Palliative care in people with chronic obstructive pulmonary diseaseBMJ 2011; 342 doi: https://doi.org/10.1136/bmj.d106 (Published 24 January 2011) Cite this as: BMJ 2011;342:d106
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Palliative care in people with chronic obstructive pulmonary disease- how do we cross 'no-man's land' between active and terminal medical care?
In this week's editorial, Thorns and Cawley highlight the
difficulties of a presiding attitude of symptom 'passive acceptance' on
the part of patients descending on the downwards spiral of terminal phase
COPD. It is suggested that if clinicians were able to dissect and identify
the approaching end of life from patient's general acceptance of health
decline "as a part of getting old", this may help to pitch care offered at
the appropriate active/palliative balance.
Opening up the involving, time-consuming lengths of sensitive and
potentially distressing discussions regarding the nature of a patient's
terminal COPD, can only be wholly justified by having the provisions to
meet the (currently ill-defined) needs of patients lost in the no-man's
land between the traditional 'acute medical' and 'terminal care'
approaches to COPD.
Thorns and Cawley rightly suggest the development of a model that
traverses the two approaches. Perhaps the bridging of the dichotomy within
the clinical values and approach of medical professionals, remains the
first step. Speciality physicians occupy the position of a unique vantage
point in observing the patient disease journey and trajectory. If we can
cultivate the knowledge skill-set and attitude of palliative management
still being an immediate, active form of medical care that is of benefit
to our patients, this may give a sense of 'worthy ownership' and
confidence in introducing a palliative approach by medical specialty
physicians earlier in the patient's disease journey.
The development of physicians who sub-specialise in palliative
medicine pertinent to their particular speciality of expertise, may prove
to be the force that leads to systematic, relevant research and consequent
development of focused services for the significant proportion of patients
who, at any one point, wind slowly and uncertainly into end-stage COPD.
Nadia R Khan (CT2 ACF Palliative Medicine)
Competing interests: NRK aims to complete an ACF project looking developing palliative care within the context of a respiratory secondary-care setting