Underutilization of palliative care in advanced COPD and heart failure: associations, disparities, and the role of specialists.

BACKGROUND

Palliative care is essential for managing advanced chronic illnesses (ACI) but remains underused.

OBJECTIVES

We aimed to evaluate the prevalence, associations, and outcomes of palliative care utilization (PCU) in patients with ACIs.

DESIGN

A prospective observational questionnaire-based study.

METHODS

The study included hospitalized patients with severe COPD (n = 53), advanced heart failure (HF; n = 56), or metastatic malignancy (n = 57). Participants were interviewed about their demographics, health status, PCU, and end-of-life decision-making.

RESULTS

A total of 166 subjects were included (median age: 77 years; 41% females), with a 1-year median of 2 hospital admissions. Subjects with COPD and HF had low rates of PCU compared to those with malignancy (6% and 11% vs 39%, p < 0.01). PCU occurred exclusively in patients who had visited a specialist (cardiologist, pulmonologist, or oncologist) before study inclusion. Patients with PCU were more aware of advance directives (71% vs 38%), signed advanced orders (23% vs 3%), and shared their end-of-life decisions with others (71% vs 29%). These differences remained significant after adjustment for prior specialist visits. Independent associations with PCU were self-identifying as non-religious (adjusted OR 3.41, 95% CI 1.2-9.9), above high-school education (AOR 2.84, 95% CI 1.1-7.3), and chronic pain (aOR 2.81, 95% CI 1.11-7.14), while COPD showed the opposite (aOR 0.25, 95% CI 0.07-0.96).

CONCLUSION

Palliative care utilization is alarmingly low among patients with HF and COPD despite significant symptom burden. Specialists should advocate for PCU as their involvement could enhance end-of-life care planning, improve patient outcomes, and address current gaps in care.