Table 4 Timing, duration and content of 61 outpatient palliative care conversations in 44 patients
Findings | |
Palliative care conversations | |
Timing of first palliative care conversation | Median 42 days (IQR 24.25–96.25) after inclusion 33/44 (75.0%) within 3 months 36/44 (81.8%) within 6 months |
Average duration | Region A: 60 minutes Region B: 60 minutes Region C: 30 minutes Region D: 15 to 30 minutes |
Number of conversations per patient | |
1 | 32 (72.7%) |
2 | 7 (15.9%) |
3 | 5 (11.4%) |
Healthcare providers present | Pulmonologist + COPD nurse: 32x (52.5%) |
Pulmonologist: 6x (9.8%) | |
COPD nurse: 23x (37.7%) | |
Advance care planning | |
Topics discussed | |
Illness trajectory | 19 (43.2%) |
Incurability of the disease | 7 (15.9%) |
Life expectation | 11 (25.0%) |
Care goals | 9 (20.5%) |
Advantages and disadvantages of life-sustaining treatment | 23 (52.3%) |
Preferences for hospitalisation in case of a next exacerbation | 16 (36.4%) |
Preferred place of death | 8 (18.2%) |
Palliative sedation and/or euthanasia | 10 (22.7%) |
Documentation of life-sustaining treatment preferences | 34 (77.3%) |
Multidimensional assessment | |
Domains addressed | |
Physical | 43 (97.7%) |
Psychological | 30 (68.2%) |
Social | 33 (75.0%) |
Spiritual | 27 (61.4%) |
Symptom management | |
Breathlessness treated with opioids | 19 (43.2%) |
Non-pharmacological breathlessness interventions | 26 (59.1%) |
Advice and breathing techniques | 15 |
Oxygen therapy | 11 |
Handheld fan | 7 |
COPD action plan | 2 |
Treatment for anxiety and depression | 11 (25.0%) |
Pharmacological treatment | 7 |
Referral to psychologist | 5 |
Breathing techniques | 2 |
Involving palliative care nurse | 1 |
Patients referred | 32 (72.3%) |
Physiotherapist | 21 |
Tertiary pulmonary rehabilitation | 12 |
Primary care COPD nurse | 11 |
Psychologist | 5 |
Dietician | 5 |
Occupational therapist | 2 |
Primary care palliative care nurse | 2 |
Spiritual counsellor | 1 |