Integrated respiratory-palliative care to benefit COPD patients


By Mardi Chapman

6 Jun 2017

A proposed model of a care for embedding palliative care into the routine care of patients with COPD will help counter patient and physician concerns, an expert says.

Dr Natasha Smallwood, who leads the Advanced Lung Disease Service at the Royal Melbourne Hospital, told the limbic there were many misconceptions regarding palliative care from patients and their carers, and respiratory physicians.

“Many patients with COPD don’t see themselves as dying and are reluctant to commence on a journey which can be seen as frightening. They may also experience a sense of abandonment if referred on.”

“For physicians who have had a long relationship with their patients, referring patients to community based palliative care is very final. Allowing that relationship to continue is important,” she said.

The model of care, published recently in Palliative and Supportive Care, provides the conceptual basis for cost effective, locally responsive services.

Dr Smallwood said respiratory physicians with additional training in palliative and supportive care would ideally run such a service.

A low-cost service might utilise existing resources such as respiratory nurses, physiotherapy and psychology and build relationships with a palliative care team.

She said there were opportunities for respiratory and palliative care physicians to learn from each other in the process.

“Palliative care physicians may have trained as GPs and have had less contact with patients with COPD and less expertise in aspects of COPD care such as inhaler management or pulmonary rehabilitation.”

“Their knowledge is hugely important for example in the finer points of using morphine to manage breathlessness, or in the management of other refractory symptoms such as fatigue or anorexia. They can also teach us good communication around those difficult conversations.”

The model proposes an objective milestone in disease progression. For example, a hospital admission for an exacerbation could trigger patient entry for a palliative care review.

“It would offer individualised care and a strong focus on dealing with symptoms themselves, as everything else is already optimised,” she said.

Screening for psychosocial issues, level of community support and health literacy would also be an important component of addressing the holistic needs of the patients.

“Patients often have a poor understanding of the disease and their escalating health requirements,” Dr Smallwood said.

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