Chest
EthicsPalliative and End-of-Life Care for Patients With Cardiopulmonary Diseases: American College of Chest Physicians Position Statement
Section snippets
Advance Care Planning
Illness and the therapies aimed at illness frequently lead to diminished mental capacity. Paradoxically, it is during the time of critical illness that extremely important decisions must be made, including decisions about initiating or foregoing therapies, undergoing invasive procedures, tube feedings, home health options, and nursing home placement, to name a few. Documents such as a living will, advance health-care directive, and/or other legal documents supported by individual state laws can
Relief of Distressing Symptoms
Patients with pulmonary and/or cardiac disease may experience significant discomfort as they enter the terminal phase of their illness. These symptoms may include breathlessness, pain, insomnia, nausea, vomiting, constipation, diarrhea, anorexia, fatigue, and edema.34, 35, 36 It is important for physicians who care for these patients to anticipate the likelihood of distressing symptoms, to counsel patients and families to seek medical therapy when they begin to experience these symptoms, and to
Assurance of Professional Education and Competence in Quality Palliative and End-of-Life Care
Most of the comments provided here are on physician education but also are applicable to other health professionals. Until recently, there were no mandated requirements for education in palliative and end-of-life care for physicians in the United States and, not surprisingly, major deficiencies in this area have been documented.70, 71, 72, 73, 74, 75, 76 Medical schools in the United States are now mandated to include end-of-life care in the curriculum, and end-of-life content will be included
CONCLUSION
In summary, the need for quality palliative and end-of-life care has become paramount in the United States.99 Many efforts have been made to stimulate physicians and other professional caregivers to focus on this important aspect, and to obtain the necessary knowledge and skills to provide this care. Chest physicians and cardiologists are urged to take the lead. It is our hope that this statement will serve as a platform from which the process can begin.
General
Americans for Better Care of the Dying. Available at: www.abed-caring.org
American Academy of Hospice and Palliative Medicare. Available at: www.aahpm.org
Center to Advance Palliative Care. Available at: www.capc.org
Education in Palliative and End-of-life Care. Available at: www.epec.net
End-of-Life Nursing Education Consortium. Available at: www.aacn.nche.edu/elnec/
Last Acts Organization. Available at: www.lastacts.org
Innovations in End-of-life Care. Available at: www2.edc.org/lastacts/
Project on
ACKNOWLEDGMENTS
The authors wish to express their appreciation to the steering committee of the ACCP Palliative and End-of-Life Care Network for their review and assistance in the preparation of this manuscript.
References (99)
- et al.
Maintaining quality of life at the end of life.
Mayo Clin Proc
(2000) - et al.
Pain characteristics of advanced lung cancer patients referred to a palliative care service.
Pain
(1994) - et al.
Measuring quality in end-of-life care.
Clin Geriatr Med
(2000) - Plenary 3. Elements and models of end-of-life acre. In: Emanuel LL, Von Gunten CF, Ferris FD, eds. The EPEC curriculum:...
- Field MJ, Cassel CK, eds. Committee on Care at the End of Life, Institute of Medicine. Approaching death: improving...
- et al.
Why don't patients and physicians talk about end-of-life care? Barriers to communication for patients with acquired immunodeficiency syndrome and their primary care clinicians.
Arch Intern Med
(2000) Initiating end-of-life discussions with seriously ill patients: addressing the “elephant in the room.”
JAMA
(2000)- et al.
Advance directives for medical care: a case for greater use.
N Engl J Med
(1991) - et al.
Ethnicity and attitudes toward patient autonomy.
JAMA
(1995) - et al.
Western bioethics on the Navajo reservation: benefit or harm?
JAMA
(1995)
Seven legal barriers to end-of-life care: myths, realities and grains of truth.
JAMA
Physician reluctance to discuss advance directives.
Arch Intern Med
Limitations of listing specific medical interventions in advance directives.
JAMA
Pulling the plug on living wills: a critical analysis of advance directives.
Chest
Crit Care Med
Chest
Ann Intern Med
JAMA
“Do everything!” Encountering “futility” in medical practice.
Ethics Med
Supporting family caregivers at the end of life: “they don't know what they don't know”.
JAMA
Early intervention in planning end-of-life care with ambulatory geriatric patients.
Arch Intern Med
Death and end-of-life planning in one midwestern community.
Arch Intern Med
Dying with dignity: the good patient versus the good death.
Am J Hosp Palliat Care
In search of a good death: observations of patients, families and providers.
Ann Intern Med
Should physicians prescribe religious activities?
N Engl J Med
Physicians and patient spirituality: professional boundaries, competency, and ethics.
Ann Intern Med
Self-reported symptom experience of critically ill cancer patients receiving intensive care.
Crit Care Med
Bioethics for clinicians: 20. Chinese bioethics.
Can Med Assoc J
Hong Kong Chinese teachers' attitudes towards life-sustaining treatment in the dying patients.
Hong Kong Med J
Bioethics for clinicians: 19. Hinduism and Sikhism.
Can Med Assoc J
The loneliness of the long-term care giver.
N Engl J Med
When the caregiver needs care: the plight of vulnerable caregivers.
Am J Public Health
The trouble with families.
Ann Intern Med
The influence of ethnicity and race on attitudes toward advance directives, life-prolonging treatments and euthanasia.
J Clin Ethics
Cross-cultural similarities and differences in attitudes about advance care planning.
J Gen Intern Med
Cultural perspectives of death, grief, and bereavement.
J Psychosoc Nurs Ment Health Serv
Management of common symptoms in terminally ill patients: Part I. Fatigue, anorexia, cachexia, nausea and vomiting.
Am Fam Physician
Management of common symptoms in terminally ill patients: Part II. Constipation, delirium and dyspnea.
Am Fam Physician
Perspectives on care at the close of life: management of dyspnea in patients with far-advanced lung disease; “once I lose it, it's kind of hard to catch it.”
JAMA
Crit Care Med
Chest
Am Rev Respir Dis
Crit Care Med
Factors considered important at the end of life by patients, family, physicians, and other care providers.
JAMA
In search of a good death: observations of patients, families, and providers.
Ann Intern Med
Mon Vital Stat Rep
JAMA
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