Sujith Vasanthakumar, SRT
The role of palliative care in treating terminal stage patients and their families is often underplayed in its importance. According to the World Health Organization (WHO, 2020), palliative care aims to improve the quality of life of those afflicted by addressing the physical, mental, social, and spiritual tolls associated with end-of-life conditions. The purpose of palliative care is to provide the much-needed comfort in knowing that optimum efforts are being made to help with disease process and comfort, while also making the transition towards the inevitable transparent by addressing all concerns related to end-of-life care. The current framework for palliative care is insufficient to support the growing number of patients needing care, with only 14% of the total population receiving it (WHO, 2020). Chronic obstructive pulmonary disease (COPD) is the third leading cause of mortality, and yet a large proportion of these patients receive insufficient palliative care (Curtis, 2008).
Researchers Duenk et al. (2017) conducted a trial to investigate the effects of proactive palliative care on patients suffering with chronic obstructive pulmonary disease (COPD) (Duenk et al., 2017). The aim of this study was to prove that palliative care would improve the quality of life of their patients, reduce psychological distress and the frequency of hospital visits related to COPD distress; in addition, the researchers wanted to test whether a proactive palliative care approach could potentially prolong survival in their patients (Duenk et al., 2017). The researchers utilized a quasi-experimental design, where a sample size of 228 individuals participated in this study, with 138 individuals in the control group and 90 in the intervention group. The intervention group participated in monthly meetings with a qualified member of the palliative care team for a period of one year or until death; these meetings consisted of advanced care planning and discussions regarding end-of-life details with the patient and their families (Duenk et al., 2017). The control and intervention groups both received treatment for their COPD. The intervention and control group also received questionnaires which were to be completed periodically throughout the trial period; the questionnaires gathered information on the patient’s quality of life, psychological well-being, number of readmissions, the extent of their advanced care planning, as well as medical information (Duenk et al., 2017).
The findings from this study showed that palliative care was beneficial to patients when it came to advanced care planning, which may ease the transition of the patient and their families during the terminal stages (Duenk et al., 2017). The researchers found that the differences in quality of life, survival length, and psychological distress were not significant between the control and experimental groups. There were several drawbacks in the study, which may have affected these findings. Although the researchers used a proactive approach, 22.8% of the participants passed away as a result of the disease; the progression of the disease also affected the ability of these patients to complete the questionnaires, resulting in only one out of every five patients completing the questionnaires by the end of the trial.
The study conducted by Duenk et al. (2017) highlighted the benefits of advanced care planning in terminal stage COPD patients, which I believe is very important. Patients requiring palliative care can benefit from having a structured plan outlining their goals and preferences regarding treatment and decision-making, and this will facilitate dialogue with family and relevant health care professionals regarding these decisions (Sanchez et al., 2020). Palliative care also extends to families who are suffering from grief after their loved one has passed on. Family- focused grief therapy has been shown to help alleviate symptoms of distress and depression, as well as prevent more chronic conditions such as pathological grief (Kissane, McKenzie, Block, Moskowitz & McKenzie, 2006).
References
Curtis, J. (2008). Palliative and end-of-life care for patients with severe COPD. European Respiratory Journal. 32, 796-803. Retrieved from https://erj.ersjournals.com/content/32/3/796
Duenk, RG., Verhagen, C., Bronkhorst, EM., Mierto, P.J.W.B., Broeders, M.E.A.C., Collard, S.M., Dekhuijzen, P.N.R., Vissers, K.C.P., Heijdra, Y. & Engels, Y. (2017). Proactive palliative care for patients with COPD (PROLONG): a pragmatic cluster controlled trial. International Journal of Chronic Obstructive Pulmonary Disease. 12, 2795-2806. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5628666/
Kissane, D., McKenzie, M., Block, S., Moskowitz, C. & McKenzie, D. (2006). Family Focused Grief Therapy: A Randomized, Controlled Trial in Palliative Care and Bereavement. The American Journal of Psychiatry. Retrieved from https://ajp.psychiatryonline.org/doi/full/10.1176/ajp.2006.163.7.1208
Sanchez, B., Guijarro, C., Velasco, M., Vicente, M., Galan, M. & Herreros, B. (2020). Evaluating the efficacy of an Advanced Care Planning Program for Health Decisions in patients with advanced heart failure: protocol for a Randomized Clinical Trial. BMC Cardiovascular Disorders. Retrieved from https://link.springer.com/article/10.1186/s12872-020-01738-0
World Health Organization (WHO) (2020). Palliative Care. Retrieved from https://www.who.int/news-room/fact-sheets/detail/palliative-care
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