Authors (including presenting author) :
Cheung Yan Ki Renee(1), Woo Kam Wing Raymond(1), Poon Yin Clara(1), Leung Ling Yan Clare(1), Kwok Oi Ling Annie(1)
Affiliation :
(1)Palliative Care unit, Department of Medicine and Geriatrics, Caritas Medical Centre, Hong Kong SAR, China
Introduction :
Access to specialized palliative care service for patients with advanced non-malignant respiratory disease is limited globally, despite being recommended by various international guidelines. Real-world data on specialist-led respiratory palliative care, especially in Asian countries, is limited.
Objectives :
This study aims to describe the characteristics and outcomes of our patients suffering from advanced non-malignant respiratory disease, and reviews the service provision, including making of Advance Directives (AD).
Methodology :
This is a retrospective chart review of patients with advanced non-malignant respiratory disease receiving specialist-led palliative care service of the Kowloon West Cluster of Hong Kong from July 2022 to July 2024. The Cluster involves 3 acute hospitals (Caritas Medical Centre, Princess Margaret Hospital, Yan Chai Hospital) and serves more than 1.3 million populations. The specialized palliative care service included specialist in-patient palliative care in the Palliative Care Unit, outpatient clinics, palliative home care nurse support, as well as palliative care in-patient consultation in the 3 hospitals. Demographical data and clinical information were retrieved and analyzed.
Result & Outcome :
There were 87 patients recruited in the respiratory palliative care service within the study period, 65 (74.7%) were male, with mean age of 76.2 (Standard deviation 10.2) years old. Sixty-four out of 87 (73.6%) suffered from chronic obstructive pulmonary disease (COPD), 13 (14.9%) suffered from interstitial lung disease and 11 (12.6%) suffered from bronchiectasis. Ten (11.5%) patients of our cohort suffered from more than one respiratory pathologies.
After enrollment into the palliative care service, 19 (21.8%), 34 (39.1%) and 39 (44.8%) patients passed away within 1, 3 and 6 months respectively.
Among our cohort, 38 (43.7%) had their ADs and Non-hospitalized Do-Not-Attempt-Cardiopulmonary Resuscitation Form (DNACPR) forms signed. Among the patients who had AD signed, most of them (n= 30, 78.9%) had passed away. The median and 1st quartile duration between AD completion and death are 8.7 months and 3.3 months respectively.
In summary, over the years, palliative care service has been extended to include patients with advanced non-malignant respiratory diseases. While COPD patients constituted the largest proportion of cohort, patients with other non-malignant respiratory diseases were also benefited. Despite the prognostic difficulties, significant proportion of patients had their ADs signed. Further studies on the respiratory palliative care service are warranted.
