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Deborah Leader, RN

How Well Do We Provide Palliative Care for Patients with End-Stage COPD?

By February 10, 2009

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It is tough when patients and families are faced with end-of-life decisions. Both usually express concern about one thing as it relates to the process of death and dying, and that is comfort care and pain management. Palliative care deals with sensitive issues such as these, as it focuses on prevention and treatment of suffering in people who are faced with life-threatening illnesses. But, how well does our healthcare system actually provide palliative care for patients with end-stage COPD, as compared to say, terminal lung cancer?

In a study which compared palliative care in those with severe COPD and patients who had inoperable lung cancer, this question was examined. The results indicated that patients with COPD had worse activities of daily living, as well as physical, social and emotional functioning compared to the lung cancer patients. COPD patients also suffered higher anxiety levels and worse depression scores. While all patients studied were generally satisfied with their medical care, when compared to the lung cancer patients, none of the COPD patients had access to a similar system of palliative care services, and only 30% of the lung cancer patients sought available, palliative care services.

The study suggests that patients in the advanced stages of COPD, have a severely impaired qualify of life and emotional well-being, and that their palliative care needs may not be met as well as those with lung cancer.

So, what can families do in light of this information? First, discuss end-of-life decisions with each other, before you are faced with them. In-other-words, don't wait until you are dying to talk about death. If you cannot talk with each other about such important issues, how can you talk to others? Secondly, talk with your healthcare provider to determine a plan of action as it relates to palliative or hospice care. Lastly, don't feel guilty about seeking hospice or palliative care for your loved one if you are a caregiver. The most loving thing that you can do for someone who is in the end stages of an illness, who cannot make decisions for themselves, is to help provide them with the comfort care that they need during the last days of their lives.

Source:

Gore JM, Brophy CJ, Greenstone MA. How well do we care for patients with end stage chronic obstructive pulmonary disease (COPD)? A comparison of palliative care and quality of life in COPD and lung cancer. Thorax. 2000 Dec;55(12):979-81.

Comments
February 3, 2011 at 2:08 am
(1) Mary Guthrie says:

Hi,
I’ve been diagnosed with stage IV COPD after a lifetime of asthma & chronic bronchitis. I am 53 years old, never smoked, but was exposed to tons of second-hand smoke in childhood as well as other air pollution off and on. Now on 2-3 liters O2 24/7, and relying on my CPAP machine for periodic relief of work of breathing, also taking oral prednisone (15 mg/daily) to keep inflammation down, I wonder if I’m just supposed to maintain until I die or what? My blood pressure has increased lately with a recent exacerbation in breathing, and moving around much sends my heart rate into 120s-130s, but saturations will drop into the 80s even on 3 liters. What does this mean? Do I need to see my doctor, or go to the hospital? I’m a little confused most of the time, so am not sure if I am imaging problems or not. When I called my pulmonary doc, his nurse told me that my problems were something to discuss with my primary care physician. I feel like I am just out here hanging around until time to call the morgue. When I have more trouble than usual breathing, the attitude seems to be, “Well, you have end-stage lung disease, what do you expect?” This doesn’t sound like the treatment cancer patients get, or is it? Maybe I’m just cranky and anxious because of hypoxia…

February 3, 2011 at 10:30 am
(2) copd says:

Mary, that your heart rate is going up that high is not normal. And, you mentioned that your sats drop down into the 80′s when you move around, this is not normal either, but, I am afraid typical of the stage you are in. All the questions you asked me should be directed to your primary care doctor. The heart rate issue could be serious. so please call and make an appointment as soon as possible.

That said, if you feel that your doctor is just blowing you off, find another doctor who will listen, and not negate your concerns.

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