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

Research output: Contribution to journalArticle

Original languageEnglish
Pages (from-to) e362-e370(9)
Number of pages9
JournalBritish Journal of General Practice
Volume61
Issue number587
DOIs
Publication statusPublished - Jun 2011

King's Authors

Abstract

Background:
Calls 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.

Aim:
To determine palliative care needs in advanced COPD.

Design:
Cross-sectional interview study in patients' homes using structured questionnaires generated from 44 south London general practices.

Method:
One hundred and sixty-three (61% response) patients were interviewed, mean age 72 years, 50% female, with diagnosis of COPD and at least two of: forced expiratory volume in the first second (FEV1) <40% predicted, hospital admissions or acute severe exacerbations with COPD, long-term oxygen therapy, cor pulmonale, use of oral steroids, and being housebound. Patients with advanced cancer, severe alcohol-related or mental health problems, or learning difficulties, were excluded; 145 patients were included in the analysis.

Results:
One hundred and twenty-eight (88%) participants reported shortness of breath most days/every day, 45% were housebound, 75% had a carer. Medical records indicated that participants were at least as severe as non-participants. Eighty-two (57%) had severe breathlessness; 134 (92%) said breathlessness was their most important problem; 31 (21%) were on suboptimal treatment; 42 (30%) who were severely affected had not been admitted to hospital in the previous 2 years; 86 of 102 who had been admitted would want admission again if unwell to the same extent. None expressed existential concerns and few discussed need in terms of end-of-life care, despite severe breathlessness and impairment.

Conclusion:
Needs in advanced COPD were considerable, with many reporting severe intractable breathlessness. Palliation of breathlessness was a priority, but discussion of need was seldom in terms of `end-of-life care'.

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