Quality of End-of-Life Care for COPD: An Opportunity to Improve

End-of-Life Care Better for those with Cancer and Dementia

Background: End-of-life care has focused mainly on those with cancer. There has been less interest and attention directed to those with a chronic heart or lung condition, like congestive heart failure or COPD. Study: Dr. Wachterman from the Veterans Administration Health Care System in Boston and co-authors performed a analysis of 146 hospitals within the Veterans Affairs health system that included 57,753 patients who died. Information was collected between October 1, 2009, and September 30, 2012. Patients had various diagnoses: end-stage kidney disease, cancer, congestive heart failure, COPD, dementia, frailty, and other conditions.  JAMA Intern Med. Published online June 26, 2016. doi:10.1001/jamainternmed.2016.1200 Outcomes: Palliative care consultations, do-not-resuscitate (DNR) orders, death in in-patient hospices, death in the intensive care unit (ICU), and quality of end-of-life care reported by family members.
Nurse caring for individual

Nurse caring for individual

Results: About 1/2 of those with COPD received a palliative care consultation compared with 74% of those with cancer and 61% of those with dementia.  Approximately 1/3 of those with COPD died in the ICU, more than double the rates among those with cancer (13%) or dementia (9%). Rates of excellent quality of end-of-life care reported by families were similar for cancer (59%) and dementia (59%), but were lower for those with heart failure or COPD (55%). Conclusions: Family reported quality of end-of-life care was significantly better for those with cancer or dementia than for other conditions including COPD.  This difference was mainly due to: higher rates of palliative care consultations and DNR orders; and fewer deaths in the ICU. The authors commented that increasing access to palliative care and increasing goals of care discussions that address code status and preferred setting of death, particularly for patients with end-organ failure (like COPD) should improve the quality of end-of-life care. My Comments: No one has a crystal ball to predict the future. It is important that you discuss your wishes for end-of-life care with family members and close friends in case you are not able to provide this information. It is also “key” to have a living will and a durable power of attorney for healthcare (these are called Advance Directives). Advance Directives can be completed with a social worker or other trained professionals who usually work at a medical facility or with a lawyer.  More information about this topic is available in Chapter 9 of COPD: Answers to Your Questions found on www.donaldmahler.com.

Donald A. Mahler, M.D. is Emeritus Professor of Medicine at Geisel School of Medicine at Dartmouth in Hanover, New Hampshire. He works as a pulmonary physician at Valley Regional Hospital in Claremont, NH, where he is Director of Respiratory Services.