Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death globally. The physical and psychological symptom burden in severe COPD is significant and yet many of these symptoms go untreated (Elkington et al, 2005). Patients with COPD have far less specialist palliative care input than patients with lung cancer despite a symptom burden at the end of life similar, or indeed greater, than patients with lung cancer (Gore et al, 2000).Methods
An anonymous questionnaire was completed by respiratory healthcare professionals including respiratory doctors of all grades, physiotherapists and nurses of different backgrounds. The questions focused on perceived ease of predicting prognosis in severe COPD, the initiating of end-of-life discussions in this group, and training received in palliative care.Results
100 questionnaires were completed. 67 participants were doctors, from house officers to consultants, 5 physiotherapists, 9 respiratory specialist nurses, 8 Macmillan nurses and 12 respiratory ward nurses. The questionnaire found 76% of participants felt it was a very important or important part of their role to initiate end-of-life discussions in severe COPD and 2% felt it was not, or definitely not part of their role. Participants initiated such discussions frequently or very frequently in 20%, and infrequently or very infrequently in 55%. Prognosis in severe COPD was difficult or very difficult in 63% and straightforward or very straightforward in 6%. This is consistent with literature (Gott et al, 2009). Training participants had received in palliating symptoms in this patient group was significant or extensive in 25% and minimal or little in 41%. Training in initiating end-of-life discussions was significant or extensive in 19% and minimal or little in 44%. Training in services available to this group of patients was significant or extensive in 17% and minimal or little in 42%.Conclusion
The need to initiate end-of-life discussions in severe COPD is felt to be important to the multidisciplinary team's role in palliating such patients, yet very few regularly have such discussions. A lack of training and self-reported difficulty in predicting prognosis in this group are perceived to be great, and are suggested as possible reasons for this imbalance.