Outcomes from an integrated respiratory and palliative care service at an Australian teaching hospital

Abstract

The unaddressed palliative care needs of patients with advanced lung disease highlight the urgent requirement for new models of care. The Advanced Lung Disease Service (ALDS) represents such a model, whereby patients with severe, non-malignant respiratory disease receive multidisciplinary specialist clinic review, and telephone and domiciliary nursing support, with management led by the respiratory team.

Aims: To examine the activity and care provided by the ALDS.

Methods: Demographic and prospective outcome data were collected for 170 consecutive patients (2013-16).

Results: 136 patients were included: 75 (55%) male; median age 75 years and primary diagnosis COPD 115 (85%). Median lung function (n=136): FEV₁ 0.9L (40%), FVC 2.3L (83%) and DLco 7.5 (34%). Median Pa0₂ on ABG 58.0mmHg, and median MMRC dyspnoea score 4. 94 (69%) patients used home oxygen and 106 (78%) had/undertaking pulmonary rehabilitation.

Active dyspnoea management was discussed with all patients. 60 (44%) patients were prescribed opioids for refractory dyspnoea, with median prescribed and consumed daily doses of 12mg and 9mg oral morphine equivalent respectively.

91 (67%) patients saw a palliative care doctor in the ALDS clinic and 33 (24%) also received community palliative care. All patients were invited to undertake Advance Care Planning (ACP) and 109 (80%) discussed and/or completed an ACP.

40 patients died, 11 (28%) in an acute hospital bed, and the remainder in a palliative care bed, nursing home or at home.

Conclusions: The ALDS, an integrated model of respiratory and palliative care, facilitates access to symptom control measures, communication and planning for patients with advanced lung disease.