What factors predict severity of palliative care symptoms and concerns in COPD in South Africa? A cross-sectional study.

BACKGROUND: The majority of deaths worldwide are attributable to non-communicable diseases, with approximately four-fifths occurring in low- and middle-income countries. Chronic Obstructive Pulmonary Disease (COPD) is currently the fourth leading cause of mortality globally and is projected to become the third leading cause by 2030. OBJECTIVES: Our objectives were to: (1) determine the self-reported burden of palliative care-related symptoms and concerns (social, spiritual, psychological, physical), and (2) identify predictors of burdensome symptoms and concerns among adults with COPD attending primary care services in South Africa (including social support). METHODS: A cross-sectional survey was conducted across eight primary care facilities in the Western Cape. Sociodemographic data (age, sex, smoking status, and number of missed medication doses in the preceding seven days), clinical data, peak expiratory flow (PEF), and Karnofsky Performance Status (KPS) were collected. Participants completed the African Palliative Care Association African Palliative Outcome Scale (APCA APOS), the Medical Outcomes Study Social Support Survey (MOS-SSS), the London Chest Activity of Daily Living scale (LCADL), and the COPD Assessment Test (CAT). Ordinal logistic regression was used to examine factors associated with palliative care-related symptoms and concerns. RESULTS: A total of 387 participants were recruited (mean age 59.5 years).In terms of clinical importance APOS items with a prevalence of at least 20% that were rated at the most burdensome levels (scores of 4 or 5) included breathlessness (50.9%), need for help and advice in planning for the future (50.13%), difficulty sharing feelings (29.1%), weakness (25.32%), worry (25.26%), and pain (22.19%). Multivariable ordinal logistic regression analysis showed that greater social support (MOS-SSS) was associated with lower (better) APOS total scores (OR 0.97, 95% CI 0.96-0.98; p<0.001). Reduced ability to perform activities of daily living (LCADL) was associated with worse palliative care outcomes (OR 1.04, 95% CI 1.02-1.07; p<0.001). Higher (worse) CAT scores were also significantly associated with poorer palliative care outcomes (OR 1.13, 95% CI 1.09-1.17; p<0.001). CONCLUSION: The impact of social support on self-report concerns demonstrates the importance of a new public health approach to palliative care for COPD patients attending primary care services in sub-Saharan Africa.