The potential of palliative care for patients with respiratory diseases

Abstract

Based on the demonstrated effectiveness of palliative care in the alleviation of symptoms and enhancement of life quality, it is important to incorporate palliative care early in the respiratory disease trajectory. Quality palliative care addresses eight domains that are all patient and family centred. Palliative care interventions in respiratory conditions include management of symptoms such as dyspnoea, cough, haemoptysis, sputum production, fatigue and respiratory secretion management, especially as the end-of-life nears. A practical checklist of activities based on the domains of palliative care can assist clinicians to integrate palliative care into their practice. Clinical management of patients receiving palliative care requires consideration of human factors and related organisational characteristics that involve cultural, educational and motivational aspects of the patient/family and clinicians.Educational aimsTo explain the basic domains of palliative care applicable to chronic respiratory diseases.To review palliative care interventions for patients with chronic respiratory diseases.To outline a checklist for clinicians to use in practice, based on the domains of palliative care.To propose recommendations for clinical management of patients receiving palliative care for chronic respiratory diseases.

Wie unterscheiden sich Bedürfnisse und Versorgung in der SAPV in Abhängigkeit von der Grunderkrankung? Auswertungen aus dem Nationalen Hospiz- und Palliativregister

“…Bei der chronisch-obstruktiven Lungenerkrankung (COPD) werden u. a. Luftnot, Fatigue oder Kachexie als führende Symptome angegeben [7][8][9][10][11][12][13]. Art und Ausprägung der Symptome ähneln denen von Patienten mit fortgeschrittenem Bronchialkarzinom.…”

Advance care planning in severe COPD: it is time to engage with the future

“…This is different from what is implemented in patients with cancer, where end-of-life care conversations, advance care planning and palliative care are more established and have already become a mainstay of cancer care. In this context we should keep in mind that COPD patients experience severe morbidity for a longer period of time than cancer patients [ 4 ], and suffer even more from impaired activities of daily living, impaired physical, social and emotional functioning, and more from anxiety and depression than patients with nonsmall cell lung cancer [ 5 ]. Additionally, dyspnoea is subjectively perceived as being as severe and life-threatening as pain, and the central processing of perceived pain as well as dyspnoea in the limbic system is quite similar [ 6 ].…”

“…We do not know many details about the healthcare needs of patients suffering from end-stage COPD [ 7 ]. COPD patients have a poor understanding of COPD as a life-limiting disease and are less likely to realise that death is imminent [ 4 ]. Patients with end-stage COPD were found not to actively express a wish for help because they do not consider their limitations to be abnormal and because they do not realise that there are possibilities to improve their situation [ 7 ].…”

“…Patients with end-stage COPD were found not to actively express a wish for help because they do not consider their limitations to be abnormal and because they do not realise that there are possibilities to improve their situation [ 7 ]. However, even physicians hesitate to discuss these issues, fearing that they are destroying hope for recovery or are unable to spend precious time in a demanding emotional encounter with severely ill patients and/or their family, and therefore tend to delay prognostic conversations and end-of-life discussions until the event that should have been anticipated has occurred [ 4 , 8 ]. Thus, the demand of the scientific community to communicate in a timely manner and implement do-not-resuscitate (DNR) orders in patients with severe COPD does not necessarily find immediate, self-evident acceptance in clinical practice [ 8 ].…”

“…This process is conducted by the patient, his/her family or healthcare attorney, his/her physician or an advance care planning facilitator. Advance care planning has numerous, well-described positive effects on end-of-life care for patients, such as reductions in futile life-sustaining treatments and increased compliance with patient preferences [ 4 ].…”