Palliative care in COPD: an unmet area for quality improvement

Abstract

COPD is a leading cause of morbidity and mortality worldwide. Patients suffer from refractory breathlessness, unrecognized anxiety and depression, and decreased quality of life. Palliative care improves symptom management, patient reported health-related quality of life, cost savings, and mortality though the majority of patients with COPD die without access to palliative care. There are many barriers to providing palliative care to patients with COPD including the difficulty in prognosticating a patient’s course causing referrals to occur late in a patient’s disease. Additionally, physicians avoid conversations about advance care planning due to unique communication barriers present with patients with COPD. Lastly, many health systems are not set up to provide trained palliative care physicians to patients with chronic disease including COPD. This review analyzes the above challenges, the available data regarding palliative care applied to the COPD population, and proposes an alternative approach to address the unmet needs of patients with COPD with proactive primary palliative care.

Resource Use and Health Care Costs of COPD Patients at the End of Life: A Systematic Review

“…Our results are corroborated by Curtis et al, who conclude that palliative care services are an important opportunity for improving end-of-life care. 31 Although certain health systems may currently not be designed to adequately reimburse palliative care treatments, 32 other possible explanations for low use of available palliative care in COPD patients may include different factors such as provider failure to recognize the imminent death of patients with COPD, the perception that palliative care services are available only to cancer patients, the assumption that the provided care is sufficient, or the belief that a terminal COPD patient already received palliative care elsewhere, such as in a long-term care facility. 7,18 Given that the use of a specific intervention is affected by disease stage, the individual's functional status, and the best evidence available at that time, not every intervention can be labeled as futile care.…”

The Transplant Palliative Care Clinic: An early palliative care model for patients in a transplant program

“…In addition, our preliminary results indicate a TPCC model may help to stabilize or improve multiple symptoms. Several studies have identified the high symptom burden of end‐stage heart and lung disease, yet palliative care integration into noncancer disease management remains poor and inconsistent …”

Early Integration of Palliative Care into Standard Oncology Care: Evidence and Overcoming Barriers to Implementation

“…That concern is amplified by the recognition that early palliative care involvement and expertise benefits not only cancer patients, but also patients with life-limiting nonmalignant disease such as congestive heart failure and chronic obstructive pulmonary disease 16,17 .…”