Effectiveness of the integration of a palliative care team in the follow-up of patients with advanced chronic obstructive pulmonary disease : The home obstructive lung disease study

Article

GAINZA-MIRANDA, D. | SANZ-PECES, E. M. | VARELA CERDEIRA, M. | PRADOS SANCHEZ, C. | ALONSO-BABARRO, A.

BACKGROUND: Access to palliative care for patients with end-stage chronic obstructive pulmonary disease (COPD) is still very poor. OBJECTIVES: Evaluate our palliative care program for patients with advanced COPD by assessing whether the referral criteria for advanced COPD patients were adequate in identifying patients in end-of-life care and determine the results of the palliative care team's intervention METHODS: This was a prospective observational study of patients admitted to a multidisciplinary unit for advanced COPD. Data on sociodemographic variables, survival, symptomatology, quality of life, ACP, and health resource utilization were analyzed. RESULTS: Eighty-three patients were included in this study. By the end of the follow-up period, 69 (83%) patients had died, mainly due to respiratory failure (96%). The median duration of survival from the start of follow-up was 4.27 months (95% confidence interval, 1.97-16.07). Most patients (94%) had a dyspnea level of 4. Sixty (72%) patients required opioids for dyspnea control. There were no significant differences in the quality of life of the patients during follow-up. Thirty (43%) patients died at home, 26 (38%) in a palliative care unit, and 13 (19%) in an acute care hospital. ACP was performed for 50 (72%) patients. Forty (57%) patients required palliative sedation during follow-up. Dyspnea was the reason for sedation in 34 (85%) patients. Hospital admissions and emergency room visits decreased significantly (p = 0.01) during follow-up. CONCLUSIONS: Our integrated model allows for adequate selection of patients, facilitates symptom control and ACP, reduces resource utilization, and favors death at home.

http://dx.doi.org/10.1016/j.hrtlng.2023.07.006

Voir la revue «Heart and lung, 62»

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