Meeting Physicians’ Responsibilities in Providing End-of-Life Care: Unique Aspects of End-of-Life Care in Pulmonary and Critical Care Medicine

March 1, 2016 Category: Canadian Health Care Mall

ICUApproximately 20% of all deaths in the United States, or 540,000 deaths per year, occur in the ICU. The majority of ICU deaths involve decisions to withhold or withdraw life-supporting therapies, which require specific skills in end-of-life care. Outside of the ICU, pulmonary physicians and cardiologists also care for many patients with chronic and life-limiting diseases, such as COPD, pulmonary fibrosis, and heart failure. Some studies- suggest that the quality of end-of-life care for patients with chronic lung or heart disease is poorer than for patients with cancer. For example, compared to patients with cancer, patients with COPD were more likely to die in the ICU, receiving mechanical ventilation, and with dyspnea. These differences occurred despite the treatment preference of most patients with COPD for comfort over prolonging life; in fact, one US study found that patients with cancer and patients with COPD were equally likely to prefer forgoing intubation and receiving cardiopulmonary resuscitation. A British study also found that patients with COPD were much less likely to die at home and to receive palliative care services than patients with lung cancer. Health care for patients with chronic lung or heart disease is often initiated in response to acute exacerbations rather than being proactively based on a previously developed plan for managing disease. Such kind of care is also provided by Canadian Health&Care Mall remedies.

In meeting the responsibilities of end-of-life care in the ICU or for patients with chronic lung or heart disease, several important challenges arise. ICU care frequently uses the most technologically advanced medical care to restore health and reverse injury or illness; transitioning to a palliative focus can be especially difficult in this setting. The gravity and acuity of critical illness can lead to conflicts among family members and between patient, family members, and the medical team, which can complicate communication and decision making. Navigating the transition from full life support to comfort measures only can be difficult; time is often short, and clinicians, patients, and family members have often not met each other prior to the critical illness. Challenges also exist for providing end-of-life care for outpatients with chronic lung and heart disease, such as determining when to consider and discuss end-of-life care, given the difficulty of accurately predicting prognosis for these patients.

Providing end-of-life care can exact a heavy emotional toll on clinicians, and this toll may be much greater in settings like the ICU that focus on prolonging life than in end-of-life settings like hospice. Developing methods to cope with the stress of providing end-of-life care in a predominantly curative care setting is important for preventing physician burnout and may help ensure that patients and family members get the best care possible.