Improving Quality of Life in Chronic Obstructive Pulmonary Disease by Integrating Palliative Approaches to Dyspnea, Anxiety, and Depression

Abstract

Chronic obstructive pulmonary disease (COPD), the third leading cause of death in the United States, is associated with persistent burdensome symptoms including dyspnea, anxiety, and depression. Few studies have examined treating these symptoms concurrently using palliative care. The goal of this study was to evaluate the feasibility and usefulness of an advance practice nurse–delivered palliative care intervention in patients with symptomatic COPD. We conducted a 3-month prospective, single-arm, mixed-method pilot study. A convenience sample of outpatients with Global Initiative for Chronic Obstructive Lung Disease stage III or IV COPD was enrolled from a single center. The advance practice nurse provided pharmacologic and nonpharmacologic palliative management of dyspnea, anxiety, and depression. Feasibility was measured by recruitment and retention rates and completion of survey measures. Usefulness was measured by changes in survey measures and an end-of-study semistructured participant interview. Sixty people were invited to participate in the study, and 15 enrolled (25%). Thirteen of 15 (87%) completed the study. Twelve of 15 (80%) used opioids for dyspnea, whereas 7 (47%) enrolled in pulmonary rehabilitation or another exercise program. All patients reported decreased anxiety and depression with improvement in dyspnea, so they opted not to treat either separately. Qualitative interviews revealed 3 themes: (1) improved quality of life, (2) issues around study participation, and (3) managing expectations. Participants reported subjective benefit from palliative care, and the intervention was feasible.