Palliative care (PALC) may be beneficial for breathlessness in patients with chronic respiratory diseases, according to a study in Respiratory Medicine.
Researchers conducted a systematic review to assess how PALC vs usual care affected patients with chronic respiratory diseases with respect to outcomes that included regarding quality of life (QOL), symptom control, symptom burden, psychological well-being, advance care planning (ACP), use of health services, and survival.
The researchers conducted a literature search of the PubMed, Cochrane, and Web of Science databases for articles published from 2012 to 2022 that compared PALC interventions to usual care. Validated scales and questionnaires such as the COPD Assessment Test, the Chronic Respiratory Disease Questionnaire, the Hospital Anxiety and Depression Scale, and the Palliative Care Outcome Scale were used to evaluate the outcomes.
The review analysis ultimately included 8 studies (7 randomized controlled trials and 1 cluster-controlled trial) with sample sizes of 22 to 228 patients. Chronic respiratory diseases, including COPD, interstitial lung disease, and idiopathic pulmonary fibrosis, represented a significant percentage of patients in several trials.
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[W]hile breathlessness control and ACP were consistently improved by the PALC interventions, for other outcomes like QOL, symptom burden, and anxiety and depression, most studies found no significant differences or showed discordant results.
QOL was assessed in all studies with 6 different measurement instruments. Most of the studies found no significant differences between groups, and 1 study found a significant difference in favor of the intervention (PALC) group. Findings for anxiety and depression were mixed among the studies.
Breathlessness control, an outcome based on a domain of the Chronic Respiratory Disease Questionnaire, was a primary outcome in 2 studies; both found significant improvement for the intervention group. A third study found improvement in breathlessness for the intervention group, although it was not significant. Regarding breathlessness intensity, 1 study reported statistically significant evidence that patients in the intervention group had less and slower worsening of their dyspnea vs the control group, and 2 other studies did not find significant differences.
For advance care planning, 2 studies found that the number of patients who made ACP choices was superior in the intervention group, and another study found no significant differences between groups for living will decisions.
Fewer hospitalizations were reported in the control group in 1 study, and 3 studies found no significant differences between groups. No significant differences in survival were observed in 4 studies, and 1 study observed a significant difference in survival in favor of the intervention group among patients with diseases other than cancer, especially COPD and interstitial lung disease.
Qualitative interviews were conducted in 3 studies. Patients and carers valued that the interventions improved their knowledge and understanding of their diseases and symptoms, their ability to cope with it, and especially their confidence.
Limitations include the possibility of selection bias and the researchers’ inability to conduct a meta-analysis owing to the heterogeneity of the studies.
“The findings were mixed, ie, while some studies reported statistically significant improvements, others showed no significant differences for the same outcomes,” stated the investigators. “More specifically, while breathlessness control and ACP were consistently improved by the PALC interventions, for other outcomes like QOL, symptom burden, and anxiety and depression, most studies found no significant differences or showed discordant results.”
Disclosure: One of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
