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

Faes, Kristof; Frène, Veerle De; Cohen, Joachim; Annemans, Lieven

doi:10.1016/j.jpainsymman.2016.04.007

Cited by 40 publications

(35 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The literature describes that the number of hospitalizations and ED visits increases with the approach of end of life of COPD patients. 53 This increase was not observed in our study, and the number actually decreased from the previous year. This result may be related with the involvement of specific palliative care teams in patient monitoring, as it was reported by at least two systematic reviews.…”

Section: Discussioncontrasting

confidence: 63%

Breaking Barriers: Prospective Study of a Cohort of Advanced Chronic Obstructive Pulmonary Disease Patients To Describe Their Survival and End-of-Life Palliative Care Requirements

Miranda

Peces

Alonso-Babarro

et al. 2019

Journal of Palliative Medicine

View full text Add to dashboard Cite

Background and Aim: Consensus has been reached on the need to integrate palliative care in the follow-up examinations of chronic obstructive pulmonary disease (COPD) patients. We analyzed the survival from the initiation of follow-up by a palliative home care team (PHCT) and described the needs and end-of-life process. Setting and Design: This study was a prospective observational cohort study of advanced COPD patients referred to a PHCT. Sociodemographic variables, survival from the start date of follow-up using the Kaplan–Meier model, health resource consumption, perceived quality of life, main symptomatology, opioid use, and advanced care planning (ACP) were analyzed. Results: Sixty patients were included. The median survival was 8.3 months. Forty-two patients died at the end of the study (85% at home or in palliative care units). The most frequent cause of death was respiratory failure in 39 patients (93%), with 29 of these patients requiring sedation (69%). Dyspnea at rest, with an average of 5 (standard deviation [SD] 2) points, was the main symptom. Fifty-five patients (91%) required opioids for symptom control. The median score in the St. George's Respiratory Questionnaire was 72 (SD 13). The mean number of visits by the home team was 7 (SD 6.5). The mean number of admissions during the monitoring period was 1.5 (SD 0.15). Conclusions: The characteristics of the cohort appear suitable for a PHCT. The follow-up care provided by our multidisciplinary unit decreased the number of hospitalizations, favored the development of ACP, and enabled death at home or in palliative care units.

show abstract

Section: Discussioncontrasting

confidence: 63%

Breaking Barriers: Prospective Study of a Cohort of Advanced Chronic Obstructive Pulmonary Disease Patients To Describe Their Survival and End-of-Life Palliative Care Requirements

Miranda

Peces

Alonso-Babarro

et al. 2019

Journal of Palliative Medicine

View full text Add to dashboard Cite

show abstract

“…59 The societal impact including the burden upon hospitals is also substantive, especially during the final months of COPD. 60 The pharmacotherapy of COPD is challenging since unlike the drug-responsive airflow restrictions that accompany asthma, bronchodilators afford only modest benefits. 61 The lung pathology underlying COPD is an exaggeration of the low-grade inflammatory cell infiltration to the bronchi and peripheral lung that occurs in most smokers.…”

Section: Acrolein and Disease: Four Exposure Scenariosmentioning

confidence: 99%

Acrolein and Human Disease: Untangling the Knotty Exposure Scenarios Accompanying Several Diverse Disorders

Burcham

2016

Chem. Res. Toxicol.

View full text Add to dashboard Cite

Acrolein is a highly toxic electrophile that participates in many diseases, yet efforts to delineate its precise mechanistic contributions to specific conditions are complicated by its wide distribution within human environments. This Perspective develops the proposal that due to its mixed status as environmental pollutant, metabolic byproduct, and endotoxicant which forms via ubiquitous pathophysiological processes, many diseases likely involve acrolein released from multiple sources. Although the category boundaries are indistinct, at least four identifiable exposure scenarios are identifiable. First, in some syndromes, such as those accompanying chronic or acute intoxication with smoke, whatever role acrolein plays in disease pathogenesis mainly traces to exogenous sources such as the combustion of tobacco or other organic matter. A second exposure category involves xenobiotics that undergo metabolism within the body to release acrolein. Still other health conditions, however, involve acrolein that forms via several endogenous pathways, some of which are activated upon intoxication with xenobiotics (i.e., Exposure Category 3), while still others accompany direct physical trauma to body tissues (Exposure Category 4). Further complicating efforts to clarify the role of endogenous acrolein in human disease is the likelihood that many such syndromes are complex phenomena that resemble "chemical mixture exposures" by involving multiple toxic substances simultaneously. This Perspective contends that while recent decades have witnessed much progress in describing the deleterious effects of acrolein at the cellular and molecular levels, more work is needed to define the contributions of different acrolein sources to "real-world" health conditions in human subjects.

