END-STAGE CARE

It is important for patients with COPD, families, and primary care providers to discuss end-of-life issues. Advance directives, living wills, and durable powers of attorney can be explained and decided upon. Many states now require that hospitalized patients be given the opportunity to receive information about advance directives in particular.

It is often difficult for patients, family members, or close friends to contemplate these serious decisions that need to be made for someone with a diagnosis that is uncurable and eventually terminal. The subject of invasive and noninvasive ventilation is a particularly necessary subject for this patient population. The multidisciplinary PR team can be honest, matter-of-fact, and sensitive in conversations about what choices need to be made. Chaplains and personal clergy can be brought in for additional support.

Decisions that patients and their families will face include whether to participate in drug trials, what type of ventilation to use and for how long, whether to consider lung transplantation, whether to take advantage of hospice, and what type of end-of-life palliation is desired. Counseling may be provided by specially trained hospice nurses or in-hospital palliative care nurses.

Palliative care becomes a valuable adjunct of medical care in patients with COPD in the absence of curative treatment, progressive and limiting dyspnea, and the use of opioids for the treatment of severe and burdensome symptoms. This means that maintaining and, when possible, improving a patient’s quality of life should always be a prime motivator of therapy. Patients with COPD experience psychological and emotional suffering and high morbidity and mortality rates. In spite of this, they do not always receive adequate palliative care.

Palliative care is a rapidly growing, multidisciplinary specialty that is used to improve quality of life for seriously ill patients and their families. The various disciplines involved include physicians, nurses, social workers, chaplains, and other specialties, when appropriate. Early palliative care also means that patients and their families should be encouraged to consider end-of-life options early in the disease process, before the patient becomes mentally compromised or the family becomes emotionally worn out (Fusi-Schmidhauser, 2021).

Too often COPD patients die in intensive care units after invasive, extensive, expensive, and often unwanted medical care. Near the end of life, adoption of hospice care will give the patient and their family the opportunity to discuss available options and the extent to which the patient wishes to be treated at the end of their life. This discussion may lead to the decision to receive palliative care at home, which can reduce unnecessary hospitalizations and allow the patient to die in comfortable and familiar surroundings.