Integrated respiratory and palliative care may improve outcomes in advanced lung disease
AuthorSmallwood, N; Thompson, M; Warrender-Sparkes, M; Eastman, P; Le, B; Irving, L; Philip, J
Source TitleERJ Open Research
PublisherEUROPEAN RESPIRATORY SOC JOURNALS LTD
AffiliationMedicine and Radiology
Document TypeJournal Article
CitationsSmallwood, N., Thompson, M., Warrender-Sparkes, M., Eastman, P., Le, B., Irving, L. & Philip, J. (2018). Integrated respiratory and palliative care may improve outcomes in advanced lung disease. ERJ OPEN RESEARCH, 4 (1), https://doi.org/10.1183/23120541.00102-2017.
Access StatusOpen Access
The unaddressed palliative care needs of patients with advanced, nonmalignant, lung disease highlight the urgent requirement for new models of care. This study describes a new integrated respiratory and palliative care service and examines outcomes from this service. The Advanced Lung Disease Service (ALDS) is a long-term, multidisciplinary, integrated service. In this single-group cohort study, demographic and prospective outcome data were collected over 4 years, with retrospective evaluation of unscheduled healthcare usage. Of 171 patients included, 97 (56.7%) were male with mean age 75.9 years and 142 (83.0%) had chronic obstructive pulmonary disease. ALDS patients had severely reduced pulmonary function (median (interquartile range (IQR)) forced expiratory volume in 1 s 0.8 (0.6-1.1) L and diffusing capacity of the lung for carbon monoxide 37.5 (29.0-48.0) % pred) and severe breathlessness. All patients received nonpharmacological breathlessness management education and 74 (43.3%) were prescribed morphine for breathlessness (median dose 9 mg·day-1). There was a 52.4% reduction in the mean number of emergency department respiratory presentations in the year after ALDS care commenced (p=0.007). 145 patients (84.8%) discussed and/or completed an advance care plan. 61 patients died, of whom only 15 (24.6%) died in an acute hospital bed. While this was a single-group cohort study, integrated respiratory and palliative care was associated with improved end-of-life care and reduced unscheduled healthcare usage.
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