Review articleHealth care needs in end-stage COPD: A structured literature review
Introduction
The demand for palliative care for patients with chronic obstructive pulmonary disease (COPD) will increase in the coming decades as a consequence of the increasing attention for palliative care and the increasing prevalence of COPD and because of an overall shift in mortality towards chronic diseases. According to the Global Burden of Disease study (GBS) of the World Health Organisation (WHO), COPD is currently the fourth leading cause of death in the world, and further increases in the prevalence and mortality of the disease can be predicted in the coming decades [1]. In the Netherlands, over 6300 people die from COPD yearly, 58% of whom are male and 42% female [2]. This accounts for almost 5% of total Dutch mortality. Palliative care historically focuses on cancer disease trajectories, and specialised services for patients with a non-malignant disease like COPD are still in a developing stage [3], [4], [5]. Palliative care focuses on maximising the quality of life of patients and their families facing problems associated with a life-threatening illness and includes care on psychological, social and spiritual dimensions.
It is important to gain more insight into the care needs of COPD patients who are going through the last part of their disease trajectory. COPD is a chronic condition that is characterised by a progressive loss of lung function with intermittent serious episodes or exacerbations [6]. Each exacerbation further diminishes lung capacity and this will finally result in death. However, the exact timing of death remains uncertain. The patient usually survives many such episodes. Therefore, the last phase of life for COPD patients can be very long and indistinct which makes it difficult to determine what type of supportive care is most appropriate at what time.
In this study, we show what is known in the literature about the needs of COPD patients in the end-stage of the disease. We conducted a structured literature review in order to gather all published data that address this question and identified specific areas where knowledge about needs is still lacking.
Section snippets
Literature search
We performed a systematic search of the literature using PubMed (1953–March 2007) and Embase (1980–week 12, 2007): (search date 28 March 2007). We searched all terms in PubMed as words in text, title and abstract and as MESH terms. In Embase we searched subject headings and key words. The search strategy consisted of three parts and was set up to search as sensitively as possible. The first part identified COPD patients, the second part focussed on the terminal or palliative phase and in the
Results
Seventy-seven publications were found after excluding doubles between databases. In total, 68 publications were excluded: 20 publications were not a primary investigation, 24 publications did not have COPD as the main subject, 10 did not describe the end-stage of the disease, 9 did not describe health care needs, 5 were not written in English or Dutch. The nine remaining publications were included in this review. One other publication was included in the review. This publication was suggested
Discussion
We found that very few studies have been published about the health care needs of end-stage COPD patients. This is surprising, because of the high prevalence and the high burden of COPD worldwide. We identified specific areas where knowledge about needs is lacking.
The studies that have been published, predominantly report on felt need, i.e. needs that are mentioned by patients themselves. All but one study used (group) interviews as a qualitative method of data collection. This is an
Acknowledgements
This research was funded by the Netherlands Asthma Foundation (CJA 04005). The authors would further like to thank Prof. J.M. Addington-Hall, Dr. A.J. Pols and Dr. E.J.M. Weersink for their invaluable advice.
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