Palliative care or end-of-life care in advanced chronic obstructive pulmonary disease A prospective community survey

White, Patrick; White, Suzanne; Edmonds, Polly; Gysels, Marjolein; Moxham, John; Seed, Paul; Shipman, Cathy

doi:10.3399/bjgp11x578043

Cited by 49 publications

(38 citation statements)

References 35 publications

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“…23 Proactive patient contact is possible; however, contact of COPD patients with general practices can be influenced by factors including the relationship with the GP, illness perceptions, and ease of access to the practice. 24,25 Therefore, illness perceptions and expectations might have influenced patients in this study in contacting their general practice or outpatient department and requesting support and advice.…”

Section: Interpretation Of Findings In Relation To Previously Publishmentioning

confidence: 99%

Coordination of end-of-life care for patients with lung cancer and those with advanced COPD: are there transferable lessons? A longitudinal qualitative study

Epiphaniou

Shipman

Harding

et al. 2014

Primary Care Respiratory Journal

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Background: Care coordination is defined as good communication between professionals to enable access to services based on need.Aims: To explore patients' experience of care coordination in order to inform current debates on how best to coordinate care and deliver services in end-of-life for patients with lung cancer and those with chronic obstructive pulmonary disease (COPD).Methods: A qualitative study involving serial interviews was performed in 18 patients recruited from three hospital outpatient clinics situated in a hospital. Interviews were transcribed verbatim and data were analysed thematically.Results: Data comprised 38 interviews. Patients experiencing services related to lung cancer reported good access enabled by the involvement of a keyworker. This contrasted with COPD patients' experiences of services. The keyworker coordinated care between and within clinical settings, referred patients to community palliative care services, helped them with financial issues, and provided support.Conclusions: For patients with lung cancer, the keyworker's role augmented access to various services and enabled care based on their needs. The experiences of patients with COPD highlight the importance of providing a keyworker for this group of patients in both secondary and primary care.

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Section: Interpretation Of Findings In Relation To Previously Publishmentioning

confidence: 99%

Coordination of end-of-life care for patients with lung cancer and those with advanced COPD: are there transferable lessons? A longitudinal qualitative study

Epiphaniou

Shipman

Harding

et al. 2014

Primary Care Respiratory Journal

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“…When end-of-life discussions occur in patients with COPD, most occur during an acute exacerbation rather than a more stable state of their disease, and the skill of the providers leading the discussion is commonly inadequate [243][244][245]. Similarly, palliative care is often not addressed or inadequately addressed in patients with COPD, permitting symptoms whose mitigation or elimination would provide comfort to patients with COPD, such as dyspnoea, cough, pain and fatigue, and less commonly poor sleep quality, depression and anxiety [246,247]. Up to 30% of patients with advanced COPD with multiple symptoms are not on optimised therapy [248].…”

Section: End-of-life Carementioning

confidence: 99%

An official American Thoracic Society/European Respiratory Society statement: research questions in COPD

et al. 2015

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Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity, mortality, and resource use worldwide. The goal of this official American Thoracic Society (ATS)/European Respiratory Society (ERS) research statement is to describe evidence related to diagnosis, assessment and management; identify gaps in knowledge; and make recommendations for future research. It is not intended to provide clinical practice recommendations on COPD diagnosis and management.Clinicians, researchers, and patient advocates with expertise in COPD were invited to participate. A literature search of Medline was performed, and studies deemed relevant were selected. The search was not a systematic review of the evidence. Existing evidence was appraised and summarised, and then salient knowledge gaps were identified.Recommendations for research that addresses important gaps in the evidence in all areas of COPD were formulated via discussion and consensus.Great strides have been made in the diagnosis, assessment and management of COPD, as well as understanding its pathogenesis. Despite this, many important questions remain unanswered. This ATS/ ERS research statement highlights the types of research that leading clinicians, researchers, and patient advocates believe will have the greatest impact on patient-centred outcomes. @ERSpublications ATS/ERS statement: which types of research will have the greatest future impact on patientcentred outcomes in COPD? http://ow.ly/I54Hb

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“…One of the goals of the intervention was indeed to have patients understand the prognosis of their disorder and the possible futility of aggressive end-of-life managements. Very little data are available on ACP in COPD; and available data show that ACP is surprisingly uncommon in this population [42-45]. Paradoxically, ACP obtained most often expressed the desire of CPR and maximal treatment, patients failing to acknowledge their prognosis and the natural history of their disease [46].…”

Section: Discussionmentioning

confidence: 99%

Can Early Introduction of Palliative Care Limit Intensive Care, Emergency and Hospital Admissions in Patients with Severe Chronic Obstructive Pulmonary Disease? A Pilot Randomized Study

et al. 2019

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Background: Despite their poor prognosis, patients with severe chronic obstructive pulmonary disease (COPD) have little access to palliative care and tend to have a high rate of hospital and intensive care unit (ICU) admissions during their last year of life. Objectives: To determine the feasibility of a home palliative care intervention during 1 year versus usual care, and the possible impact of this intervention on emergency, hospital and ICU admissions, survival, mood, and health-related quality of life (HRQL). Methods: Prospective controlled study of patients with severe COPD (GOLD stage III or IV) and long-term oxygen therapy and/or home noninvasive ventilation and/or one or more hospital admissions in the previous year for acute exacerbation, randomized to usual care versus usual care with add-on monthly intervention by palliative care specialists at home for 12 months. Results: Of 315 patients screened, 49 (15.5%) were randomized (26 to early palliative care; 23 to the control group); aged (mean ± SD) 71 ± 8 years; FEV₁ was 37 ± 14% predicted; 88% with a COPD assessment test score > 10; 69% on long-term oxygen therapy or home noninvasive ventilation. The patients accepted the intervention and completed the assessment scales. After 1 year, there was no difference between groups in symptoms, HRQL and mood, and there was a nonsignificant trend for higher admission rates to hospital and emergency wards in the intervention group. Conclusion: Although this pilot study was underpowered to formally exclude a benefit from palliative care in severe COPD, it raises several questions as to patient selection, reluctance to palliative care in this group, and modalities of future trials.

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Palliative care or end-of-life care in advanced chronic obstructive pulmonary disease A prospective community survey

Abstract: BackgroundCalls for better end-of-life care for advanced chronic obstructive pulmonary disease (COPD) reflect the large number who die from the disease and their considerable unmet needs.

Cited by 49 publications

References 35 publications

Coordination of end-of-life care for patients with lung cancer and those with advanced COPD: are there transferable lessons? A longitudinal qualitative study

Coordination of end-of-life care for patients with lung cancer and those with advanced COPD: are there transferable lessons? A longitudinal qualitative study

An official American Thoracic Society/European Respiratory Society statement: research questions in COPD

Can Early Introduction of Palliative Care Limit Intensive Care, Emergency and Hospital Admissions in Patients with Severe Chronic Obstructive Pulmonary Disease? A Pilot Randomized Study

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