show abstract

“…Simply expanding existing cancer‐focused models of care to include noncancer diseases may not be appropriate, as COPD patients are on average older than cancer patients and have different patterns of dependency and functional decline, as well as multi‐morbidity (Pantilat, O' Riordan, Dibble, & Landefeld, ) including cardiovascular, metabolic, musculoskeletal, cancer and psychiatric conditions (Divo, Martinez, & Mannino, ). Patients with COPD experience a trajectory of slow physical decline, punctuated by serious and unpredictable disease exacerbations and therefore can frequently receive more aggressive hospital intervention towards end of life (Faes, De Frène, Cohen, & Annemans, ); and are more likely to require admission to intensive care, than those with cancer (Au, Udris, Fihn, McDonell, & Curtis, ). While there are large numbers of patients who are affected by the burden of COPD, several barriers to the delivery of adequate palliative care for patients with COPD exist (Brown, Jecker, & Curtis, ).…”

Section: Introductionmentioning

confidence: 99%

Nurse‐led integration of palliative care for chronic obstructive pulmonary disease: An integrative literature review

Ora

Mannix

Morgan

et al. 2019

Journal of Clinical Nursing

View full text Add to dashboard Cite

Aims and objectives To uncover what is known about nurse‐led models or interventions that have integrated palliative care into the care of patients with chronic obstructive pulmonary disease. Background Chronic obstructive pulmonary disease is a highly symptomatic, incurable disease characterised by chronic symptoms that without appropriate palliation can lead to unnecessary suffering for patients and their caregivers. While palliative care practices can relieve suffering and improve quality of life, most palliative models of care remain cancer‐focused. New models, including nurse‐led care that integrates palliative care for patients with chronic obstructive pulmonary disease, could address patient suffering and therefore need to be explored. Method A mixed‐studies integrative review was undertaken. Seven databases were searched for articles published between 2008–2018. The PRISMA framework was applied to the search, and six studies met the review eligibility criteria. Content analysis of the articles was undertaken, and data were compared, looking for different nurse‐led models and outcomes related to palliative care in chronic obstructive pulmonary disease. Results Nurse‐led, integrated palliative care models for patients with chronic obstructive pulmonary disease are rare and just four of the six articles found in this review had published results. Advance care planning was found to be the most common focus for nurse‐led interventions in chronic obstructive pulmonary disease, and in all cases, results demonstrated an improvement in end‐of‐life discussions and completion of advance care directives. Of the reviewed articles, none used a qualitative framework to explore nurse‐led models that integrated palliative care in chronic obstructive pulmonary disease. Conclusion While nurse‐led advance care planning was one type of palliative care practice associated with positive patient outcomes, there is a need for deeper exploration of nurse‐led models that holistically address the bio‐psycho‐social‐spiritual needs of patients with chronic obstructive pulmonary disease, and their caregivers. Relevance to clinical practice Integrating nurse‐led supportive care clinics into chronic obstructive pulmonary disease services could be a way forward to address the unmet bio‐psycho‐social‐spiritual needs of patients with chronic obstructive pulmonary disease, and their caregivers.

show abstract

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

Cited by 40 publications

References 32 publications

Breaking Barriers: Prospective Study of a Cohort of Advanced Chronic Obstructive Pulmonary Disease Patients To Describe Their Survival and End-of-Life Palliative Care Requirements

Breaking Barriers: Prospective Study of a Cohort of Advanced Chronic Obstructive Pulmonary Disease Patients To Describe Their Survival and End-of-Life Palliative Care Requirements

Acrolein and Human Disease: Untangling the Knotty Exposure Scenarios Accompanying Several Diverse Disorders

Nurse‐led integration of palliative care for chronic obstructive pulmonary disease: An integrative literature review

Contact Info

Product

Resources

About