Background: Palliative care is essential for managing advanced chronic illnesses (ACI) but remains underused.
Objectives: We aimed to evaluate the prevalence, associations, and outcomes of palliative care utilization (PCU) in patients with ACIs.
Design: A prospective observational questionnaire-based study.
Methods: The study included hospitalized patients with severe COPD (n = 53), advanced heart failure (HF; n = 56), or metastatic malignancy (n = 57). Participants were interviewed about their demographics, health status, PCU, and end-of-life decision-making.
Results: A total of 166 subjects were included (median age: 77 years; 41% females), with a 1-year median of 2 hospital admissions. Subjects with COPD and HF had low rates of PCU compared to those with malignancy (6% and 11% vs 39%, p < 0.01). PCU occurred exclusively in patients who had visited a specialist (cardiologist, pulmonologist, or oncologist) before study inclusion. Patients with PCU were more aware of advance directives (71% vs 38%), signed advanced orders (23% vs 3%), and shared their end-of-life decisions with others (71% vs 29%). These differences remained significant after adjustment for prior specialist visits. Independent associations with PCU were self-identifying as non-religious (adjusted OR 3.41, 95% CI 1.2-9.9), above high-school education (AOR 2.84, 95% CI 1.1-7.3), and chronic pain (aOR 2.81, 95% CI 1.11-7.14), while COPD showed the opposite (aOR 0.25, 95% CI 0.07-0.96).
Conclusion: Palliative care utilization is alarmingly low among patients with HF and COPD despite significant symptom burden. Specialists should advocate for PCU as their involvement could enhance end-of-life care planning, improve patient outcomes, and address current gaps in care.
Keywords: COPD; HF; advance directives; end-of-life; palliative care; specialist.
Palliative care use by patients with advanced lung and cardiac diseasesPalliative care is medical care focused on improving the quality of life for people with serious illnesses. However, many people with chronic conditions like heart failure (HF) and chronic obstructive pulmonary disease (COPD) are not receiving this type of care. This study looked at how often palliative care is used by people with severe COPD, advanced heart failure, or metastatic cancer by interviewing patients with these conditions while they were admitted to the hospital. The results showed that palliative care was much more common among cancer patients than the others. Patients who had visited a specialist doctor (such as a cardiologist, pulmonologist, or oncologist) were more likely to receive palliative care. Those who received palliative care were also more aware of end-of-life planning, more likely to have signed advance directives (legal documents that outline future medical care wishes), and more likely to have shared their end-of-life preferences with loved ones. In conclusion, many people with severe heart failure and COPD are not getting palliative care, even though they could benefit from it. Specialists play a key role in improving access to this care and more awareness and better communication between doctors and patients could improve end-of-life care for people with these chronic illnesses.