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J Palliat Med. 2019 Mar;22(3):290-296. doi: 10.1089/jpm.2018.0363. Epub 2018 Nov 2.

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.

Author information

1
1 Palliative Homecare Team Northern Area of Madrid, SERMAS , San Sebastian de los Reyes, Spain .
2
2 Palliative Care Department, La Paz Hospital , Madrid, Spain .
3
3 Pneumology Department, La Paz Hospital , Madrid, Spain .
4
4 Preventive Medicine, Public Health , SERMAS, San Sebastian de los Reyes, Spain .
5
5 Investigation Support Unit for Primary Care , Gerencia Atención Primaria, Madrid, Spain .
6
6 Investigation Support Multidisciplinary Unit for Primary Care and Community North Area of Madrid, Madrid, Spain.

Abstract

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.

KEYWORDS:

ACP; end of life; palliative care; place of death; pulmonary disease chronic obstructive; quality of life

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