultations occurred were not captured within this study but a recent systematic review found that current practices for AECOPD patients could improve considerably. 20 It would appear reasonable to include palliative care as an important adjunct to the management of AECOPD in ICU whenever LOMT has been decided.…”

“…18,19 Different views between intensivists and respiratory physicians on the likely clinical trajectory of AECOPD and the need for ICU admission are not uncommon. Transparent and honest discussion between healthcare professionals, patients and their relatives about goals of treatment is to be encouraged, and limitations of medical therapy and palliative care, even while active treatment is ongoing, 20 should be considered. Compared to patients with cancer, patients with AECOPD receive less palliative care and are more likely to succumb to their disease following aggressive and invasive treatments with an admission to ICU.…”

“…Compared to patients with cancer, patients with AECOPD receive less palliative care and are more likely to succumb to their disease following aggressive and invasive treatments with an admission to ICU. 20,21 In this study, we aimed to describe patients with AECOPD admitted to a major Australian teaching hospital ICU over a period of 6 years focusing on the performance of ICU prognostic systems and mortality outcomes in ICU, during admission and over a 1-year follow-up period. Patients were divided into three study groups defined by the decision to provide full and active treatment, to limit medical therapy or to withdraw life-sustaining therapy.…”

A cluster randomized controlled trial on a multifaceted implementation strategy to promote integrated palliative care in COPD: study protocol of the COMPASSION study

“…However, it is not yet clear how palliative care can be successfully integrated into COPD-care. At the moment, discussions on prognosis, goals of care and advance care planning rarely occur or only at a very late stage of the disease [9]. Neither are patients with COPD regularly referred to specialist palliative care [10].…”