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dc.contributor.authorRoss, L
dc.contributor.authorTaverner, J
dc.contributor.authorJohn, J
dc.contributor.authorBaisch, A
dc.contributor.authorIrving, L
dc.contributor.authorPhilip, J
dc.contributor.authorSmallwood, N
dc.date.accessioned2021-06-25T02:17:28Z
dc.date.available2021-06-25T02:17:28Z
dc.date.issued2021-10-23
dc.identifier.citationRoss, L., Taverner, J., John, J., Baisch, A., Irving, L., Philip, J. & Smallwood, N. (2021). Burden of diagnostic investigations at the end of life for people with chronic obstructive pulmonary disease. INTERNAL MEDICINE JOURNAL, 51 (11), pp.1835-1839. https://doi.org/10.1111/imj.14943.
dc.identifier.issn1444-0903
dc.identifier.urihttp://hdl.handle.net/11343/275914
dc.description.abstractBACKGROUND: Chronic obstructive pulmonary disease (COPD) is an incurable, chronic condition that leads to significant morbidity and mortality, with most patients dying in hospital. While diagnostic tests are important for actively managing patients during hospital admissions, the balance between benefit and harm should always be considered. This is particularly important when patients reach the end of life, when the focus is to reduce burdensome interventions. AIMS: To examine the use of diagnostic testing in a cohort of people with COPD who died in hospital. METHODS: Retrospective medical record audits were completed at two Australian hospitals (Royal Melbourne Hospital and Northeast Health Wangaratta), with all patients who died from COPD over 12 years between 1 January 2004 and 31 December 2015 included. RESULTS: Three hundred and forty-three patients were included, with a median of 11 diagnostic testing episodes per patient. Undergoing higher numbers of diagnostic tests was associated with younger age, intensive care unit admission and non-invasive ventilation use. Reduced testing was associated with recent hospital admission for COPD, domiciliary oxygen use and a prior admission with documentation limiting medical treatment. Most patients underwent diagnostic tests in the last 2 days of life, and 12% of patients had ongoing diagnostic tests performed after a documented decision was made to change the goal of care to provide comfort care only. CONCLUSION: There were missed opportunities to reduce the burden of diagnostic tests and focus on comfort at the end of life. Increased physician education regarding communication and end-of-life care, including recognising active dying may address these issues.
dc.languageEnglish
dc.publisherWILEY
dc.titleBurden of diagnostic investigations at the end of life for people with chronic obstructive pulmonary disease
dc.typeJournal Article
dc.identifier.doi10.1111/imj.14943
melbourne.affiliation.departmentAnatomy and Neuroscience
melbourne.affiliation.departmentRural Clinical School
melbourne.affiliation.departmentMedicine (RMH)
melbourne.affiliation.departmentMedicine (St Vincent's)
melbourne.affiliation.facultyMedicine, Dentistry & Health Sciences
melbourne.source.titleInternal Medicine Journal
melbourne.source.volume51
melbourne.source.issue11
melbourne.source.pages1835-1839
melbourne.elementsid1498938
melbourne.internal.embargodate2021-06-16
melbourne.contributor.authorPhilip, Jennifer
melbourne.contributor.authorIrving, Louis
melbourne.contributor.authorSmallwood, Natasha
melbourne.contributor.authorJohn, Jenny Aleyamma
melbourne.contributor.authorBaisch, Andreas
dc.identifier.eissn1445-5994
melbourne.accessrightsOpen Access


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