Abstract
COPD is an incurable, progressive illness, with associated significant morbidity and mortality. Refractory dyspnoea is often undertreated and few patients access palliative care.
Aims: To examine the end of life care delivered to COPD patients during the final hospital admission in which death occurred.
Methods: A retrospective audit was performed for 209 consecutive patients who died from COPD at an Australian teaching hospital from 2004-2016.
Results: Of 163 patients included: 106 (65%) male, median age 80 years; median respiratory function: FEV1 0.8L (39%), FVC 2.0L (72%) and DLco 9 (39%); 85 (52%) used home oxygen; 120 were ex-smokers (74%); and 11 (7%) had seen palliative care prior to the final admission.
For 134 (82%) patients the goal of care was documented as palliation in the final admission, a median of 1 day prior to death. 133 (82%) patients received opioids and 96 (59%) received benzodiazepines to palliate symptoms. Median starting and final opioid doses were 8mg and 15mg oral morphine equivalent/24 hours. 61 (37%) patients were reviewed by the palliative care team.
Antibiotics were given to 149 (92%) patients and ceased prior to death in 95 (64%) patients. Non-invasive ventilation was given to 93 (57%) patients and ceased in 72 (77%) patients.
11 (7%) patients had made an advance care plan prior to admission, however 56 (34%) had prior admissions in which the medical team completed a limitation of medical treatment order.
Conclusions: While most patients received some form of palliation, this occurred late, mainly in the day prior to death. Despite disease severity, few patients completed an advance care plan or saw a palliative care team prior to the final admission.
- Copyright ©the authors 2016
