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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