Tele-Assisted Palliative Homecare for Advanced Chronic Obstructive Pulmonary Disease: A Feasibility Study

Background: Despite real needs, very few chronic obstructive pulmonary disease (COPD) patients with life-limiting disease receive a well-organized support for palliative care (PC). Objective: To test the feasibility of, and patient satisfaction with, an advanced care plan for severe COPD patients followed by tele-assistance at home for six months that focused on monitoring patient's palliative topics through a dedicated checklist. Methods: Ten hospitalized patients with severe COPD (<1-year life expectancy) received a 60 minutes PC talk by a specialist to define an advanced care plan in the case of very severe respiratory insufficiency, based on three options: (1) endotracheal intubation (EI); (2) noninvasive ventilation; or (3) no mechanical aid; O-2 and drugs, for example, opiates. After the talk, patients expressed their personal choice. Following discharge home, patients received structured monthly telephone monitoring from specialized tutor nurses for six months on palliative topics. Patient's anxiety before and after talk, depression, quality of life, specialist's quality of communication, and customer satisfaction were evaluated. Results: The palliative talk was feasible and anxiety low during the talk. Nine out 10 patients were followed up by nurse till the end of the program. Overall bad days of life, negative emotions, and perception of disease deterioration were the palliative topics more frequently declared by patient during the phone calls. Two patients changed their preference from EI to O-2 therapy/sedation as a consequence of the intervention. Five out of 10 patients died. All patients expressed a high level of satisfaction of the service. Discussion: Tele-assisted PC is feasible and well accepted. According to these observations, a suitable supportive program can be the goal of a future study.