Equal palliative care for patients with COPD? A nationwide register study

Figures & data

Table 1. Differences in patients who died in either specialized palliative care or in nursing homes (n = 770).

	Patients receiving specialized palliative care, in-patient or in their own home (n = 355)	Nursing home and short-term facilities (n = 415)	p-value, diff between sp pall care and nursing home
	Mean (SD)	Mean (SD)
Time between last visit and death, days	662.6 (518.5)	618.9 (521.4)	0.24
Demographic variables
Age	73.9 (8.0)	79.3 (7.7)	<0.001
	n (%)	n (%)
Gender
Men	168 (47.3%)	204 (49.2%)	0.61
Women	187 (52.7%)	211 (50.8%)
Social situation:
Living alone	48 (32.9%)	68 (56.7%)	<0.001
Co-habiting	98 (67.1%)	52 (43.3)
Clinical variables	n (%)	n (%)
Stage of COPD			0.28
I: (80-100% of predicted FEV1)	11 (4.3%)	6 (2.7%)
II: (50-79% of predicted FEV1)	86 (33.6%)	73 (32.7%)
III: (30-49% of predicted FEV1)	103 (40.2%)	98 (43.9%)
IV: (0-29% of predicted FEV1)	56 (21.9%)	43 (19.3%)
	Mean (SD)	Mean (SD)
Number of exacerbations in the last 12 months	1.37 (2.06)	1.24 (2.04)	0.48
Number of hospitalizations in the last 12 months	0.62 (1.30)	0.76 (1.82)	0.32
FEV% of predicted value	43.50 (18.42)	43.52 (16.65)	0.99
Exercise capacity	2.42 (2.79)	1.79 (2.58)	0.012
Patient -reported variables	n (%)	n (%)
Smoking:
Non-smoker	15 (4.7%)	40 (13.5%)	<0.001
Have quit smoking	205 (64.9%)	188 (63.5%)
Still smoking	96 (30.4%)	68 (23%)
	Mean (SD)	Mean (SD)
Dyspnea	2.61 (1.30)	2.80 (1.23)	0.113
HRQoL (CCQ)	2.29 (1.34) (n = 150)	2.41 (1.22) (n = 124)	0.42
HRQoL (CAT)	17.95 (7.61) (n = 59)	17.78 (6.90) (n = 45)	0.91
Comorbidity	n (%)	n (%)
Heart failure	45 (18.4%)	92 (36.7%)	<0.001
Ischemic heart disease	60 (24.4%)	102 (39.8%)	<0.001
Stroke	18 (8.9%)	21 (11.5%)	0.39
Hypertension	118 (45.0%)	173 (60.3%)	<0.001
Diabetes	35 (13.3%)	62 (24.7%)	0.001
Osteoporosis	39 (17.9%)	57 (26.9%)	0.025
Depression/anxiety	65 (25.0%)	88 (33.3%)	0.036
Lung cancer	19 (9.5%)	17 (8.9%)	0.84
Alpha-1-antitrypsin deficiency	3 (1.7%)	0	0.094

T-test was used for comparisons between continuous variables, Chi 2 for comparisons between categorical, variables.

Table 2. Characteristics of symptom experience, assessment, and management registered in specialized palliative care and in nursing homes.

Palliative care characteristics	Patients receiving specialized palliative care (n = 355)	Nursing home and short-term facilities (n = 415)	p-value, diff between sp pall care and nursing home
Pressure ulcer on admission			0.53
No pressure ulcer	285 (85.3%)	292 (85.1%)
Grade 1	21 (6.3%)	19 (5.5%)
Grade 2	17 (5.1%)	14 (4.1%)
Grade 3	7 (2.1%)	11 (3.2%)
Grade 4	4 (1.2%)	7 (2.0%)
Pressure ulcer at death			0.88
No pressure ulcer	242 (71.6%)	255 (72.9%)
Grade 1	43 (12.7%)	41 (1.7%)
Grade 2	37 (10.9%)	25 (7.1%)
Grade 3	11 (3.3%)	17 (4.9%)
Grade 4	5 (1.5%)	12 (3.4%)
Symptoms or assessments during the last week of life
Mouth health assessment	253 (78.6%)	193 (62.9%)	<0.001
Symptom assessment other than pain	101 (32.0%)	67 (20.5%)	0.001
Pain, prevalence	254 (73.0%)	240 (69.8%)	0.36
Pain assessment	184 (54.1%)	116 (34.3%)	<0.001
Prescribed rescue medication for pain	344 (98.3%)	317 (90.3%)	<0.001
Pain alleviated			0.74
Totally	213 (80.4%)	199 (81.6%)
Partly	52 (19.6%)	45 (18.4%)
Not at all	0	0
Rattle, prevalence	204 (58.3%)	183 (53.5%)	0.206
Prescribed rescue medication for rattle	336 (96.3%)	316 (89.8%)	0.001
Rattle alleviated			0.88
Totally	113 (52.8%)	98 (52.4%)
Partly	90 (42.1%)	84 (44.9%)
Not at all	11 (5.1%)	5 (2.7%)
Nausea, prevalence	45 (13.0%)	47 (14.2%)	0.21
Prescribed rescue medication for nausea	324 (92.6%)	259 (74.0%)	<0.001
Nausea alleviated			0.117
Totally	41 (69.5%)	27 (52.9%)
Partly	15 (25.4%)	23 (45.1%)
Not at all	3 (5.1%)	1 (2.0%)
Anxiety, prevalence	194 (57.2%)	201 (62.2%)	0.19
Prescribed rescue medication for anxiety	344 (98.3%)	311 (88.4%)	<0.001
Anxiety alleviated			0.49
Totally	142 (68.6%)	134 (65.4%)
Partly	65 (31.4%)	71 (34.6%)
Not at all	0	0
Dyspnea, prevalence	179 (52.2%)	150 (44.9%)	0.058
Dyspnea alleviated			0.060
Totally	83 (43.7%)	48 (31.4%)
Partly	104 (54.7%)	101 (66.0%)
Not at all	3 (1.6%)	4 (2.6%)
Delirium, prevalence	77 (22.7%)	85 (26.5%)	0.26
Delirium alleviated			0.59
Totally	30 (33.0%)	23 (26.1%)
Partly	49 (53.8%)	51 (58.0%)
Not at all	12 (13.2%)	14 (15.9%)

