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Poster Numbers 242 – 279 – Palliative care: all conditions and all ages: Poster No: 273
End-of life care in chronic obstructive pulmonary disease: Are we failing our patients?
  1. Jennifer Scaife1,
  2. Stephen Murphy1 and
  3. Mark Lee2
  1. 1City Hospitals Sunderland, Sunderland, UK
  2. 2St Benedict's Hospice, Sunderland, UK

Abstract

Background Chronic obstructive pulmonary disease (COPD) is a progressive and life-limiting condition. Most patients die in hospital.

Aims This study aimed to characterise end-stage COPD and assess quality and effectiveness of end-of-life (EOL) care for patients dying in hospital from COPD.

Methods Medical records of in-patient deaths due to COPD in a 6 month period in 2009 were reviewed. Data included COPD severity assessment (Global initiative on Obstructive Lung Disease; GOLD), WHO performance status (WHO-PS) and co-morbidities. In addition, use of the Liverpool Care Pathway (LCP), EOL- prescribing and factors influencing treatment decisions were assessed.

Results 28 patients were included in the study; 46.4% male, mean (SD) age 74.4 (8.7) years. Most (92%) had severe or very severe (GOLD stage 3-4) disease and poor performance status (73% WHO-PS 3-4). 46% received non-invasive ventilation (NIV). Ceiling of care was documented in 53.6%. Median (IQ range) survival was 7 (2-15) days. 89% had a DNACPR order but evidence of discussion of EOL-care with patient or family was infrequent (14.3% and 64.3%) and rarely involved a consultant (25%). EOL drugs were prescribed in 28.6% and the LCP was used in 32.1%. There were no differences in COPD severity, performance status or co-morbidity between patients on/off the LCP. Patients receiving NIV were less likely to be on the LCP (25% vs 46% OR 0.44 (0.06-3.1) or receive EOL-drugs (16.6 % vs 42.8% OR 0.27 (0.027-2.2).

Conclusion Poor prognosis is rarely communicated to end stage COPD patients and there is inadequate planning for EOL-care. When ‘active’ interventions such as NIV are used, it seems that EOL-care measures (such as LCP) are less likely to be considered. An emphasis on ‘life-prolonging’ treatments for COPD and a failure to recognise futility in end-stage disease results in many patients being denied adequate palliative measures. Further studies are required.

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