title: "The unpredictable death"-The last year of life for patients with advanced COPD: Relatives' stories.
abstract: OBJECTIVE
  The end stage of chronic obstructive pulmonary disease (COPD) is described as prolonged, and the symptom burden for patients with COPD is often high. It progresses slowly over several years and can be punctuated by abrupt exacerbations that sometimes end in sudden death or a recovery of longer or shorter duration. This makes it difficult to identify the critical junctures in order to prognosticate the progress and time of death. Patients with COPD often express a fear that the dying process is going to be difficult. There is a fear that the dyspnea will worsen and lead to death by suffocation. The present article aimed to retrospectively describe the final year of life for patients with advanced COPD with a focus on death and dying from the perspective of relatives.
  
  
  METHODS
  Interviews were conducted with the relatives of deceased family members who had advanced COPD. In total, 13 interviews were conducted and analyzed by means of content analysis.
  
  
  RESULTS
  All relatives described the patients as having had a peaceful death that did not correspond with the worry expressed earlier by both the patients and themselves. During the final week of life, two different patterns in the progress of the illness trajectory emerged: a temporary improvement where death was unexpected and a continued deterioration where death was inevitable.
  
  
  CONCLUSIONS
  The patients and their relatives lived with uncertainty up until the time of death. Little support for psychosocial and existential needs was available. It is essential for the nurse to create relationships with patients and relatives that enable them to talk about dying and death on their own terms.
authors.affiliation: School of Health and Education, University of Skövde,Skövde,Sweden.
authors.forename: Kristina
authors.initials: K
authors.lastname: Ek
authors.affiliation: Department of Palliative Care Research,Ersta Sköndal University College,Stockholm,Sweden.
authors.forename: Birgitta
authors.initials: B
authors.lastname: Andershed
authors.affiliation: School of Health and Medical Sciences, Örebro University,Örebro,Sweden.
authors.forename: Eva
authors.initials: E
authors.lastname: Sahlberg-Blom
authors.affiliation: Department of Palliative Care Research,Ersta Sköndal University College,Stockholm,Sweden.
authors.forename: Britt-Marie
authors.initials: BM
authors.lastname: Ternestedt
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001293:Attitude to Death; D003371:Cough / Q000209:etiology; D018450:Disease Progression; D004417:Dyspnea / Q000209:etiology*; D005190:Family / Q000523:psychology*; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D010166:Palliative Care / Q000379:methods / Q000523:psychology*; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000523:psychology*; D036301:Qualitative Research; D012189:Retrospective Studies; D013548:Sweden; D019452:Terminally Ill / Q000523:psychology*
keywords: Chronic obstructive pulmonary disease; Dying and death; End of life; Oxygen therapy; Palliative care