Chest
Volume 128, Issue 5, November 2005, Pages 3599-3610
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Ethics
Palliative and End-of-Life Care for Patients With Cardiopulmonary Diseases: American College of Chest Physicians Position Statement

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Acute and chronic pulmonary and cardiac diseases often have a high mortality rate, and can be a source of significant suffering. Palliative care, as described by the Institute of Medicine, “seeks to prevent, relieve, reduce or soothe the symptoms of disease or disorder without effecting a cure. Palliative care in this broad sense is not restricted to those who are dying or those enrolled in hospice programs.” The American College of Chest Physicians strongly supports the position that such palliative and end-of-life care of the patient with an acute devastating or chronically progressive pulmonary or cardiac disease and his/her family should be an integral part of cardiopulmonary medicine. This care is best provided through an interdisciplinary effort by competent and experienced professionals under the leadership of a knowledgeable and compassionate physician. To that end, it is hoped that this statement will serve as a framework within which physicians may develop their own approach to the management of patients requiring palliative care.

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.

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