title: End-of-Life Discussion, Patient Understanding and Determinants of Preferences in Very Severe COPD Patients: A Multicentric Study.
abstract: Discussion about patients' end-of-life (E-o-L) preferences should be part of the routine practice. Using a semi-structured interview with a scenario-based decision, we performed a prospective multicentre study to elicit the patients' E-o-L preferences in very severe chronic obstructive pulmonary disease (COPD). We also checked their ability to retain this information and the respect of their decisions when they die. Forty-three out of ninety-one of the eligible patients completed the study. The choice of E-o-L practice was equally distributed among the three proposed options: endotracheal intubation (ETI), 'ceiling' non-invasive ventilation (NIV), and palliation of symptoms with oxygen and morphine. NIV and ETI were more frequently chosen by patients who already experienced them. ETI preference was also associated with the use of anti-depressant drugs and a low educational level, while a higher educational level and a previous discussion with a pneumologist significantly correlated with the preference for oxygen and morphine. Less than 50% of the patients retained a full comprehension of the options at 24 hours. About half of the patients who died in the follow-up period were not treated according to their wishes. In conclusion, in end-stage COPD more efforts are needed to improve communication, patients' knowledge of the disease and E-o-L practice.
authors.affiliation: a Pulmonary Rehabilitation Unit , IRCCS Fondazione S. Maugeri , Pavia , Italy.
authors.forename: Annalisa
authors.initials: A
authors.lastname: Carlucci
authors.affiliation: b Pulmonary Rehabilitation Unit IRCCS Fondazione S. Maugeri , Lumezzane , Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Vitacca
authors.affiliation: c Laboratorio di Informatica e Sistemica per la Ricerca Clinica , IRCCS Fondazione S. Maugeri , Pavia , Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Malovini
authors.affiliation: d Respiratory Unit , Concord Hospital , University of Sydney , NSW , Australia.
authors.forename: Paola
authors.initials: P
authors.lastname: Pierucci
authors.affiliation: e Respiratory and Critical Care Unit , S. Orsola-Malpighi Hospital , Bologna , Italy.
authors.forename: Aldo
authors.initials: A
authors.lastname: Guerrieri
authors.affiliation: b Pulmonary Rehabilitation Unit IRCCS Fondazione S. Maugeri , Lumezzane , Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Barbano
authors.affiliation: a Pulmonary Rehabilitation Unit , IRCCS Fondazione S. Maugeri , Pavia , Italy.
authors.forename: Piero
authors.initials: P
authors.lastname: Ceriana
authors.affiliation: a Pulmonary Rehabilitation Unit , IRCCS Fondazione S. Maugeri , Pavia , Italy.
authors.forename: Antonella
authors.initials: A
authors.lastname: Balestrino
authors.affiliation: a Pulmonary Rehabilitation Unit , IRCCS Fondazione S. Maugeri , Pavia , Italy.
authors.forename: Carmen
authors.initials: C
authors.lastname: Santoro
authors.affiliation: f Alma Mater University Department of Clinical , Integrated and Experimental Medicine (DIMES) , Respiratory and Critical Care Unit , S. Orsola-Malpighi Hospital , Bologna , Italy.
authors.forename: Lara
authors.initials: L
authors.lastname: Pisani
authors.affiliation: f Alma Mater University Department of Clinical , Integrated and Experimental Medicine (DIMES) , Respiratory and Critical Care Unit , S. Orsola-Malpighi Hospital , Bologna , Italy.
authors.forename: Nadia
authors.initials: N
authors.lastname: Corcione
authors.affiliation: f Alma Mater University Department of Clinical , Integrated and Experimental Medicine (DIMES) , Respiratory and Critical Care Unit , S. Orsola-Malpighi Hospital , Bologna , Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Nava
mesh_terms: D000368:Aged; D000701:Analgesics, Opioid / Q000627:therapeutic use; D003142:Communication; D032882:Comprehension; D004522:Educational Status; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007442:Intubation, Intratracheal; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000627:therapeutic use; D063087:Noninvasive Ventilation; D010102:Oxygen Inhalation Therapy; D010166:Palliative Care; D057240:Patient Preference; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000503:physiopathology*; D012720:Severity of Illness Index; D013727:Terminal Care / Q000379:methods
chemical_list: D000701:Analgesics, Opioid; D009020:Morphine
keywords: Acute respiratory failure; advanced care planning; communication; palliative care; terminal care