1 Palliative Homecare Team Northern Area of Madrid, SERMAS , San Sebastian de los Reyes, Spain .
2 Palliative Care Department, La Paz Hospital , Madrid, Spain .
J Palliat Med. 2019 Mar;22(3):290-296. doi: 10.1089/jpm.2018.0363. Epub 2018 Nov 2.
Consensus has been reached on the need to integrate palliative care in the follow-up examinations of chronic obstructive pulmonary disease (COPD) patients. We analyzed the survival from the initiation of follow-up by a palliative home care team (PHCT) and described the needs and end-of-life process.
This study was a prospective observational cohort study of advanced COPD patients referred to a PHCT. Sociodemographic variables, survival from the start date of follow-up using the Kaplan-Meier model, health resource consumption, perceived quality of life, main symptomatology, opioid use, and advanced care planning (ACP) were analyzed.
Sixty patients were included. The median survival was 8.3 months. Forty-two patients died at the end of the study (85% at home or in palliative care units). The most frequent cause of death was respiratory failure in 39 patients (93%), with 29 of these patients requiring sedation (69%). Dyspnea at rest, with an average of 5 (standard deviation [SD] 2) points, was the main symptom. Fifty-five patients (91%) required opioids for symptom control. The median score in the St. George's Respiratory Questionnaire was 72 (SD 13). The mean number of visits by the home team was 7 (SD 6.5). The mean number of admissions during the monitoring period was 1.5 (SD 0.15).
The characteristics of the cohort appear suitable for a PHCT. The follow-up care provided by our multidisciplinary unit decreased the number of hospitalizations, favored the development of ACP, and enabled death at home or in palliative care units.
人们已经达成共识，需要将姑息治疗纳入慢性阻塞性肺疾病（COPD）患者的随访检查中。我们分析了姑息家庭护理团队（PHCT）启动随访后的生存情况，并描述了患者的需求和临终过程。
这是一项针对被转诊至 PHCT 的晚期 COPD 患者的前瞻性观察性队列研究。分析了社会人口统计学变量、使用 Kaplan-Meier 模型计算的随访开始日期后的生存情况、卫生资源消耗、感知生活质量、主要症状、阿片类药物使用和先进的护理计划（ACP）。
共纳入 60 例患者。中位生存期为 8.3 个月。42 例患者在研究结束时死亡（85%在家中或姑息护理病房）。最常见的死亡原因是呼吸衰竭，共 39 例（93%），其中 29 例需要镇静（69%）。静息时呼吸困难，平均 5（标准差 2）分，是主要症状。55 例（91%）患者需要阿片类药物控制症状。圣乔治呼吸问卷的中位数评分为 72（标准差 13）。家庭团队的平均访视次数为 7（标准差 6.5）。监测期间的平均住院次数为 1.5（标准差 0.15）。
该队列的特征似乎适合 PHCT。我们多学科小组提供的随访护理减少了住院次数，有利于 ACP 的开展，并使患者能够在家中或姑息护理病房中去世。
