End of life care in chronic obstructive pulmonary disease: in search of a good death

Figures & data

Figure 1 Definitions (^{NHS Executive 1996}; ^{Department of Health 2007}).

Table 1 Symptom prevalence in advanced COPD (^{Solano et al 2006})

Symptom	Prevalence
Breathlessness	60%–88%
Fatigue	68%–80%
Anxiety	51%–75%
Pain	34%–77%
Depression	37%–71%
Insomnia	55%–65%
Anorexia	35%–67%
Constipation	27%–44%

Figure 2 Typical disease trajectories for progressive chronic illness. (a) Long-term limitation with intermittent acute episodes eg COPD. (b) Prolonged dwindling eg dementia. (c) Short period of decline eg cancer. (Adapted from Murray et al with permission from BMJ Publishing Group Ltd.).

Figure 3 World Health Organisation three step analgesic ladder (^{WHO 1996}). Non opioids include paracetamol and NSAIDs; weak opioids include codeine (approx. 1/10th potency of oral morphine) and tramadol (approx. 1/5th potency of oral morphine); strong opioids include morphine, oxycodone and fentanyl; adjuvants are additional drugs that can be used as part of pain management, such as secondary analgesics (eg. gabapentin for neuropathic pain) and drugs to control analgesic adverse effects.

Table 2 Major components of a good death (^{Steinhauser et al 2000})

Pain and symptom management

Clear decision making

Preparation for death

Completion

Contributing to others

Affirmation of the whole person

Table 3 Barriers to communication about end of life issues in COPD

Healthcare professional barriers

Difficulty in timing discussions because of uncertain prognosis

Lack of time during consultations

Concern about taking away patients’ hope

Belief that patients are not ready to discuss end of life issues

Patient barriers

Expectation that healthcare professionals will initiate discussions

Societal taboos with regard to discussing death

Uncertainty about which professionals will be involved during end of life phase

Lack of certainty about the type of care that would be wanted when less well

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