title: Last 3 months of life in home-ventilated patients: the family perception.
abstract: We studied the family's perception of care in patients under home mechanical ventilation during the last 3 months of life. In 11 respiratory units, we submitted a 35-item questionnaire to relatives of 168 deceased patients exploring six domains: symptoms, awareness of disease, family burden, dying, medical and technical problems. Response rate was 98.8%. The majority of patients complained respiratory symptoms and were aware of the severity and prognosis of the disease. Family burden was high especially in relation to money need. During hospitalisation, 74.4% of patients were admitted to the intensive care unit (ICU). 78 patients died at home, 70 patients in a medical ward and 20 in ICU. 27% of patients received resuscitation manoeuvres. Hospitalisations and family economical burden were unrelated to diagnosis and mechanical ventilation. Families of the patients did not report major technical problems on the use of ventilators. In comparison with mechanical invasively ventilated patients, noninvasively ventilated patients were more aware of prognosis, used more respiratory drugs, changed ventilation time more frequently and died less frequently when under mechanical ventilation. We have presented good points and bad points regarding end-of-life care in home mechanically ventilated patients. Noninvasive ventilation use and diagnosis have impact on this burden.
authors.affiliation: Respiratory Dept, Fondazione Salvatore Maugeri, IRCCS, Via Giuseppe Mazzini 129, 25066 Lumezzane (Brescia), Italy. michele.vitacca@fsm.it
authors.forename: M
authors.initials: M
authors.lastname: Vitacca
authors.forename: M
authors.initials: M
authors.lastname: Grassi
authors.forename: L
authors.initials: L
authors.lastname: Barbano
authors.forename: G
authors.initials: G
authors.lastname: Galavotti
authors.forename: C
authors.initials: C
authors.lastname: Sturani
authors.forename: A
authors.initials: A
authors.lastname: Vianello
authors.forename: E
authors.initials: E
authors.lastname: Zanotti
authors.forename: L
authors.initials: L
authors.lastname: Ballerin
authors.forename: A
authors.initials: A
authors.lastname: Potena
authors.forename: R
authors.initials: R
authors.lastname: Scala
authors.forename: A
authors.initials: A
authors.lastname: Peratoner
authors.forename: P
authors.initials: P
authors.lastname: Ceriana
authors.forename: L
authors.initials: L
authors.lastname: Di Buono
authors.forename: E
authors.initials: E
authors.lastname: Clini
authors.forename: N
authors.initials: N
authors.lastname: Ambrosino
authors.forename: N
authors.initials: N
authors.lastname: Hill
authors.forename: S
authors.initials: S
authors.lastname: Nava
mesh_terms: D000368:Aged; D002423:Cause of Death; D015897:Comorbidity; D005190:Family / Q000523:psychology*; D005260:Female; D006699:Home Care Services; D006801:Humans; D007558:Italy; D016015:Logistic Models; D008297:Male; D029424:Pulmonary Disease, Chronic Obstructive / Q000401:mortality / Q000628:therapy; D012121:Respiration, Artificial; D011795:Surveys and Questionnaires; D013727:Terminal Care