Comparing end‑of‑life care in hospitalized patients with chronic obstructive pulmonary disease with and without palliative care in Taiwan

Abstract

• Background: We investigated the difference of clinical practice pattern between end‑stage chronic obstructive pulmonary disease (COPD) patients with and without palliative care at the end of life in Taiwan.
• Materials and Methods: A total of 91 COPD patients who died in an acute care hospital were enrolled from one community teaching hospital in northern Taiwan between September 1, 2007 and December 31, 2009. The patients were divided into palliative (n = 17) and non‑palliative care (n = 74) groups. Demographics and medical care data obtained through retrospective review of medical records were analyzed to determine significant between‑group differences.
• Results:There were no between‑group differences in intensive care unit (ICU) utilization, duration of ICU stay, duration of ventilator usage, invasive diagnostic procedures, invasive treatments, medications, and total medical cost. Patients in the palliative group had longer hospital stays (median 26 days vs. 11 days, P < 0.01) and higher rate of do‑not‑resuscitate orders (100% vs. 51%, P < 0.001), but lower rates of ICU mortality (73% vs. 41%, P = 0.026), invasive ventilation (57% vs. 29%, P = 0.04), cardiopulmonary resuscitation (12% vs. 51%, P < 0.001), and daily medical cost (250 US dollars vs. 444 US dollars, P < 0.001).
• Conclusion: Palliative care was underutilized and referral was delayed for COPD patients. COPD patients are polysymptomatic approaching the end of life and this characteristic should be taken into account in providing appropriate end‑of‑life care in the same way as for cancer patients. Palliative care for COPD patients is urgently needed in Taiwan
  and should be promoted
• Key words: Chronic obstructive pulmonary disease, end‑of‑life, palliative care