8(th) International conference on management and rehabilitation of chronic respiratory failure: the long summaries – Part 3

Ambrosino, Nicolino; Casaburi, Richard; Chetta, Alfredo; Clini, Enrico; Donner, Claudio F.; Dreher, Michael; Goldstein, Roger; Jubran, Amal; Nici, Linda; Owen, Caroline A.; Rochester, Carolyn; Tobin, Martin J.; Vagheggini, Guido; Vitacca, Michele; ZuWallack, Richard

As compared to hospitalized patients with lung cancer, individuals with COPD were more likely to receive mechanical ventilation, tube feeding, and resuscitation [117] . Furthermore, in COPD patients, mechanical ventilation had greater short term effectiveness, based on survival to hospital discharge (76 % vs. 38 %), and had higher 2-month and 6-month survival. Curtis and colleagues [118] pointed out an additional important problem related to EOL is the strategy of communication: the physicians' frequent difficulties in discussing EOL care with patients and their families and caregivers Health care utilization is strongly weighted toward the end of life in COPD as well as in other diseases. For example, Andersson and colleagues [119] showed that more than 68 % of all COPD admissions and 74 % of all days in hospital occurred in the 3.5 years before death. The last 6 months of life accounted for 22 % and 28 % of all COPD admissions and days, respectively. Suboptimal surveillance, inadequate services, and absence of palliative home care are common in severe COPD patients with EOL issues [120] . This also holds for respiratory patients who are housebound with high levels of morbidity and high requirements for community health services. COPD patients approaching EOL require, at a minimum, education on diagnosis and disease process, available treatment modalities, what they have to do and what to expect, and information on prognosis. Despite this, only 32 % of respiratory patients report discussing EOL cares with their physicians [120] . Stated barriers in this study included, "I would rather concentrate on staying alive than talk about death" or "I'm not sure which doctor will be taking care of me if I get very sick." Thus, it is necessary to identify areas of communication that physicians do not address and areas that patients rate poorly, including talking about prognosis, dying and spirituality.