{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T14:27:35Z","timestamp":1791988055447,"version":"4.4.0"},"reference-count":20,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2021,10,23]],"date-time":"2021-10-23T00:00:00Z","timestamp":1634947200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Internal Medicine Journal"],"published-print":{"date-parts":[[2021,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Chronic obstructive pulmonary disease (COPD) is an incurable, chronic condition that leads to significant morbidity and mortality, with most patients dying in hospital. While diagnostic tests are important for actively managing patients during hospital admissions, the balance between benefit and harm should always be considered. This is particularly important when patients reach the end of life, when the focus is to reduce burdensome interventions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aims<\/jats:title><jats:p>To examine the use of diagnostic testing in a cohort of people with COPD who died in hospital.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Retrospective medical record audits were completed at two Australian hospitals (Royal Melbourne Hospital and Northeast Health Wangaratta), with all patients who died from COPD over 12\u2009years between 1 January 2004 and 31 December 2015 included.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Three hundred and forty\u2010three patients were included, with a median of 11 diagnostic testing episodes per patient. Undergoing higher numbers of diagnostic tests was associated with younger age, intensive care unit admission and non\u2010invasive ventilation use. Reduced testing was associated with recent hospital admission for COPD, domiciliary oxygen use and a prior admission with documentation limiting medical treatment. Most patients underwent diagnostic tests in the last 2\u2009days of life, and 12% of patients had ongoing diagnostic tests performed after a documented decision was made to change the goal of care to provide comfort care only.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>There were missed opportunities to reduce the burden of diagnostic tests and focus on comfort at the end of life. Increased physician education regarding communication and end\u2010of\u2010life care, including recognising active dying may address these issues.<\/jats:p><\/jats:sec>","DOI":"10.1111\/imj.14943","type":"journal-article","created":{"date-parts":[[2020,6,17]],"date-time":"2020-06-17T03:53:43Z","timestamp":1592366023000},"page":"1835-1839","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Burden of diagnostic investigations at the end of life for people with chronic obstructive pulmonary disease"],"prefix":"10.1111","volume":"51","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4913-2250","authenticated-orcid":false,"given":"Lauren","family":"Ross","sequence":"first","affiliation":[{"name":"Department of Respiratory and Sleep Medicine The Royal Melbourne Hospital  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Taverner","sequence":"additional","affiliation":[{"name":"Department of Respiratory and Sleep Medicine The Royal Melbourne Hospital  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"John","sequence":"additional","affiliation":[{"name":"Department of Rural Health University of Melbourne, Northeast Health Wangaratta  Wangaratta Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Baisch","sequence":"additional","affiliation":[{"name":"Department of Medicine Northeast Health Wangaratta  Wangaratta Victoria Australia"},{"name":"Department of Rural Health University of Melbourne  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Louis","family":"Irving","sequence":"additional","affiliation":[{"name":"Department of Respiratory and Sleep Medicine The Royal Melbourne Hospital  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Philip","sequence":"additional","affiliation":[{"name":"Palliative Medicine University of Melbourne, St Vincent's Hospital and Victorian Comprehensive Cancer Centre  Melbourne Victoria Australia"},{"name":"St Vincent's Hospital  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3403-3586","authenticated-orcid":false,"given":"Natasha","family":"Smallwood","sequence":"additional","affiliation":[{"name":"Department of Respiratory and Sleep Medicine The Royal Melbourne Hospital  Melbourne Victoria Australia"},{"name":"Department of Medicine (Royal Melbourne Hospital) University of Melbourne  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,10,23]]},"reference":[{"key":"e_1_2_8_2_1","unstructured":"Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy for the diagnosis management and prevention of COPD (2018 report). 2018 [cited 2019 Apr]. Available from URL:http:\/\/www.goldcopd.org"},{"key":"e_1_2_8_3_1","unstructured":"World Health Organization (WHO). Global health observatory data. Top 10 causes of death. Geneva Switzerland: WHO;2018[cited 2019 May]. Available from URL:https:\/\/www.who.int\/gho\/mortality_burden_disease\/causes_death\/top_10\/en"},{"key":"e_1_2_8_4_1","volume-title":"Mortality from Asthma and COPD in Australia","author":"Australian Institute of Health and Welfare","year":"2014"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41533-017-0017-y"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.289.18.2387"},{"key":"e_1_2_8_7_1","unstructured":"Australian Institute of Health and Welfare. Palliative care services in Australia. Canberra: AIHW; 2017 [cited 2018 Dec]. 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