Thomas Gibson, BSc SRT

Palliative care is often misconstrued as being end-of-life care, which can ease the process of dying due to, advanced terminal illness. However, the potential for using palliative care is much more broad than this. The National Institute on Aging describes palliative care as “… a resource for anyone living with a serious illness…” and believes “… palliative care can be helpful at any stage of illness…” (National Institute on Aging, 2017). In addition, the World Health Organization (2020) outlines the scarcity of palliative care in those who need it by stating, “… only about 14% of people who need palliative care currently receive it.”

The Use of Palliative Care in COPD Patients

One disease which has shown benefit from the use of palliative care is chronic obstructive pulmonary disease (COPD) (Mechler & Liantonio, 2019). However, the use of palliative care in COPD prior to end-stage of the disease is uncommon (Iyer et al., 2019). A small exploratory study by Iyer et al. (2019) looked at the needs of patients with moderate to very severe COPD and the needs of their families to see if participants felt they could benefit from early palliative care. The study had an equal number of patients with moderate, severe and very severe COPD and used surveys to measure quality of life, anxiety, depression and feelings of social isolation in both patients and their families (Iyer et al., 2019). The study found an equal distribution of reported poor quality of life, anxiety symptoms, depressive symptoms and social isolation, across all severities of the disease (Iyer et al., 2019). Only 30% of participants had heard of palliative care and of this 30%, the majority held the misconception that palliative care was intended for end-of-life only (Iyer et al., 2019). After a standardized description of palliative care was delivered, every single participant was receptive to palliative care being initiated as early as the moderate stage in COPD (Iyer et al., 2019). The study identified five broad themes for using palliative care early in COPD patients which consist of improvement in coping with COPD, emotional symptoms, respiratory symptoms, illness understanding, and prognostic awareness (Iyer et al., 2019). The study concluded that both patients with moderate to very severe COPD and their families felt they could benefit from palliative care prior to the end-stage of the disease (Iyer et al., 2019). To support these needs, a separate study conducted by Iyer et al. (2020) investigated the opinions of pulmonary and palliative care clinicians in providing palliative care to COPD patients prior to the end-stage of the disease. Clinicians from both specialties supported early palliative care in COPD and believed addressing misconceptions of palliative care, formalizing referral criteria and implementing novel early palliative care models are all necessary steps in providing adequate early palliative care to COPD patients (Iyer et al., 2020).

Limitations

The limitations with these studies include low enrollment numbers and weak levels of evidence. However, an ongoing study is looking at the feasibility of early integrated palliative care in COPD and chronic heart failure by implementing care directly into pulmonology and cardiology wards (Siouta et al., 2019). It is hopeful this study will generate large enrollment, high levels of evidence and be a driver for change in the early use of palliative care.

Clinical Implications

The presented literature shows an alternative perspective for the use of palliative care. The use of early palliative care prior to end-stage COPD is supported by patients, families, pulmonary clinicians and palliative clinicians (Iyer et al., 2020 & Iyer et al., 2019). As Respiratory Therapists, we can use this information to understand the needs of our patients and to advocate for potential methods of care that may be of benefit to them.

References

Iyer, A. S., Dionne-Odom, J. N., Ford, S. M., Crump Tims, S. L., Sockwell, E. D., Ivankova, N. V., Brown, C. J., Tucker, R. O., Dransfield, M. T., & Bakitas, M. A. (2019). A Formative Evaluation of Patient and Family Caregiver Perspectives on Early Palliative Care in Chronic Obstructive Pulmonary Disease across Disease Severity. AnnalsATS, 43(8), 1024-1033. https://doi.org/10.1513/annalsats.201902-112oc

Iyer, A. S., Dionne-Odom, J. N., Khateeb, D. M., O’Hare, L., Tucker, R. O., Brown. C. J., Dransfield, M. T., & Bakitas, A. B. (2020). A Qualitative Study of Pulmonary and Palliative Care Clinician Perspectives on Early Palliative Care in Chronic Obstructive Pulmonary Disease. Journal of Palliative Medicine, 23(4), 513-526. https://doi.org/10.1089/jpm.2019.0355

Mechler , K., & Liantonio, J. (2019). Palliative Care Approach to Chronic Diseases: End Stages of Heart Failure, Chronic Obstructive Pulmonary Disease, Liver Failure, and Renal Failure. Primary Care, 46(3), 415-432. https://doi.org/10.1016/j.pop.2019.05.008

National Institute on Aging. (2017) What Are Palliative Care and Hospice Care?. Retrieved March 14, 2021, from https://www.nia.nih.gov/health/what-are-palliative-care-and-hospice-care

Siouta, N., Heylen, A., Aertgeerts, B., Clement, P., Cleemput, J. V., Janssens, W., & Menten, J. (2019). Early integrated palliative care in chronic heart failure and chronic obstructive pulmonary disease: protocol of a feasibility before-after intervention study. Pilot and Feasibility Studies, 5(31). https://doi.org/10.1186/s40814-019-0420-y

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