End of life strategies among patients with advanced chronic obstructive pulmonary disease (COPD)
Gershon AS, Maclagan LC, Luo J, To T, Kendzerska T, Stanbrook MB, Bourbeau J, Etches J, Aaron SD. Am J Respir Crit Care Med. 2018; Jun 11 [Epub ahead of print].
Rationale — The burden of advanced COPD is high globally; however, little is known about how often end of life strategies are used by this population.
Objectives — To describe trends in the use of end of life care strategies by people with advanced COPD in Ontario, Canada.
Methods — A population-based repeated cross-sectional study examining end of life care strategies in individuals with advanced COPD was conducted. Annual proportions of individuals who received formal palliative care, long-term oxygen therapy or opioids from 2004 to 2014 were determined. Results were age- and sex- standardized as well as stratified by age, sex, socioeconomic status, urban/rural residence and immigrant status. Measurement/Main Results: There were 151,912 persons with advanced COPD in Ontario between 2004 and 2014. Use of formal palliative care services increased 1% per year from 5.3% in 2004 to 14.3% in 2014 (p value for trend <0.001), while use of long-term oxygen therapy increased 1.1% per year from 26.4% in 2004 to 35.3% in 2013 (p value for trend <0.001). The use of opioids was relatively stable (40.0% in 2004 and 41.8% in 2014, p value for trend=0.08). Younger individuals were less likely to use formal palliative care services and long-term oxygen therapy. Males were less likely than females to receive long-term oxygen therapy and opioids.
Conclusions — The proportion of people with advanced COPD using end of life strategies, although increasing, remains low. Efforts should focus on increasing access to such strategies as well as educating patients and providers of their benefits.