Authors (including presenting author) :
Chan KY (1), Li Bryan (1), Tam WO (2), Tsang KW (1), Tam CC (3)
Affiliation :
(1) Palliative Medical Unit, GH; (2) Tuberculosis & Chest Unit, GH; (3) Department of medicine, QMH
Introduction :
Patients with advanced chronic obstructive pulmonary disease (COPD) have substantial symptom and psychosocial burdens but their access to palliative care remains limited. We pioneered a structured and coordinated Integrated Palliative Care (IPC) program for patients with advanced COPD under the care of different respiratory units in Hong Kong West Cluster (HKWC).
Objectives :
To investigate the impact of the IPC program on symptoms, advance care planning (ACP), number of acute admissions (AA) and length of stay (LOS) in hospital.
Methodology :
We recruited patients with advanced COPD referred by the respiratory teams during in-patient consultation to participate in our IPC program. The program comprised the following components:1) early referral for patients who are oxygen-dependent or require ventilator support during admission or recurrent admissions; 2) on-site symptom control and psychosocial care provided by palliative physician, nurse and trained social worker; 3) structural advanced care planning discussions; 4) triage to other PC services (e.g. home care) or community partner support; 5) regular structured review of patients' clinical condition and goals; 6) feedback to linked doctors to ensure congruence of care. Patients matched for disease and demographics but did not receive IPC were selected in a 1:2 ratio as Controls.
Result & Outcome :
One hundred and fifty-five patients (51 in the IPC group and 104 in Control group) were included for analysis during the period of January 2019 to October 2020. 116 patients (75%) were oxygen-dependent and 31 (20%) required home non-invasive ventilator support. 125 (81%) had partially/totally dependent functional states. The median duration of PC service is 102 (1-410) days. Thirty-eight (75%) and 35 patients (69%) had significant dyspnoea and anxiety (with Edmonton System Assessment Scale (ESAS) score ≥4) level respectively before the commencement of the IPC program. Thirty-one patients (61%) had received home care and 22 patients (43%) had community partner support. All patients had documented ACP discussions. The proportion of patients with significant dyspnoea and anxiety level decreased by 32% and 28% respectively after initiation of the IPC program. Seventeen patients in the IPC group died within study period, in which 88% of them had Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) order. The IPC group had reduced but statistically insignificant number of AA and LOS in acute hospital in the last 3 months compared with Controls. Our IPC program can relieve physical and psychological symptoms, achieve high compliance rate for ACP and reduce healthcare costs in advanced COPD patients.
