P223 End of life discussion in pulmonary rehabilitation: too scary or worth a try?

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End of life is a topic which may be included in pulmonary rehabilitation (PR) education sessions. Patient expectations from such a session, its optimal content, and who should deliver it is unknown.


The community PR programme in Hammersmith and Fulham has included a session entitled “Managing the Final Stages of COPD” since April 2010. Apprehensions and training needs around this subject were identified in respiratory staff running PR and therefore a community matron with an interest in palliative and end of life care led the sessions. Twelve–sixty min end of life discussion sessions were delivered from April 2010 to June 2011. The content was based around the eponymous British Lung Foundation (BLF) leaflet. Discussions focused principally on making a will, arranging a funeral and considering a Power of Attorney or Advance Decision. Participants were given advance notice and an opportunity to “opt out”.


72 patients attended these sessions (average number 6). None opted out. One patient asked for more information afterwards. Two partcipants became upset during the session; one opted to attend in spite of a recent bereavement and the other reported “feeling relieved”. Evaluation responses are shown in Abstract P223 table 1.


Advanced care planning is well received and can be delivered as part of community PR education. Respiratory staff leading PR are now confident about delivering this themselves. However this setting is not able to address the advanced care planning needs of specific patients with adverse prognostic indicators and this needs separate planning.

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