Study identifies palliative care needs of patients with COPD, health care professionals

Palliative care is increasingly being implemented for nonmalignant diseases such as severe COPD, and a new study identified unmet needs of patients, caregivers and health professionals.

“Different models of palliative care services are emerging for COPD patients, including integrated services, short-term palliative care and outpatient services. A set of palliative approaches has proved beneficial, including pulmonary rehabilitation, improving patients’ breathlessness and psychosocial wellbeing,” Yu Fu, PhD, senior research fellow in the Academic Unit of Palliative Care at the Leeds Institute of Health Sciences, U.K., and colleagues wrote in Chest. “ However, research suggests that patients with COPD still have limited access to palliative care. Compared with lung cancer patients, patients with severe COPD receive less palliative support because of the difficulty in predicting prognosis and barriers to referral and adherence to services. These issues can lead to poor palliative care input in terms of frequency and quality and, consequently, to unmet needs and dissatisfaction in patients and carers.”

The multicenter qualitative study evaluated 20 patients with severe COPD, six caregivers and 25 health professionals in COPD services and specialist palliative care in the U.K. Researchers obtained data from semi-structured interviews to analyze themes observed in COPD care and support.

Researchers identified four themes from the interviews:

• management of exacerbations;
• palliative care needs;
• access to palliative care; and
• pathways and integration of palliative care support.

Among patients and caregivers, researchers observed a commonality between uncertainty and fear. In addition, patients with COPD and their caregivers identified a need for reassurance, rapid medical access, home care and financial advice related to the disease.

For health professionals, an important factor in COPD care stemmed from timely palliative care. Palliative care had been integrated into COPD services with varied models across different regions. Health professionals also highlighted the importance of reliable screening tools, needs assessments, embedded psychological care, enhanced palliative care training and communication skills to have timely palliative care and optimized management.

According to the researchers, these results provide evidence on integrating palliative care into COPD services, but the current pathways and care delivery models are unclear.

“Patients with severe COPD and their [caregivers] have unmet needs for managing uncertainty and fear, daily living and finances, although palliative care increasingly is being integrated and implemented for nonmalignant diseases including COPD throughout the United Kingdom,” the researchers wrote. “A standardized screening and needs assessment tool is required to achieve early palliative care and to address the identified needs of this population.”