Introduction The chronic obstructive pulmonary disease (COPD) illness trajectory consists of a gradually deteriorating baseline with intermittent exacerbations. In end-stage COPD, exacerbations carry a significant risk of mortality (Iyer, 2022).2Patients and their families often underestimate the severity of the disease and the risk of mortality (Elkington, 2005; Janssen, 2012).1,3 Given the disease trajectory, there is an important role for early advance care planning.
Aim To assess the effects of an educational intervention on the quality of generalist palliative care provided to patients with advanced COPD during an acute hospital admission.
Methods We reviewed the notes of patients admitted under the respiratory team at Hereford County Hospital with a COPD exacerbation and a background of at least one poor prognostic factor. These were assessed in the three months before and after an educational intervention. The notes were assessed for a range of quality outcomes in palliative and supportive care.
Results There were twenty-three patients who met the inclusion criteria pre-intervention, and nineteen patients’ post-intervention. Discussions with patients regarding their illness trajectory occurred more frequently post-intervention, in 42% of cases vs 17% of cases. Post-intervention, patients were more likely to have a Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) with a documented ceiling of treatment, present in 95% of patients compared with 83% pre-intervention. Discussions surrounding preferred place of care and/or death took place in 26% of cases post-intervention vs 9% pre-intervention. Previously expressed future care wishes were reassessed more frequently post intervention, in 69% of cases compared to 54% pre-intervention.
Conclusions Following an educational intervention, discussions around prognosis and future care planning took place more frequently in hospital inpatients with end-stage COPD. We are proposing an expanded educational programme with a focus on respiratory nurse specialists.
Elkington A, White P, Addington-Hall J, Higgs R, Edmonds E. The healthcare needs of chronic obstructive pulmonary disease patients in the last year of life, Palliative Medicine, 2005;19(6):485–91.
Iyer AS, Sullivan DR, Lindell KO, Reinke LF. The role of palliative care in COPD, Chest, 2022;161(5):1250–1262.
Janssen DJA, Engelberg RA, Wouters EFM, Curtis JR. Advance care planning for patients with COPD: Past, present, and future, Patient Education and Counseling, 2012;86(1):19–24.
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