Palliative care in chronic obstructive airways disease: a needs assessment

Skilbeck, Julie; Mott, Laurie; Page, Hilary; Smith, Diane A.; Hjelmeland-Ahmedzai, Sam; Clark, David

doi:10.1191/026921698677124622

Cited by 144 publications

(156 citation statements)

References 16 publications

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“…A recent study of patients with COPD or lung cancer in the US Veterans Affairs Health System also found that patients with COPD were much more likely to be admitted to an ICU, and have greater lengths of stay in the ICU during their terminal hospitalisation, than patients with lung cancer. In the same study, significant geographic variation in ICU utilisation was found for patients with COPD [15]. Although variation in care may be influenced by many factors including availability, access and reimbursement issues, such geographic variation suggests a lack of consensus concerning the best approach to palliative and endof-life care for patients with COPD.…”

Section: Poor Palliative Care In Copd and The Link To Poor Communicationmentioning

confidence: 78%

Palliative and end-of-life care for patients with severe COPD

2007

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Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. For many patients, maximal therapy for COPD produces only modest or incomplete relief of disabling symptoms and these symptoms result in a significantly reduced quality of life.Despite the high morbidity and mortality associated with severe COPD, many patients receive inadequate palliative care. There are several reasons for this. First, patient-physician communication about palliative and end-of-life care is infrequent and often of poor quality. Secondly, the uncertainty in predicting prognosis for patients with COPD makes communication about end-oflife care more difficult. Consequently, patients and their families frequently do not understand that severe COPD is often a progressive and terminal illness.The purpose of the present review is to summarise recent research regarding palliative and end-of-life care for patients with COPD. Recent studies provide insight and guidance into ways to improve communication about end-of-life care and thereby improve the quality of palliative and end-of-life care the patients receive. Two areas that may influence the quality of care are also highlighted: 1) the role of anxiety and depression, common problems for patients with COPD; and 2) the importance of advance care planning.Improving communication represents an important opportunity for the improvement of the quality of palliative and end-of-life care received by these patients.

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Section: Poor Palliative Care In Copd and The Link To Poor Communicationmentioning

confidence: 78%

Palliative and end-of-life care for patients with severe COPD

2007

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“…They may describe disabling shortness of breath, depression, cough, fatigue, pain, confusion, anorexia, or thirst [5][6][7][8]. This morbidity is reflected in severe impairment of quality of life and activities of daily living [5,6,9]. Social isolation is common [5].…”

Section: Introductionmentioning

confidence: 99%

“…This morbidity is reflected in severe impairment of quality of life and activities of daily living [5,6,9]. Social isolation is common [5]. Exacerbations may result in frequent hospital admissions and high use of primary care services [5,9] C o p y r ig h t G e n e r a l P r a c t ic e A ir w a y s G r o u p R e p r o d u c t io n p r o h ib it e d is high, but less than half have access to appropriate social and nursing support [5][6][7]9].…”

Section: Introductionmentioning

confidence: 99%

“…Social isolation is common [5]. Exacerbations may result in frequent hospital admissions and high use of primary care services [5,9] C o p y r ig h t G e n e r a l P r a c t ic e A ir w a y s G r o u p R e p r o d u c t io n p r o h ib it e d is high, but less than half have access to appropriate social and nursing support [5][6][7]9]. Unmet spiritual distress increases anxiety, panic attacks and the unscheduled use of medical services [10].…”

Section: Introductionmentioning

confidence: 99%

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Palliative care for people with COPD: we need to meet the challenge

Murray

Pinnock

Sheikh

2006

Primary Care Respiratory Journal

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SummaryThe need to extend the palliative care approach to people dying with a wide range of chronic diseases is increasingly recognised. Whilst of relevance internationally, this topic is particularly timely in the UK as the General Medical Services contract will reward practices that create a register of patients ''in need of palliative/supportive care''. Difficulty predicting prognosis can lead to uncertainty about which patients with COPD to include in a register, potentially reducing the impact of this initiative. In this Discussion paper we highlight this challenge, and offer some practical strategies to help clinicians recognise these patients.

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“…Several authors argue that this can be a consequence of the fact that healthcare professionals do not take psychosocial and existential needs into account and preferentially focus only on the physical aspects of COPD (Au et al, 2006;Skilbeck et al, 1998). An example in the present study is the daughter whose mother had recurrent periods of confusion.…”

Section: Discussionmentioning

confidence: 99%

“The unpredictable death”—The last year of life for patients with advanced COPD: Relatives' stories

Andershed

Sahlberg‐Blom

et al. 2014

Pall Supp Care

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Objective: The end stage of chronic obstructive pulmonary disease (COPD) is described as prolonged, and the symptom burden for patients with COPD is often high. It progresses slowly over several years and can be punctuated by abrupt exacerbations that sometimes end in sudden death or a recovery of longer or shorter duration. This makes it difficult to identify the critical junctures in order to prognosticate the progress and time of death. Patients with COPD often express a fear that the dying process is going to be difficult. There is a fear that the dyspnea will worsen and lead to death by suffocation. The present article aimed to retrospectively describe the final year of life for patients with advanced COPD with a focus on death and dying from the perspective of relatives.Method: Interviews were conducted with the relatives of deceased family members who had advanced COPD. In total, 13 interviews were conducted and analyzed by means of content analysis.Result: All relatives described the patients as having had a peaceful death that did not correspond with the worry expressed earlier by both the patients and themselves. During the final week of life, two different patterns in the progress of the illness trajectory emerged: a temporary improvement where death was unexpected and a continued deterioration where death was inevitable.Significance of Results: The patients and their relatives lived with uncertainty up until the time of death. Little support for psychosocial and existential needs was available. It is essential for the nurse to create relationships with patients and relatives that enable them to talk about dying and death on their own terms.

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Palliative care in chronic obstructive airways disease: a needs assessment

Cited by 144 publications

References 16 publications

Palliative and end-of-life care for patients with severe COPD

Palliative and end-of-life care for patients with severe COPD

Palliative care for people with COPD: we need to meet the challenge

“The unpredictable death”—The last year of life for patients with advanced COPD: Relatives' stories

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