title: End-of-life care in COPD: a survey carried out with Portuguese pulmonologists.
abstract: BACKGROUND
  End-of-life (EoL) care is a major component in the management of patients with advanced COPD. Patient-physician communication is essential in this process.
  
  
  OBJECTIVE
  To evaluate the practice of Portuguese Pulmonologists in EoL communication and palliative care in COPD.
  
  
  METHODS
  An on-line survey was sent to physicians affiliated to the Portuguese Pneumology Society.
  
  
  RESULTS
  We obtained 136 answers from 464 eligible participants (29.3%). About half of the physicians reported that they have rarely introduced EoL discussions with their COPD patients (48.5%). Most had never/rarely suggested decision-making on the use of invasive mechanical ventilation (68.4%). Discussions were described as occurring mostly during/after a major exacerbation (53.7%). Only 37.5% of participants reported treating dyspnoea with opioids frequently/always. Only 9.6% stated that they never/rarely treated anxiety/depression. Most participants perceive the discussion of EoL issues as being difficult/very difficult (89.0%). The reasons most frequently given were feeling that patients were not prepared for this discussion (70.0%), fear of taking away a patient's hope (58.0%) and lack of training (51.0%).
  
  
  CONCLUSIONS
  Patient and medical staff EoL communication in COPD is still not good enough. Training in this area and the creation of formal protocols to initiate EoL have been identified as major factors for improvement.
authors.affiliation: Serviço de Pneumologia do Centro Hospitalar Lisboa Norte, EPE - Hospital Pulido Valente, Lisbon, Portugal. Electronic address: carina.gaspar@gmail.com.
authors.forename: C
authors.initials: C
authors.lastname: Gaspar
authors.affiliation: Serviço de Pneumologia do Centro Hospitalar Lisboa Norte, EPE - Hospital Pulido Valente, Lisbon, Portugal.
authors.forename: S
authors.initials: S
authors.lastname: Alfarroba
authors.affiliation: Serviço de Pneumologia do Centro Hospitalar Lisboa Norte, EPE - Hospital Pulido Valente, Lisbon, Portugal.
authors.forename: L
authors.initials: L
authors.lastname: Telo
authors.affiliation: Serviço de Pneumologia do Centro Hospitalar Lisboa Norte, EPE - Hospital Pulido Valente, Lisbon, Portugal.
authors.forename: C
authors.initials: C
authors.lastname: Gomes
authors.affiliation: Serviço de Pneumologia do Centro Hospitalar Lisboa Norte, EPE - Hospital Pulido Valente, Lisbon, Portugal; Centro de Estudos Doenças Crónicas (CEDOC), Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Lisbon, Portugal.
authors.forename: C
authors.initials: C
authors.lastname: Bárbara
mesh_terms: D003142:Communication; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010817:Physician-Patient Relations; D011174:Portugal; D029424:Pulmonary Disease, Chronic Obstructive / Q000628:therapy*; D015272:Pulmonary Medicine; D011795:Surveys and Questionnaires; D013727:Terminal Care
keywords: COPD; Communication; Comunicação; Cuidados paliativos; DPOC; End-of-life; Fim de vida; Palliative care