End-of-Life Discussions Help COPD Patients and Families
Would you be surprised if your patient died within the next year due to their chronic obstructive pulmonary disease (COPD)? If the answer is “no,” a physician should consider introducing discussions with the patient about the future course of the disease and how end-of-life issues can be addressed.
This is according to Canadian palliative care physician, Mervyn M. Dean, in an article published in Primary Care Respiratory Journal. “Both physicians and patients find end-of-life issues difficult to discuss, although once discussion is started, many patients appreciate it,” states Dean. If the patient is not comfortable with the topic, they will at least be aware that when they are ready, their physician will be willing to address matters as needs arise.
Three primary areas to be covered are:
- Likely disease course and prognosis
- Advance health care directives
- Symptom management
Other areas to be covered, by appropriate referral if necessary, are psychosocial and spiritual concerns. Family members may want to be involved as well.
In the author’s experience, “patients are often very much more aware of their state of health than they are given credit for,” though they feel it is the physician’s responsibility to introduce the topic. Dean prefers asking a question such as, “Do you have any concerns about how things are going, or what’s going to happen to you?” If the patient says yes, he uses a “WPC” approach: Warn, Pause, Check. For example, if a patient asks about her prognosis, he might warn, “I’m afraid it is not good news.” He would then pause. The patient likely knows already that the news will not be good, and may say so. If the patient says nothing, he will check by asking if he can continue. It is helpful to gauge how much the patient wants to know, and also to let him or her know that they can stop the conversation at any time.
End-of-life discussions should be balanced with positive aspects, says Dean. The physician can assure the patient that symptoms such as depression, pain, and shortness of breath can be managed and that the patient should focus on making the most of the time they have left, while allowing for the uncertainty of their prognosis. If the patient, family, and physician have already discussed the patient’s goals, values, and wishes, it will be easier to make decisions as the disease progresses; and this fact underscores the importance of well written and appropriately distributed advance health care directives, Dean concludes.
Source: “End-of-Life Care for COPD Patients,” Primary Care Respiratory Journal, 2008; 17(1):46-50. Dean, MM, Western Memorial Regional Hospital, Western Health Authority, Newfoundland & Labrador, Canada.
Reprinted with permission from Quality of Life Matters®, copyright 2008.
Published by Quality of Life Publishing Co., Naples, FL
