End-of-Life Discussion, Patient Understanding and Determinants of Preferences in Very Severe COPD Patients: A Multicentric Study

Annalisa Carlucci, Michele Vitacca, Alberto Malovini, Paola Pierucci, Aldo Guerrieri, Luca Barbano, Piero Ceriana, Antonella Balestrino, Carmen Santoro, Lara Pisani, Nadia Corcione, Stefano Nava

Research output: Contribution to journalArticle

Abstract

Discussion about patients’ end-of-life (E-o-L) preferences should be part of the routine practice. Using a semi-structured interview with a scenario-based decision, we performed a prospective multicentre study to elicit the patients’ E-o-L preferences in very severe chronic obstructive pulmonary disease (COPD). We also checked their ability to retain this information and the respect of their decisions when they die. Forty-three out of ninety-one of the eligible patients completed the study. The choice of E-o-L practice was equally distributed among the three proposed options: endotracheal intubation (ETI), ‘ceiling’ non-invasive ventilation (NIV), and palliation of symptoms with oxygen and morphine. NIV and ETI were more frequently chosen by patients who already experienced them. ETI preference was also associated with the use of anti-depressant drugs and a low educational level, while a higher educational level and a previous discussion with a pneumologist significantly correlated with the preference for oxygen and morphine. Less than 50% of the patients retained a full comprehension of the options at 24 hours. About half of the patients who died in the follow-up period were not treated according to their wishes. In conclusion, in end-stage COPD more efforts are needed to improve communication, patients’ knowledge of the disease and E-o-L practice.

Original languageEnglish
Pages (from-to)1-7
Number of pages7
JournalCOPD: Journal of Chronic Obstructive Pulmonary Disease
DOIs
Publication statusPublished - 2016

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Keywords

  • Acute respiratory failure
  • advanced care planning
  • communication
  • palliative care
  • terminal care

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

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