Too much testing for patients with end stage COPD


27 Mar 2018

COPD patients are being unnecessarily pricked, probed and prodded in their last days of life – sometimes despite clear documentation that palliation was the goal of care.

A review of COPD patients who died between 2004 and 2016 found patients typically endured seven episodes of venepuncture, nine arterial blood gases and three chest X-rays during their terminal admission.

The research found almost a third of patients (32%) had tests on the day of their death.

Co-author Dr Natasha Smallwood, a respiratory and sleep medicine physician at the Royal Melbourne Hospital, said it was difficult to prevent tests and X-rays when patients were transferred to hospital at such a late stage.

“These patients obviously have severe disease. Many have had previous admissions, they have severely reduced lung function, 50% of them are on oxygen and yet they are transferred to hospital.”

“When patients are admitted and die on the same day I think that reflects we are failing them in the community.”

“This is obviously a group that need better palliative care, who need a better explanation of how we can manage them at home, and need advance care planning.”

Dr Smallwood said communication and time management issues contributed to 12% of patients still having tests in hospital after documentation of a change from active treatment to palliation.

“If we make the decision to palliate, then stopping investigations should happen routinely. We need to be more proactive about remembering to cross off everything on the drug chart and cancelling the blood test requests.”

“Sometime the team is caught up in doing the family meeting and perhaps then forget the basic stuff which will make a difference to the patient.”

The study found less than a third of patients (29%) had community or hospital-based palliative care before their final admission.

She said workloads were also preventing respiratory physicians from having the time-consuming discussions with their patients about palliation and advance care planning.

“One of the challenges is the huge burden of work we face and trying to fit this in – time to deliver advance care planning or symptom palliation.”

“We need new models of care for patients so we can actually achieve more of these things and break the cycle.”

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