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04-07-2013 | Respiratory | Article

Call for palliative care awareness in COPD

Abstract

Free abstract

medwireNews: Researchers in Belgium say that more must be done to make both physicians and patients aware that palliative care is an option for patients with COPD.

They found that patients with the condition were significantly less likely to be referred to palliative care than patients with other chronic diseases, and many received ongoing curative or life-prolonging treatment instead of being made comfortable in the last weeks of life.

The population-based study included data on 1197 patients whose deaths were from COPD (9.3%), heart failure (7.4%), cancer (56.2%), or involved severe dementia (27.2%).

Only 20% of patients with COPD were referred to palliative care services in the last 3 months of life, while the odds for referral were 2.0-fold greater for patients with heart failure (34.1%), 2.3-fold greater for patients with dementia (37.4%), and 6.1-fold greater for patients with cancer (60.3%).

Patients with COPD also had a lower median number of days between referral and death, at 10 days compared with 12, 14, and 20 days for heart failure, dementia, and cancer patients, respectively. However, this did not remain significant after adjusting for confounders.

Furthermore, patients with COPD were more likely than patients with other conditions to still be receiving treatment aimed at cure or life prolongation in the last week of life, with 40.2% of patients not receiving treatment with a comfort or palliative goal during this time. This contrasts with a figure of just 15.1% among cancer patients.

"Our study shows that palliative care services still serve mainly cancer patients in comparison with others, despite the World Health Organisation calling for palliative care for all chronic life-limiting diseases," the authors, led by Kim Beernaert (Vrije Universiteit Brussel & Ghent University) comment in Respiratory Medicine.

They suggest that this may be due to the historical focus on cancer and the easier predictability of the disease's trajectory. However, they say " it is particularly remarkable that COPD, with disease symptoms and trajectory comparable to heart failure and an unpredictable prognosis comparable to dementia, has a significantly lower proportion of referrals… and differs a great deal in terms of treatment goals at the end of life."

The authors note that not all patients with COPD will require specialist palliative care and therefore, palliative expertise should be cascaded down to general practitioners and respiratory doctors.

"By combining the skills of general practitioners, respiratory physicians and palliative care services, the care of patients with COPD can be advanced," they conclude.

medwireNews (www.medwirenews.com) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2013

By Kirsty Oswald, medwireNews Reporter

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