Palliative care utilization in patients with severe COPD and its associations with end-of-life care

<bold>Introduction:</bold> Based on the ERS 2023 guidelines, palliative care should be integrated into the routine care of people with chronic obstructive pulmonary disease (COPD). Yet, real-world evidence in this field is lacking. <bold>Objective:</bold> To evaluate the prevalence, determinants, and associations of palliative care utilization in subjects with COPD. <bold>Methods:</bold> An observational study including subjects with severe COPD (n=53), chronic heart failure (CHF, n=56), and active malignancy (n=57), that were interviewed regarding their overall health, prior palliative care, and end-of-life decisions. <bold>Results:</bold> Subjects with COPD (median age 75, 42% female) had a 1-year mean of 2 hospitalizations, 66% used home oxygen, and 40% suffered chronic pain. Three (6%) visited a palliative care clinic (PCC) in the previous year, compared to subjects with CHF (11%, p=0.34) and malignancy (39%, p<0.01). PCC visits occurred only in subjects with prior specialist follow-up, which was also lowest among subjects with COPD (47% vs. 70-88%, p<0.05). Additional independent predictors for PCC visits were non-religious identity (adjusted OR 3.41, 95% CI 1.2-9.9, p=0.02) and above high-school education (AOR 2.84, 95% CI 1.1-7.3, p=0.03). Attending PCC was associated with advanced directive awareness (p=0.01), planning (p<0.01), and sharing of end-of-life decisions (p<0.01). Wanting to avoid mechanical ventilation in non-reversible acute conditions was lowest in subjects with COPD (57%), higher in those visited a PCC (19% vs. 34%). <bold>Conclusion:</bold> Palliative care utilization of patients with COPD is low. Our findings highlight the importance of specialist follow-up and assessment of social determinants to address this unmet need.