title: [Palliative care for patients with COPD: a challenge].
abstract: BACKGROUND
  The aim of our study was to examine the practices and performance of a team working in a respiratory unit concerning the palliative care of patients with COPD, in a group of patients who died in hospital as a result of their disease.
  
  
  METHODS
  The first step was focused on those patients who died in the respiratory care unit of the General Hospital of Saint-Nazaire during the year 2008 and who received end-of-life care, and the reasons for their death. In the second step, we selected and analysed retrospectively the records of patients who died from COPD. In the third step semi-directive interviews were held with a sample of nine care workers who were judged to be representative of the staff working in the respiratory ward of Saint-Nazaire Hospital. The interviews consisted of seven questions related to palliative practices and professional experiences acquired during the care of patients with COPD.
  
  
  RESULTS
  In a population of 51 patients who received end-of-life care during the year 2008, 34 were referred on account of lung cancer and only one was referred for COPD. Bronchial carcinoma was the main cause of death (36 cases) then COPD (16 cases) in a total of 92 deaths (2008). Retrospective analysis of the records of patients who died from COPD showed a limitation of care in 43% of cases, midazolam induced sedation in 43%, treatment with morphine in 37%, support for the family or relatives in 62% and some anticipated decisions in 6%. Analysis of the interviews showed that the subject of death is rarely or never discussed with these patients in contrast to patients dying from bronchial cancer.
  
  
  CONCLUSIONS
  The practices of a respiratory team concerning palliative care in COPD patients appear to be limited to end-of-life care. This clearly reflects a need for palliative care education in workers of respiratory care units in order to deliver a global palliative approach at an earlier stage in the care of COPD patients and to improve communication concerning end-of-life treatments.
authors.affiliation: Service de pneumologie, CHG de Saint-Nazaire, Saint-Nazaire cedex, France. l.ducouedic@ch-saintnazaire.fr
authors.forename: L
authors.initials: L
authors.lastname: du Couëdic
authors.forename: V
authors.initials: V
authors.lastname: Morel
authors.forename: L
authors.initials: L
authors.lastname: Trehello
authors.forename: A
authors.initials: A
authors.lastname: Trehony
authors.forename: M
authors.initials: M
authors.lastname: Robert
authors.forename: D
authors.initials: D
authors.lastname: Sandron
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001984:Bronchial Neoplasms / Q000628:therapy; D015897:Comorbidity; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D005602:France; D017052:Hospital Mortality; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D008297:Male; D008874:Midazolam / Q000627:therapeutic use; D008875:Middle Aged; D009020:Morphine / Q000627:therapeutic use; D009294:Narcotics / Q000627:therapeutic use; D010102:Oxygen Inhalation Therapy / Q000706:statistics & numerical data; D010166:Palliative Care / Q000379:methods / Q000706:statistics & numerical data*; D011368:Professional-Family Relations; D011369:Professional-Patient Relations; D029424:Pulmonary Disease, Chronic Obstructive / Q000401:mortality / Q000628:therapy*; D012124:Respiratory Care Units / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012907:Smoking / Q000453:epidemiology; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000379:methods / Q000706:statistics & numerical data*
chemical_list: D006993:Hypnotics and Sedatives; D009294:Narcotics; D009020:Morphine; D008874:Midazolam