Where and how non oncological respiratory patients die: A palliative answer

Michele Vitacca, Luca Barbano

Research output: Chapter in Book/Report/Conference proceedingChapter

Abstract

Death due to respiratory diseases is high, being chronic obstructive pulmonary disease (COPD) an important risk factor for death. The COPD dying trajectory is often unknown. Commonest cause of death after Intensive Care Unit (ICU) discharge is respiratory failure, while respiratory causes for death are often under-diagnosed. Among COPD patients, a lot of subjects may be defined under palliative and at risk of end of life conditions. Three different situations emerge depending on the fact that patient is in hospital, at home or using mechanical ventilation. The hospital scenario often offers a high percentage of respiratory patients receiving end of life decisions by different professional figures involved in end of life (EOL) strategies. Major difficulties are represented by death prediction, particularly in those patients admitted in ICU, or by interaction with patient expressing different preferences for a life support or having a poor level of discussion among doctors and between doctors and patients. A second scenario is represented by chronic respiratory patients at home. More than 68% of all COPD admissions and 74% of all days in-hospital occurred in the 3.5 years before death, indicating longer stays closer to death. The last 6 months of life accounted for 22% and 28% of all COPD admissions and days, respectively. Poor symptom control remains an important cause of distress. The most frequent cause of death after discharge is heart disease. Lack of surveillance and inadequate services with absence of palliative care is a routinely experience. The more frequent request from COPD patients is education on diagnosis and disease process, treatments, prognosis for survival, quality of life and advance care planning. They do not receive holistic care as patients with lung cancer. The last scenario is relative to patients with home mechanical ventilation. Despite these patients are usually pleased about their chose, they are well confident about the high burden imposed to their caregivers. Moreover, for these patients dyspnoea and secretion encumbrance remain the main unresolved symptoms. In comparison with mechanical invasively ventilated patients, non invasively ventilated patients are more aware of prognosis, use more respiratory drugs, change ventilation time more frequently and die less frequently when under mechanical ventilation. Palliative home care programs and Hospice admissions for EOL care in respiratory patients are insufficient or absent. Individual approach to patients with non homogenous disease is often necessary. Hospital and home palliation protocols (milestones, skills and interventions) for non-oncological respiratory patients are urgently needed.

Original languageEnglish
Title of host publicationPalliative and Nursing Home Care: Policies, Challenges and Quality of Life
PublisherNova Science Publishers, Inc.
Pages145-159
Number of pages15
ISBN (Print)9781611224177
Publication statusPublished - Jan 2011

ASJC Scopus subject areas

  • Nursing(all)

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