Improving end-of-life care for patients with chronic obstructive pulmonary disease

Abstract

Global chronic obstructive pulmonary disease care Worldwide, chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death [Mannino and Kiri, 2006], although individuals diagnosed with this disease around the globe do not always fare well in the medical community. An article from Japan states that patients with end-stage COPD have more deterioration in quality of life, more dyspnea, anxiety, appetite loss and general fatigue compared with patients with lung cancer [Katsura, 2003]. The article goes on to state that patients with COPD are also more likely to be treated aggressively with lifesustaining therapy, and receive inadequate symptom control [Katsura, 2003]. French authors reveal a similar lack of palliative care for patients with COPD. In 43% of patients with end-stage COPD, there was limited care [du Couedic et al. 2012]. Analysis of interviews showed that the subject of death was rarely or never discussed when the diagnosis was COPD [du Couedic et al. 2012]. Researchers in Australia also noted a lack of palliative care for individuals with COPD [Disler et al. 2012]. An integrated review to determine what approach was used to reduce symptoms at end of life revealed a range of palliative interventions. Although many components were present, there appeared to be limited evidence for health service coordination and active management of palliative care [Disler et al. 2012]. It is clear that medical institutions know how to deliver palliative care, just not always effectively for patients with end-stage COPD. Lack of understanding Palliative care is a term used liberally when discussing hospice and end-of-life care, but not always when addressing symptom control. Many healthcare professionals perceive palliative care to be only for the dying. Spence and colleagues did a qualitative study of professionals delivering palliative care to people with COPD. According to the participants, when treating patients with COPD the focus was on symptom management but predominately using an acute care model [Spence et al. 2009]. The delivery of palliative care was viewed as a specialist's role rather than an integral component of care. Patients with COPD have many bothersome symptoms; dyspnea is just one of them. These symptoms unfortunately exist long before the patient is deemed to have endstage disease. Nonhospice palliative care is a reality and can be offered at the same time as life-extending and curative therapies [Kelley and

Type and course of symptoms demonstrated in the terminal and dying phases by people with dementia in nursing homes

“…Another noteworthy result of this study is that the data do not confirm the uncertainty about prognosis of an advanced chronic illness, as discussed by Sorenson [44], in the case of dementia. Rather, the study results indicate that the healthcare professionals and the family clearly notice specific changes in people with dementia in the dying phase.…”

Living with Advanced Chronic Obstructive Pulmonary Disease: A Qualitative Interview Study with Patients and Informal Carers

“…3 Patients experience a high symptom burden as the disease progresses. 4 This leads to unintentional activity limitation, which may be associated with progressive social isolation and the reduction of the perceived quality of life in patients with COPD. 5 Furthermore, this high prevalence of physical symptoms and psychological distress in advanced COPD is comparable with, or worse than the symptom burden reported in the lung cancer population.…”

Palliative Care Provision for Patients with Advanced Chronic Obstructive Pulmonary Disease: A Systematic Integrative Literature Review

“…2 Disease progression in COPD is correlated with an increased symptom burden. 3,4 The high prevalence of physical symptoms and psychological distress in advanced COPD is comparable with or worse than the symptom burden reported in the lung cancer population. 5 Although COPD is recognized as being a life-limiting condition with palliative care needs, palliative care provision is seldom implemented in this population.…”