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Lancet. 2017 Sep 2;390(10098):988-1002. doi: 10.1016/S0140-6736(17)32127-X.

Palliative care and management of troublesome symptoms for people with chronic obstructive pulmonary disease.

Author information

1
Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, London, UK.
2
Department of Palliative Medicine, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK; Department of Oncology, University of Cambridge, Cambridge, UK.
3
Harefield Pulmonary Rehabilitation and Muscle Research Laboratory, Harefield Hospital, Royal Brompton & Harefield NHS Foundation Trust, London, UK.
4
Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, London, UK. Electronic address: irene.higginson@kcl.ac.uk.

Abstract

People with advanced chronic obstructive pulmonary disease (COPD) have distressing physical and psychological symptoms, often have limited understanding of their disease, and infrequently discuss end-of-life issues in routine clinical care. These are strong indicators for expert multidisciplinary palliative care, which incorporates assessment and management of symptoms and concerns, patient and caregiver education, and sensitive communication to elicit preferences for care towards the end of life. The unpredictable course of COPD and the difficulty of predicting survival are barriers to timely referral and receipt of palliative care. Early integration of palliative care with respiratory, primary care, and rehabilitation services, with referral on the basis of the complexity of symptoms and concerns, rather than prognosis, can improve patient and caregiver outcomes. Models of integrated working in COPD could include: services triggered by troublesome symptoms such as refractory breathlessness; short-term palliative care; and, in settings with limited access to palliative care, consultation only in specific circumstances or for the most complex patients.

PMID:
28872031
DOI:
10.1016/S0140-6736(17)32127-X
[Indexed for MEDLINE]
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