Abstract：
BACKGROUND:Patients with advanced chronic obstructive pulmonary disease (COPD) have a significant symptom burden despite maximal medical therapy, yet few are referred for concomitant palliative care. OBJECTIVE:To evaluate the utilization and impact of palliative care on the location of death and to identify clinical variables associated with palliative care contact. DESIGN:Retrospective chart review from 2010 to 2016 at the VA Western New York Healthcare System using ICD-9/10 diagnosis of COPD. Palliative care contact was identified by Z51.5 or stop code 353. RESULTS:Only 0.5% to 2% of living patients received palliative care, increasing abruptly at death (6%). Lower diffusion capacity for carbon monoxide (DLCO) (greater emphysema) was associated with palliative care contact, independent of comorbid disease burden or age. Initial outpatient contact was associated with a longer duration of palliative care (P = .003) and death in a home-like setting. Outpatient palliative care was associated with more severe airflow obstruction (forced expiratory volume in 1 second, percent predicted [FEV1%]), whereas greater disease exacerbation frequency was associated with inpatient contact. COPD patients not referred to palliative care had a greater comorbid disease burden, similar FEV1%, fewer disease exacerbations, and a greater DLCO. CONCLUSION:Few patients with COPD received palliative care, similar to national trends. Initial outpatient palliative contact had the longest duration of care and death in the preferred home environment. The extent of emphysema (DLCO reduction) and more frequent disease exacerbations identified in patients were more likely to receive palliative care. Our study begins to define the benefits of palliative care in advanced COPD and confirms underutilization in the years before death, where a prolonged impact on the quality of life may be realized.
journal_name
J Palliat Carejournal_title
Journal of palliative careauthors
Kraskovsky V,Schneider J,Mador MJ,Provost KAdoi
10.1177/0825859719851486subject
Has Abstractpub_date
2019-07-02 00:00:00pages
825859719851486eissn
0825-8597issn
2369-5293pub_type
杂志文章abstract：INTRODUCTION:Health system restructuring combined with the preferences of many terminally ill care recipients and their caregivers has led to an increase in home-based palliative care, yet many care recipients die within institutional settings such as hospitals. This study sought to determine the place of death and its...
journal_title：Journal of palliative care
pub_type： 杂志文章
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更新日期：2010-01-01 00:00:00
abstract：BACKGROUND AND OBJECTIVES:The use of chemotherapy at the end of life in advanced cancer patients has increased and end of life care has become increasingly aggressive. The aim of this study is to evaluate patients receiving chemotherapy in the last 3 months of life and the aggressiveness of end-of-life support of these...
journal_title：Journal of palliative care
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abstract：:The study assessed the components of high-quality HIV palliative care using the multidimensional model of quality assessment developed by Maxwell (4). Data collection consisted of interviews with individual subjects and focus groups. The interviews took place in three London health authorities. Seven service users and...
journal_title：Journal of palliative care
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更新日期：1999-01-01 00:00:00
abstract：:In traditional Chinese culture, death was sensitive and mentioning it was sacrilegious and to be avoided. Many Chinese families object to telling the patient a "bad" diagnosis or prognosis, which may hinder the chance in advance care planning (ACP) discussion. While death remains an inevitable consequence of being bor...
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abstract：:Comfort care for cancer patients in the terminal stage has been the goal of hospice programs since their inception. Among the many treatment modalities available to homebound patients, transfusions have been little studied for their effects on advanced disease symptoms, particularly for those in the terminal phase. Ou...
journal_title：Journal of palliative care
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更新日期：1993-10-01 00:00:00
abstract：BACKGROUND:Bleeding occurs with some regularity at the end of life. Patients often endure fatigue, weakness, pain, dyspnea and anxiety. These symptoms are magnified in visually apparent bleeds. Management can be particularly challenging as we attempt to balance therapies with goals of care. Children are at risk for suc...
journal_title：Journal of palliative care
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abstract：AIM:By examining clinical parameters associated with survival time and analyzing patients' survival times using prognostic scores, this study aimed to provide helpful information related to the treatment of terminal cancer patients. METHODS:We retrospectively reviewed the medical records of 415 inpatients who died in ...
journal_title：Journal of palliative care
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更新日期：2014-04-01 00:00:00
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journal_title：Journal of palliative care
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abstract：:In Spain, there is a general tendency to conceal the prognosis from a terminally ill patient. We conducted grounded-theory-based, phenomenological, qualitative research on this using a final sample of 42 in-depth interviews with doctors and nurses from different fields. We found that most health professionals believe ...
journal_title：Journal of palliative care
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更新日期：2009-10-01 00:00:00
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journal_title：Journal of palliative care
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journal_title：Journal of palliative care
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更新日期：2000-01-01 00:00:00
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journal_title：Journal of palliative care
pub_type： 临床试验,杂志文章,随机对照试验
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更新日期：2004-07-01 00:00:00
abstract：AIM:Physical activity (PA) has a positive effect on the cardiorespiratory fitness, lung cancer symptoms, and quality of life of lung cancer patients. The aim of our study was to identify barriers to, and facilitators of PA in lung cancer patients. METHODS:We collected data from five patients diagnosed with primary, ad...
journal_title：Journal of palliative care
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journal_title：Journal of palliative care
pub_type： 杂志文章
doi：
更新日期：2010-04-01 00:00:00
abstract：:Palliative care is one of the newer health specialties and continues to mature. While there has been remarkable progression of clinical skills and education, there has been a lack of focus on palliative care interdisciplinary leadership or development of leadership skills. This article highlights the importance of int...
journal_title：Journal of palliative care
pub_type： 杂志文章
doi：10.1177/0825859718791427
更新日期：2018-08-16 00:00:00
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journal_title：Journal of palliative care
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abstract：:With increasing trends towards home care of children with even the most complex conditions and care requirements, respite becomes critical in improving the quality of life for terminally ill children and their families. This article reports on the respite component of an evaluation project that examined the effect of ...
journal_title：Journal of palliative care
pub_type： 杂志文章
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更新日期：2004-01-01 00:00:00
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journal_title：Journal of palliative care
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更新日期：2001-04-01 00:00:00
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journal_title：Journal of palliative care
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更新日期：2001-10-01 00:00:00
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journal_title：Journal of palliative care
pub_type： 杂志文章,多中心研究
doi：
更新日期：1999-04-01 00:00:00
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journal_title：Journal of palliative care
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journal_title：Journal of palliative care
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更新日期：1995-10-01 00:00:00
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journal_title：Journal of palliative care
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