Call to refer early to palliative care

COPD patients should be referred to palliative care services at the same time as pulmonary rehabilitation, delegates at ATS 2018 were told.

Dr Amanda Stephens, Hospice and Palliative Care Fellow at the University of Colorado, said both services have a lot of features in common and can be given at the same time as life-prolonging treatment.

She railed against media coverage of former First Lady Barbara Bush’s end of life care earlier this year, which often misrepresented palliative care as not involving medical care.

“Palliative care is medical care – it’s extra support for anyone with chronic progressive disease and distressing symptoms – it’s just not curative treatment,” she said.

Dr Stephens said pulmonary rehabilitation was the palliative intervention with the most data behind it.

“We know that pulmonary rehabilitation improves dyspnea which is the best palliative care that you can imagine for lung disease.”

While palliative care might add in pharmacological therapies such as opiates, it might also include other integrative therapies such as yoga positions that help clear secretions in COPD.

“I like the idea of doing both at the same time for patients who are functional enough for the pulmonary rehabilitation aspect of things given pulmonary rehab is cardio intensive. And I think the patients who are further along in their disease can still benefit from physical therapies like walking and yoga which are not very intense.”

“And of course the advance care planning and discussion of spiritual care and bereavement.”

Dr Stephens admitted there was a problem with the supply of pulmonary rehabilitation and palliative care not meeting the demand.

“And the way we overcome that in palliative care is by teaching primary pulmonology clinicians to do some of the things that we do in palliative care in terms of discussing advance care planning with their patients.”

“And while it won’t necessarily be expert secondary palliative care symptom management they can definitely start the discussions about what is most important to these patients, what are the things they like to do, and then as we get out the evidence about symptom management that can get diffused also to the primary pulmonary clinicians as we grow as a field ourselves.”

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