COPD and palliative care: a collaborative model to improve quality of life and reduce readmissions

Abstract

Introduction: Symptom control is a challenge in severe COPD, causing recurrent admission. Addressing palliative care (PC) needs and advanced care planning (ACP), by an integrated respiratory and PC service, should improve symptom management . Objectives: We sought to increase referrals to PC for the more severe and symptomatic COPD population - by integrating a validated palliative care questionnaire (IPOS) and ACP into the Trust’s COPD discharge package. Methods: Each patient admitted with a COPD exacerbation was graded by GOLD and predicted 12-month mortality. ACP was discussed where appropriate and an electronic care plan (ECP) commenced, accessible to all relevant practitioners in the hospitals and community networks. IPOS was completed and personalised PC referral made on discharge, so patients were channelled appropriately into programmes e.g. our Breathlessness service, led by respiratory physiotherapists in the Hospice - a collaborative working model. IPOS was repeated after an intervention. Readmission, mortality and patient reported outcomes were assessed. Results: 136 COPD patients were admitted June to November 2018: 58 were GOLD C/D, meeting eligibility criteria for PC referral. IPOS identified extent of symptoms and repeat IPOS post intervention showed symptom improvement physically and mentally, with a fall in average physical symptom score from 20.2 to 11.6 (p-value=0.02) and depression and anxiety scores (8.1 to 3.6; p-value 0.01). Conclusion: Severe COPD patients experience an array of symptoms, not just ‘respiratory’. Evaluation by IPOS improves focus on these, leading to more holistic care. Its incorporation into the national COPD audit tool would standardise its use.