Palliative Care for Patients Dying in the Intensive Care Unit with Chronic Lung Disease Compared with Metastatic Cancer

Abstract

Rationale: Palliative care has been focused largely on patients with cancer, and yet patients with chronic lung diseases also have high morbidity and mortality. The majority of deaths in intensive care units (ICUs) follow decisions to withhold or withdraw life-sustaining treatments, suggesting that palliative care is critically important in this setting.Objectives: We explored differences in receipt of elements of palliative care among patients with interstitial lung disease (ILD) and chronic obstructive pulmonary disease (COPD) who die in ICUs compared with patients with cancer.Methods: We identified patients with COPD, ILD, or metastatic cancer who died in the ICUs of 15 Seattle-area hospitals between 2003 and 2008. We used robust multivariable logistic and linear regression to compare differences in receipt of elements of palliative care and length of stay. Measurements and Main Results:Compared with patients with cancer, patients with COPD were more likely to receive cardiopulmonary resuscitation before death and patients with ILD were less likely to have documentation of pain assessment in the last day of life. Patients with ILD and COPD were less likely to have a do-not-resuscitate order in place at the time of death and less likely to have documentation of discussions about prognosis than patients with cancer. Patients with COPD had longer hospital lengths of stay, and patients with COPD and ILD had longer ICU lengths of stay. Conclusions:Among patients who die in the ICU, patients with ILD and COPD receive fewer elements of palliative care and have longer lengths of stay than patients with cancer. These findings identify areas for improvement in caring for patients with chronic lung diseases.Clinical trial registered with www.clinicaltrials.gov (NCT00685893).

Life-Sustaining Procedures, Palliative Care, and Cost Trends in Dying COPD Patients in U.S. Hospitals: 2005~2014

“…To the best of our knowledge, the current study reports the first ten-year national temporal trends of LSTs, palliative care, is predictable, the disease trajectories for chronic advanced non-cancer disease, such as COPD, are heterogeneous which makes it difficult to accurately assess prognosis (23,27,34,40) and introduce palliative care appropriately. In contrast, other systemic procedures such as blood transfusion and nutrition decreased over time.…”

“…When compared with patients with cancer or other severe chronic diseases, end-stage COPD patients were less likely to be referred for a palliative consultation (16). COPD patients are more likely than patients with other chronic illnesses to receive a disproportionate amount of life-sustaining treatment (LST) including intensive procedures (8,27) and ICU admissions (28).…”

The palliative care needs of patients with idiopathic pulmonary fibrosis: A qualitative study of patients and family caregivers

“…9–12 Patients with IPF represent a group of individuals with a chronic respiratory disease who are without disease-reversing treatment options and, absent lung transplantation, inevitably face progressive decline and death. 1 Prior work supports that location of death too frequently occurs in an acute care setting, without the benefit of support available through advance care planning including the introduction of palliative care.…”

Developing a Research Agenda for Integrating Palliative Care into Critical Care and Pulmonary Practice To Improve Patient and Family Outcomes

“…Although palliative care for patients with COPD is less well developed than for patients with cancer, 65,66 palliative care for other chronic pulmonary diseases is even more nascent. Patients with chronic ILD are less likely to receive palliative care than patients with cancer or patients with COPD 67 and tend to receive palliative care only very late in their illness trajectory. 68 Patients with ILD and pulmonary fibrosis report a desire to engage in discussions about end-oflife care, yet this need is generally unmet.…”

“…74 Even once in the ICU, patients with COPD or ILD receive fewer indicators of palliative care than patients with cancer. 63,67 Given the prevalence of patient fear, anxiety, and depression related to their illness and frailty, equipping providers with tools to help address patients' emotional distress is important.…”