Department of Respiratory and Sleep Medicine, The Royal Melbourne Hospital, Melbourne, VIC, 3050, Australia.
Department of Medicine (Royal Melbourne Hospital), University of Melbourne, Melbourne, VIC, 3050, Australia.
BMC Palliat Care. 2018 Oct 15;17(1):115. doi: 10.1186/s12904-018-0371-8.
Chronic obstructive pulmonary disease (COPD) guidelines recommend early access to palliative care together with optimal, disease-directed therapy for people with advanced disease, however, this occurs infrequently. This study explored the approaches of respiratory and palliative medicine specialists to palliative care and advance care planning (ACP) in advanced COPD.
An online survey was emailed to all specialists and trainees in respiratory medicine in Australia and New Zealand (ANZ), and to all palliative medicine specialists and trainees in ANZ and the United Kingdom.
Five hundred seventy-seven (33.1%) responses were received, with 440 (25.2%) complete questionnaires included from 177 respiratory and 263 palliative medicine doctors. Most respiratory doctors (140, 80.9%) were very or quite comfortable providing a palliative approach themselves to people with COPD. 113 (63.8%) respiratory doctors recommended referring people with advanced COPD to specialist palliative care, mainly for access to: psychosocial and spiritual care (105, 59.3%), carer support (104, 58.5%), and end-of-life care (94, 53.1%). 432 (98.2%) participants recommended initiating ACP discussions. Palliative medicine doctors were more likely to recommend discussing: what palliative care is (p < 0.0001), what death and dying might be like (p < 0.0001) and prognosis (p = 0.004). Themes highlighted in open responses included: inadequate, fragmented models of care, with limited collaboration or support from palliative care services.
While both specialties recognised the significant palliative care and ACP needs of people with advanced COPD, in reality few patients access these elements of care. Formal collaboration and bi-directional support between respiratory and palliative medicine, are required to address these unmet needs.
慢性阻塞性肺疾病（COPD）指南建议为晚期疾病患者提供早期姑息治疗以及最佳的疾病导向治疗，但这种情况很少发生。本研究探讨了呼吸和姑息医学专家对晚期 COPD 患者姑息治疗和预先医疗指示（ACP）的方法。
向澳大利亚和新西兰（ANZ）的所有呼吸医学专家和学员，以及 ANZ 和英国的所有姑息医学专家和学员发送了在线调查电子邮件。
共收到 577 份（33.1%）回复，其中包括来自 177 名呼吸科医生和 263 名姑息科医生的 440 份（25.2%）完整问卷。大多数呼吸科医生（140 名，80.9%）对自己为 COPD 患者提供姑息治疗方法非常或相当有信心。113 名（63.8%）呼吸科医生建议将晚期 COPD 患者转介给专科姑息治疗团队，主要是为了获得：心理社会和精神关怀（105 名，59.3%）、照顾者支持（104 名，58.5%）和临终关怀（94 名，53.1%）。432 名（98.2%）参与者建议启动 ACP 讨论。姑息科医生更有可能建议讨论：姑息治疗是什么（p<0.0001）、死亡和临终可能是什么样子（p<0.0001）和预后（p=0.004）。开放回复中突出的主题包括：护理模式不足、碎片化，姑息治疗服务的协作或支持有限。
尽管两个专业都认识到晚期 COPD 患者有重大的姑息治疗和 ACP 需求，但实际上很少有患者获得这些护理内容。需要呼吸和姑息医学之间建立正式的协作和双向支持，以满足这些未满足的需求。
