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End-of-life strategies among patients with advanced chronic obstructive pulmonary disease

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; 198(11):1389-96. Epub 2018 Jun 11.

Rationale — The burden of advanced chronic obstructive pulmonary disease (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 and 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), whereas 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 and educating patients and providers of their benefits.