Palliative Care Initiation in Chronic Obstructive Pulmonary Disease: Prognosis-Based, Symptoms-Based or Needs-Based?

Area of Science:

• Pulmonary Medicine
• Palliative Care
• Geriatrics

Background:

• Late or absent palliative care (PC) initiation is a significant issue for patients with chronic obstructive pulmonary disease (COPD).
• Current PC services often begin too late in the disease trajectory, even in advanced or end-of-life stages.
• Identifying appropriate criteria for early PC initiation in COPD remains a challenge.

Purpose of the Study:

• To identify prognostic variables and multicomponent indices for predicting survival in COPD patients.
• To determine symptoms and unmet needs that can guide the initiation of PC in COPD.
• To evaluate tools for predicting poor survival and criteria for early PC appropriateness.

Main Methods:

• Systematic review of reviews published in PubMed from January 1, 2015, to January 6, 2020.
• Search strategy screened 202 findings, resulting in 16 articles screened and 10 selected for inclusion.
• Adherence to Preferred Reporting Items for Systematic Review and Meta-analysis Protocols (PRISMA-P) guidelines.

Main Results:

• Existing prognostic variables and multicomponent indices are not sufficiently reliable for exclusively predicting poor survival in COPD.
• Barriers to PC in COPD include prognostic difficulties, unreliable tools, troublesome symptoms, and unmet patient needs.
• The decision to initiate PC should prioritize refractory symptoms and patients' expressed needs and preferences.

Conclusions:

• No single prognostic variable or index reliably predicts poor survival in COPD for exclusive PC initiation.
• Early PC initiation in COPD should be guided by the presence of refractory symptoms and patient-reported unmet needs.
• Developing a model for PC initiation at the time of COPD diagnosis is a future goal for trained clinicians.