The Use of Specialist Palliative Care Services Differs in Chronic Obstructive Pulmonary Disease and Interstitial Lung Disease: a National Cohort Study.

Abstract

Background: High symptom burden and psychosocial needs in chronic obstructive pulmonary disease (COPD) and interstitial lung disease (ILD) warrant palliative care. We assessed the use of specialist palliative care (SPC) and its association with the use of emergency department (ED) and hospital inpatient days in COPD and ILD.

Methods: A retrospective cohort study of all Finnish decedents who died of COPD (n=1189) or ILD (n=382) in 2019. Data was gathered from the registries of the Finnish Institute of Health and Welfare. Demographics, the use of SPC, the use of ED, and hospital inpatient days during the last six months of life were evaluated.

Results: During the last six months of life, ILD patients used more ED (92% vs. 84%, p<0.001) and spent more time at the hospital (median of 19 vs. 12 days, p<0.001) compared to COPD. Overall, 12% and 8% of the ILD and COPD patients had contact with SPC, respectively (p=0.012). During the last month of life, SPC reduced the use of ED both in COPD (57% vs. 68%, p=0.036) and ILD (58% vs. 74%, p=0.021), as well as the number of days spent in secondary care hospitals in ILD (median of 0 vs. 2 days, p=0.011). Also in multivariate analysis, SPC reduced the use of ED. Most patients (72%) died in a hospital.

Conclusions: ILD patients received more SPC than COPD patients, yet the numbers were low in both patient groups. Using acute hospital resources was common during the last months of life, but SPC reduced this.