Temporal Trends, Setting, and Timing of Palliative and Hospice Care in COPD in the Veterans Health Administration, 2010-2020.

BACKGROUND: People with COPD experience physical, psychosocial, and health care burdens that decrease their quality of life. Early specialist palliative care is recommended to alleviate these burdens. RESEARCH QUESTION: What factors are associated with palliative care use among decedents with COPD? STUDY DESIGN AND METHODS: This was a national retrospective cohort study of veterans with COPD who died between 2010 and 2020. Mixed-effects multivariate regression was used to assess the relationship between baseline patient characteristics and the primary outcome of receipt of palliative care within 1 year of death. Secondary outcomes included Veterans Affairs inpatient hospice, timing of palliative care, and trend in palliative care use over time. RESULTS: Among 332,770 decedents, 16.8% received palliative care (61.6% in the inpatient setting) in the year before death. Patient characteristics associated with receipt of palliative care included lung cancer (adjusted OR [aOR], 2.48; 95% CI, 2.40-2.55), congestive heart failure (aOR, 2.02; 95% CI, 1.97-2.06), being underweight (aOR, 1.75; 95% CI, 1.70-1.82), housing instability (aOR, 1.38; 95% CI, 1.33-1.43), Latino/Hispanic ethnicity (aOR, 1.22; 95% CI, 1.12-1.32), and Black race (aOR, 1.21; 95% CI, 1.17-1.26). In contrast, married patients (aOR, 0.88; 95% CI, 0.86-0.90) and those receiving care in a rural facility (aOR, 0.94; 95% CI, 0.91-0.97) were less likely to receive palliative care. Palliative care use increased from 10.4% to 16.0% (P < .05). The median time between first palliative care encounter and death was 46 days (interquartile range, 12-138). INTERPRETATION: Despite an increase in palliative care use over the past decade among veterans with COPD, our findings indicate that most did not receive palliative care or Veterans Affairs inpatient hospice within their final year of life. Those who received palliative care received it late in the illness course. These results highlight the need for targeted strategies to increase access to palliative care and hospice services for patients with COPD.