Table 3. Characteristics of palliative care registered in specialized palliative care and in nursing homes. (chi-square).

Palliative care characteristics	Patients receiving specialized palliative care (n = 355)	Nursing home and short-term facilities (n = 415)	p-value, diff between sp pall care and nursing home
Death was expected	349 (98.3%)	337 (84.5%)	<0.001
Could the patient express his/her wishes?			<0.001
Yes, all the time	44 (12.7%)	61 (18.2%)
Lost ability express hours before death	146 (42.2%)	102 (30.4%)
Lost ability express days before death	143 (41.3%)	119 (35.5%)
Lost ability to express weeks before death	12 (3.5%)	27 (8.1%)
Lost ability to express months before death	1 (0.3%)	26 (7.8%)
(EOL) communication	280 (88.1%)	210 (66.2%)	<0.001
Patients’ preferred place of death?			<0.001
Yes	234 (77.7%)	176 (62.0%)
Do not know	50 (16.6%)	93 (32.7%)
No	17 (5.6%)	15 (5.3%)
Anyone present at time of death			<0.001
None	68 (19.2%)	88 (21.2%)
Relatives	169 (47.6%)	109 (26.3%)
Relatives and HCP	63 (17.7%)	61 (14.7%)
HCP	52 (14.6%)	153 (36.9%)
Do not know	3 (0.8%)	4 (1.0%)
(EOL) communication with relatives/family			<0.001
Have no relatives
Yes	3 (0.9%)	8 (2.3%)
No	297 (88.4%)	242 (69.3%)
Do not know	27 (8.0%)	73 (20.9%)
Family invited to bereavement dialogue	9 (2.7%)	26 (7.4%)	<0.001
Yes	329 (93.5%)	271 (66.6%)
No	10 (2.8%)	74 (18.2%)
Do not know	13 (3.7%)	62 (15.2%)
Parenteral or enteral infusion of fluids last 24 hours			0.65
No	314 (93.5%)	336 (96.3%)
Yes	21 (6.3%)	9 (2.6%)
Do not know	1 (0.3%)	4 (1.1%)
Consultation with pain unit	2 (0.6%)	4 (1.0%)	0.53
Consultation with palliative care team	17 (4.8%)	37 (8.9%)	0.025
Consultation with other hospital unit	12 (3.4%)	22 (5.3%)	0.20
Contact with physiotherapists, occupational therapists and social workers	4 (1.1%)	10 (2.4%)	0.18
Spiritual counselor	5 (1.4%)	2 (0.5%)	0.18

Table 4. Logistic regression with nursing home or specialized palliative care as place of death as dependent variable. Nursing home as reference variable, i.e. 0 and specialized palliative care as 1.

	Specialized palliative care as place of death compared to nursing home
	Bivariate	Multivariate
Independent variables	OR (95% CI) p	OR (95% CI) p
Constant		1171.14 p < 0.001
Time between last visit and death	1.00 (1.00, 1.00) 0.24
Age, divided by 10 years	0.42 (0.34, 0.51) <0.001	0.36 (0.22, 0.61) <0.001
Gender (1= man, 2 = woman)	0.93 (0.70, 1.23) 0.61
Social situation (0= living alone; 1= co-habiting)	2.67 (1.62, 4.40) <0.001	4.57 (2.17, 9.62) <0.001
FEV1% of predicted value	1.00 (0.99, 1.01) 0.99
Number of exacerbations in the last 12 months	1.03 (0.95, 1.12) 0.47
Number of hospitalizations in the last 12 months	0.94 (0.84, 1.06) 0.32
BMI	1.02 (0.99, 1.06) 0.15
Exercise capacity	1.09 (1.02, 1.17) 0.013
Smoking:
Non-smoker	1
Have quit smoking	2.91 (1.56, 5.44) 0.001
Still smoking	3.77 (1.93, 7.34) <0.001
Quality of life (CCQ) (0-6)	1.00 (0.95, 1.06) 0.90
Dyspnea (mMRC) (0-4)	1
	0.98 (0.38, 2.51) 0.97
	0.96 (0.37, 2.49) 0.94
	0.58 (0.23, 1.44) 0.24
	0.72 (0.30, 1.76) 0.48
Comorbidity
Heart failure	0.39 (0.26, 0.59) <0.001
Ischemic heart disease	0.49, (0.33, 0.72) <0.001
Stroke	0.75 (0.38, 1.45) 0.39
Hypertension	0.54 (0.38, 0.76) <0.001
Diabetes	0.47 (0.30, 0.74) 0.001
Osteoporosis	0.59 (0.37, 0.94) 0.026
Depression/anxiety	0.67 (0.46, 0.98) 0.036
Lung cancer	1.08 (0.54, 2.12) 0.84