The Investigation And Intervention Study Of Palliative Care Needs In Patients With Severe Chronic Obstructive Pulmonary Disease

Objective Palliative care is an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.Even though Palliative care is not confined to the field of cancer or other malignant diseases, palliative care mainly focus on incurable disease such as cancer at present, rarely involved in the field of non-malignant diseases. The developing course of Severe chronic obstructive pulmonary disease cause a sharply decline in patients’quality of life, but palliative care needs of COPD patients tend to be ignored. The study was to explore the palliative care needs of patients with severe COPD and advanced lung cancer (LC),to compare the difference of both groups, in order to appeal the attention of domestic scholars of COPD palliative care.Knowing influencing factors of palliative care needs of severe COPD patients is to provide theoretical basis for building severe COPD palliative care model; through which to improve the quality of life of patients with COPD and alleviate their caregiver burden.Methods This study consisted of two parts including investigation and intervention. (1) The investigation part:154 patients (COPD 77, LC 77) in Pneumology Department (ward one and ward two) of the first affiliated hospital of guangxi medical university were recruited in the survey by convenience sampling in the September of the year of 2014 to the December of the year of 2015. All patients were investigated by Modified Borg Scale, Karnofsky Performance Status (KPS) Scale, the hospital anxiety and depression scale (HAD), Palliative Outcome Scale(POS) for assessing the degree of dyspnea, functional status, anxiety and depression,palliative care needs. The influencing factors of the palliative care needs of severe COPD patients were analyzed by multiple linear regression analysis. (2)The intervention part:60 patients with severe COPD patients and their caregivers were respectively recruited from Pneumology Department (ward one 30, ward two 30) of the first affiliated hospital of guangxi medical university.All the recruited severe COPD patients were devided into two groups,the control group(ward two) was given the regular health education,the intervention group(ward one) was given regular health education and Palliative care health education. At the time of admission and at least one month after intervention, the patient’s quality of life and caregiver burden were assessed by chronic obstructive pulmonary disease CAT scores and Zarit Burden Interview by the form of telephone follow-up, to evaluate the effectiveness of palliative care health education model.Results (1)The survey results show that the palliative care needs score of severe COPD patients was (14.584±5.434),and the advanced LC patients’was (14.376±5.316); Both were in the medium level. The anxiety depression scores of both group were respectively (17.000±7.453) and (16.610±7.089), it showed no statistically significant difference (p>0.05);The breathlessness score of both group were respectively (4.910±1.310) and (2.450±1.882),it showed statistically significant difference (p<0.05);The functional status score were respectively (62.210±14.834) and (69.740±10.879), it showed statistically significant difference (p<0.05); Palliative care needs was positive correlated with functional status, and both anxiety and depression. (2) Analyzing influencing factors of the palliative care needs of COPD patients separately, according to the results, Anxiety and depression, pulmonary function classification, and complication were the influencing factors of palliative care needs. The regression equation for the POS score=5.353+0.144x anxiety and depression+1.156xcomplications number+2.186x lung function classification +1.341 x course.(3) Before the intervention,there was no difference between the two groups in quality of life and their caregiver burden, (p>0.05). After the intervention, there was statistically significant difference between the two groups in quality of life and their caregiver burden (p<0.05); The quality of life and caregiver burden were different before and after the intervention in the intervention group(p<0.05).Conclusions (1)Both severe COPD and advanced LC patients have similar palliative care needs, which are in a middle level of palliative care needs.(2) The palliative care needs of COPD patients is related to breathlessness, functional status, anxiety and depression. Anxiety and depression, pulmonary function classification, complication and course of disease are the influencing factors of palliative care needs.(3)The Palliative care health education model can improve patients’quality of life and alleviate their caregiver burden.