Chronic obstructive pulmonary disease (COPD) is the third leading cause of death in the United States, claiming the lives of over 124,000 people in 2007 according to the Centers for Disease Control and Prevention.  Yet patients with COPD are less likely to be offered palliative care resources than cancer patients, according to a study recently published in Chest, the official journal of the American College of Chest Physicians.

Researchers analyzed questionnaire responses of 374 COPD patients treated at the Veterans Affairs health care system in Seattle and Tacoma, WA.  Among their findings were:

• 67.6% of patients with COPD indicated a desire for end-of-life planning discussions.
• Only 14.6% reported having had such discussions with their clinicians.
• Patients who had end-of-life discussions were more than twice as likely to rate their care as the “best imaginable.”
• Discussions were more likely to have occurred among patients with worse overall health status than among those with more advanced COPD.

The authors note that a 2004 guideline from the American Thoracic Society recommends that end-of-life care be integrated into routine COPD therapy, but this has not yet been translated into clinical practice.  As a result, patients with COPD are more likely to receive treatment consistent with preservation of life at the end of life.  “Moreover, palliative care resources often made available to cancer patients are less likely to be offered to patients with COPD,” they conclude.

The authors observe that physicians may feel that it is not appropriate to discuss end-of-life preferences until patients reach very advanced stages of COPD.  Discussions may then occur when patients and family are already under significant stress, making careful reflection about preferences difficult.

How can hospice help COPD patients at end of life?  Hospice care involves management of pain and symptoms such as shortness of breath and anxiety.  It also includes an individualized care plan, emotional, psychological and spiritual support, support for loved ones on caring for the patient, and bereavement support and counseling.  Hospice is about living every day to its fullest at the end of life, in comfort and in control.

Any person with a life-limiting illness, regardless of age, may be eligible for one of our programs at Regional Hospice and Home Care of Western CT.  Many different diagnoses may be considered, including COPD.  Hospice care is a covered benefit under Medicare, Medicaid, and many private insurance carriers.  Anyone can make a referral—a patient, family member, physician or friend.  Call 203-702-7400 to refer someone to Regional Hospice and Home Care.

(Source of the study:  “The Effect of End-of-Life Discussions on Perceived Quality of Care and Health Status among Patients with COPD,” Chest; Epub ahead of print, January 2012; DOI:  10.1378/chest.11-2222.  Leung JM, Udris EM, Uman J, Au DH; Critical Care Medicine Dept., National Institutes of Health, Bethesda, Maryland; Dept. of Medicine, Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle; and Health Services Research and Development, VA Puget Sound Health Care System, Seattle.)