Background: End of life (EoL) care is often suboptimal in chronic respiratory illness, compared to thoracic malignancy despite the benefits of Palliative Care. Objectives: Evaluate differences in current end of life care practices between patients with malignant and non-malignant terminal respiratory illness to improve future delivery of anticipatory care planning. Design, setting and subjects: Retrospective review of all Respiratory patients admitted to Royal Perth Hospital in Australia, presenting with a ‘terminal admission’ between 2015 and 2017, defined as patient death or discharge for terminal care to hospice/home. Patients without an underlying chronic/end stage respiratory illness were excluded. Data were collected through medical and investigation records. Results: Of 89 cases, 37 had thoracic malignancy and 52 had non-malignant disease. Those with non-malignant disease were less likely to be referred to Palliative Care (8.1% vs 28.8%, p=0.016) or have informal discussions regarding end of life wishes (73.6% vs 92.1%, p=0.03). More of these patients died in hospital (63.5% vs 37.8%, p=0.017), received non-invasive ventilation (48% vs 11.1%, p=0.001) and had Palliative Care referral only on day of death (21.1% vs 2.7%, p=0.018). Most frequent general EoL clinical indicators in both groups were deteriorating symptom burden, decreasing response to treatments and ECOG status ≥3. In the COPD subgroup they included FEV1 < 30%, MRC Grade 4/5 dyspnoea and meeting criteria for long-term oxygen. Conclusions: Significant disparity exists in provision of end of life care between these groups. The common general and disease specific end of life clinical indicators are identified, which may prompt early palliative care input and anticipatory care planning.
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