Equal palliative care for patients with COPD? A nationwide register study

Ingela  Henoch; Peter  Strang; Claes-Göran  Löfdahl; Ann  Ekberg-Jansson

doi:10.1080/03009734.2019.1586803

Ingela Henoch Department of Research and Development, Angered Local Hospital, Gothenburg, Sweden; The Sahlgrenska Academy, Institute of Health and Care Sciences, University of Gothenburg, Sweden http://orcid.org/0000-0002-1987-5419
Peter Strang Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden; Stockholms Sjukhem Foundation's Research and development unit, Stockholm, Sweden
Claes-Göran Löfdahl University of Lund, Sweden; COPD Center, Institute of Medicine, Sahlgrenska University Hospital, University of Gothenburg, Sweden
Ann Ekberg-Jansson Department of Research and Development, Region Halland, Sweden; The Sahlgrenska Academy, Institute of Medicine, University of Gothenburg, Sweden

DOI: https://doi.org/10.1080/03009734.2019.1586803

Keywords: Palliative care, chronic obstructive pulmonary disease, symptoms, advance care planning, register study

Abstract

Background: Although chronic obstructive pulmonary disease (COPD) is a life-limiting disease with a significant symptom burden, the patients are more often referred to nursing homes (NH), than to specialist palliative care (SPC) at the end of life (EOL). This study aimed to compare patients with COPD in SPC with those in NH and to compare the care provided.

Methods: A national register study was carried out where the Swedish National Airway Register and the Swedish Register of Palliative Care were merged. COPD patients who died in NHs or short-term facilities were included in the NH group (n = 415) and those who died in SPC were included in the SPC group (n = 355). Demographic and clinical variables were included from the Swedish National Airway Register and variables concerning EOL care from the Swedish Register of Palliative Care.

Results: Symptom prevalence was similar in NHs and SPC, but symptom assessment (32% vs 20%), symptom relief medication (93-98% in SPC vs 74-90% in NH), EOL discussions (88% vs 66%), and bereavement support (94% vs 67%) were more likely in SPC (in all comparisons p < 0.001). Younger age and co-habiting increased the probability of dying in SPC (p < 0.001).

Conclusion: Despite similar symptom prevalence, older persons are more likely to be referred to NHs. If applying a palliative care philosophy in NHs, routine symptom assessment and prescription of rescue medication for frequent symptoms, would be more likely. Promoting advance care planning and EOL discussions at an earlier stage would result in more prepared patients and families.

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