Tsim Selina, Davidson Scott
1Department of Respiratory Medicine, Glasgow Royal Infirmary, Glasgow, UK.
Am J Hosp Palliat Care. 2014 Mar;31(2):172-4. doi: 10.1177/1049909113481261. Epub 2013 Mar 15.
Patients with advanced chronic lung disease such as chronic obstructive pulmonary disease (COPD) often have an unpredictable clinical course and a high symptom burden. Their prognosis is similar to that of patients with lung cancer.
We retrospectively assessed end of life care in all patients who were admitted and subsequently died on a general respiratory ward in a central teaching hospital over a period of 11 months (1st June 2010-1st May 2011). We compared our practice with guidelines set out in Living and Dying Well, a national action plan for palliative and end of life care in Scotland.
There were 66 deaths, data was obtained for 57 patients (86.4%). Patients with lung cancer had higher rates of recorded discussions regarding their prognosis in comparison to those with COPD (60%, n=9 vs. 8.3%, n=1 respectively). In addition, they had greater levels of in-patient palliative care involvement (50%, n= 7 vs. 0% respectively) and higher rates of recorded wishes end of life care destination (28.6%, n=4 vs. 8.3%, n=1 respectively). This is despite patients with lung cancer having a lower mean number of end of life clinical indicators (2.64 vs. 3.17 respectively) and a lower mean number of admissions in the 12 months preceding death (1.67 vs. 4.08).
Palliative care involvement and discussion of patients' end of life care wishes is poor in COPD. Timely and effective discussions regarding disease prognosis and patient wishes, including early consideration for initiating anticipatory care planning needs to be instituted.
患有晚期慢性肺部疾病（如慢性阻塞性肺疾病，COPD）的患者临床病程往往不可预测，且症状负担较重。他们的预后与肺癌患者相似。
我们回顾性评估了在一所中心教学医院的普通呼吸科病房住院并随后死亡的所有患者的临终关怀情况，时间跨度为11个月（2010年6月1日至2011年5月1日）。我们将我们的做法与苏格兰姑息治疗和临终关怀国家行动计划《活得好与死得好》中规定的指南进行了比较。
共有66例死亡病例，获取了57例患者（86.4%）的数据。与COPD患者相比，肺癌患者关于其预后的记录讨论率更高（分别为60%，n = 9 vs. 8.3%，n = 1）。此外，他们的住院姑息治疗参与程度更高（分别为50%，n = 7 vs. 0%），记录的临终关怀目的地意愿率也更高（分别为28.6%，n = 4 vs. 8.3%，n = 1）。尽管肺癌患者的临终临床指标平均数量较低（分别为2.64 vs. 3.17），且在死亡前12个月的平均住院次数也较低（1.67 vs. 4.08）。
COPD患者的姑息治疗参与度以及对其临终关怀意愿的讨论情况较差。需要就疾病预后和患者意愿进行及时有效的讨论，包括尽早考虑启动预立护理计划。
