Respiratory physicians need to talk to palliative care specialists about COPD

People with COPD are missing out on palliative care because respiratory physicians are not ‘on the same page’ as palliative medicine specialists, an Australian study suggests.

Lack of communication and poor relationships between respiratory and palliative care specialists are key reasons why COPD patients do not access palliative care, a survey of 177 respiratory physicians in Australia and New Zealand finds.

The survey confirms previous findings that palliative care services are fragmented and overburdened. But it also shows that while respiratory physicians believe there is a role for specialist services they are often more comfortable with providing palliative approaches themselves – particularly for symptoms – rather than referring patients.

The study, published in BMC PalliativeCare, showed that 80.9% of respiratory physicians were comfortable providing a palliative approach to people with COPD. Two out of three respiratory physicians (63.8%) said they would refer patients with advanced COPD to specialist palliative care, with female physicians being twice as likely as males to refer patients.

Respiratory physicians were most likely to refer patients with COPD for psychosocial and spiritual care, carer support and end-of-life care.

The survey – which also included responses from 263 palliative medicine specialists – also elicited many comments about the inadequate model of care for COPD patients, with services being under-resourced to support their ongoing long-term needs.

“(This is a) difficult and big problem, and an area that clearly requires greater investment into formal palliative care services for this patient group, and greater formal systems of collaboration between respiratory physicians, palliative care teams, and community health providers,” wrote one Australian respiratory medicine specialist.

And many comments pointed to lack of shared understanding and co-operation between specialities on COPD palliative care.

“It’s end organ disease – we need to enable respiratory physicians to manage their patients in all phases of the illness, and use consultative services when necessary, rather than ‘handing over’ care to palliative care when goals of care are palliative,” one palliative medicine specialist commented.

The study authors, led by Dr Natasha Smallwood of the Department of Respiratory and Sleep Medicine at the Royal Melbourne Hospital, said the findings pointed to a need for a better integrated service model, such as that used by the Melbourne Advanced Lung Disease Service.

“Collaboration, trust, and bi-directional education between respiratory and palliative medicine, perhaps through integrated, multidisciplinary services, are urgently required to address the unmet needs of people with advanced COPD,” they concluded.

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