Abstract
Background. Chronic obstructive pulmonary disease (COPD) is a common cause of death. Despite the heavy symptom burden in late stages, these patients are relatively seldom referred to specialist palliative care.Methods. A web-based survey concerning medical and organizational aspects of palliative care in COPD was distributed to respiratory physicians in Sweden. There were 93 respondents included in the study.Results. Palliative care issues were regularly discussed with the patients according to a third of the respondents. About half of the respondents worked in settings where established routines for co-operation with palliative units were available at least to some extent. Less than half of the respondents (39%) were aware of current plans to develop palliative care, either as a co-operative effort or within the facility. Palliative care is focused on physical, psychological, social, and existential dimensions, and the proportions of respondents providing support within these dimensions, ‘always' or ‘often', were 83%, 36%, 32%, and 11%, respectively. Thus, to treat the physical dimensions was perceived as much more obvious than to address the other dimensions.Conclusions. The survey indicates that the priorities and resources for palliative care in COPD are insufficient in Sweden. The data, despite limitations, reveal a lack of established team-work with specialized palliative care units and actual plans for such co-operation.
Highlights
Chronic obstructive pulmonary disease (COPD) is a progressive, disabling, and life-limiting disease
In Sweden, 5%–15% of the population over 45 years of age is believed to suffer from COPD; the number of hospitalizations due to COPD has increased by 40%, and the number of deaths has doubled during the last decades [1,2]
About one-third of the respondents discussed palliative care issues with their patients only partly or not at all. One of those who did not discuss palliative care commented: ‘The patient is expected to realize that all medical efforts in COPD are palliative and palliation is not discussed as for cancer patients’
Summary
Chronic obstructive pulmonary disease (COPD) is a progressive, disabling, and life-limiting disease. The social consequences are mainly related to limitations in everyday life, affecting both the patient and the family [13,5], whereas the existential burden is a suffering connected to feelings of meaninglessness, guilt, and impending death [14,15,16]. Despite the heavy symptom burden in late stages, these patients are relatively seldom referred to specialist palliative care. About half of the respondents worked in settings where established routines for co-operation with palliative units were available at least to some extent. Palliative care is focused on physical, psychological, social, and existential dimensions, and the proportions of respondents providing support within these dimensions, ‘always’ or ‘often’, were 83%, 36%, 32%, and 11%, respectively. The data, despite limitations, reveal a lack of established team-work with specialized palliative care units and actual plans for such co-operation
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