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Improving Quality of Life in Chronic Obstructive Pulmonary Disease by Integrating Palliative Approaches to Dyspnea, Anxiety, and Depression

Long, Mary Bronwyn DNP, MBA; Bekelman, David B. MD, MPH; Make, Barry MD

Journal of Hospice & Palliative Nursing: December 2014 - Volume 16 - Issue 8 - p 514–520
doi: 10.1097/NJH.0000000000000111
Feature Articles

Chronic obstructive pulmonary disease (COPD), the third leading cause of death in the United States, is associated with persistent burdensome symptoms including dyspnea, anxiety, and depression. Few studies have examined treating these symptoms concurrently using palliative care. The goal of this study was to evaluate the feasibility and usefulness of an advance practice nurse–delivered palliative care intervention in patients with symptomatic COPD. We conducted a 3-month prospective, single-arm, mixed-method pilot study. A convenience sample of outpatients with Global Initiative for Chronic Obstructive Lung Disease stage III or IV COPD was enrolled from a single center. The advance practice nurse provided pharmacologic and nonpharmacologic palliative management of dyspnea, anxiety, and depression. Feasibility was measured by recruitment and retention rates and completion of survey measures. Usefulness was measured by changes in survey measures and an end-of-study semistructured participant interview. Sixty people were invited to participate in the study, and 15 enrolled (25%). Thirteen of 15 (87%) completed the study. Twelve of 15 (80%) used opioids for dyspnea, whereas 7 (47%) enrolled in pulmonary rehabilitation or another exercise program. All patients reported decreased anxiety and depression with improvement in dyspnea, so they opted not to treat either separately. Qualitative interviews revealed 3 themes: (1) improved quality of life, (2) issues around study participation, and (3) managing expectations. Participants reported subjective benefit from palliative care, and the intervention was feasible.

Mary Bronwyn Long, DNP, MBA, is palliative care and oncology clinical nurse specialist, National Jewish Health, Denver, Colorado.

David B. Bekelman, MD, MPH, is associate professor of Medicine and Nursing at the Department of Veterans Affairs, Eastern Colorado Health Care System, and the University of Colorado School of Medicine at the Anschutz Medical Campus, Denver.

Barry Make, MD, is professor, Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, Colorado.

Address correspondence to Mary Bronwyn Long, DNP, MBA, National Jewish Health, 1400 Jackson St, 2 Goodman, Room K236, Denver, CO 80206 (

This study was funded through a Hospice and Palliative Nurses Foundation grant via The American Nurses Foundation. Dr. Make is funded by a Department of Veterans Affairs Career Development Award (HSR&D CDA 08-022).

The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government.

Dr Make has no direct conflicts of interest with the subject of this manuscript. In the general area of chronic obstructive pulmonary disease, he has served on Medical Advisory Boards for Aerocrine, AstraZeneca, Boehringer Ingelheim, Breathe, CSL Bering, Coviden, Forest, GlaxoSmithKline, Ikaria, Merck, Novartis, Sunovian, and Theravance; funds for clinical trials have been received and controlled by the National Jewish Health from the National Heart, Lung, and Blood Institute, Forest, Sunovian, GlaxoSmithKline, AstraZeneca; he is on the Data Safety and Monitoring Board for Spiration trial and has been on the speakers’ bureaus for GlaxoSmithKline, Forest, and Pfizer. The remaining authors have no conflicts of interest to disclose.

© 2014 by The Hospice and Palliative Nurses Association.