Palliative Care and End of Life Issues: Palliative Care and End of Life |

Dying at Home From COPD: Feasible or Fantasy? FREE TO VIEW

Rachelle Blackman; Jillian Demmons; Darcy Gilllis; Graeme Rocker, DM
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Dalhousie University, Halifax, NS, Canada

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):951A. doi:10.1016/j.chest.2016.08.1053
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SESSION TITLE: Palliative Care and End of Life

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Monday, October 24, 2016 at 01:30 PM - 02:30 PM

PURPOSE: Chronic obstructive pulmonary disease (COPD) is increasing in prevalence locally and worldwide, imposing significant burdens on patients, families and on the healthcare system. While a home death from respiratory disease is traditionally difficult to facilitate, The INSPIRED COPD Outreach ProgramTM implemented in Halifax, Nova Scotia in 2010 strives to alleviate burdens on patients and families by reducing facility reliance and providing supported home deaths where possible in accordance with patient preference.

METHODS: Retrospective chart review of deaths attributable to COPD among INSPIRED patients (2011-2013, 2011-2015) and those outside of the program in HRM from 2011-2013. We explored local databases for available location of death data among patients with COPD/lower respiratory tract disease in Nova Scotia in 2009-2011. Our primary outcome of interest was proportion of home deaths. Secondary outcomes included length of stay (LOS) for hospital deaths, ICU/IMCU use, availability of personal directives and involvement of palliative care.

RESULTS: Among INSPIRED patients in both time frames, more died at home (6/20, 30%, 23/84, 38%, p<0001) by comparison with historical controls in Nova Scotia from 2009-2011(11/129, 8.3%). Of the INSPIRED decedents who died in hospital from 2011-15 (52/84, 62%), median (Interquartile range) LOS was significantly shorter (≤0.0001) at 2 (0-6) days compared to Non-INSPIRED decedents 7 (4-15) days. Fewer INSPIRED patients, were admitted to ICU or IMCU in their last hospitalization 6/84 (7%) compared to Non-INSPIRED decedents (21%). Current completion rate for personal directives within the INSPIRED program (2014-2015) is 74%

CONCLUSIONS: The INSPIRED COPD Outreach ProgramTM facilitates quality end of life care for Nova Scotians living with COPD through: 1) Higher rates (x3-4) of home deaths versus historical data outside of the program 2) Shorter length of stay (for those dying in hospital) 3) Fewer admissions to ICU/IMCU and 4) More available personal directives

CLINICAL IMPLICATIONS: Home deaths, while always difficult to facilitate for those with advanced respiratory disease, are feasible with a dedicated Pulmonology-based outreach team with training in palliative approaches These home deaths do not overburden our already stretched palliative care serices, but they are available where needed in specific cases Next Steps: Ongoing initiatives such as collaboration with Emergency Health Services to document goals of care should further help to align care provided near the end of life with preferences of patients and families

DISCLOSURE: The following authors have nothing to disclose: Rachelle Blackman, Jillian Demmons, Darcy Gilllis, Graeme Rocker

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