COPD as a Life-Limiting Illness: Implications for Advanced Practice Nurses

Donna M. Goodridge, RN, PhD

Disclosures

Topics in Advanced Practice Nursing eJournal. 2006;6(4) 

In This Article

Healthcare Resources and Service Utilization

A significant gap exists between the care needs of people with advanced COPD and the resources available to them. Healthcare has tended to focus on acute exacerbations, with interventions primarily directed at crisis management, rather than adequate management of baseline symptoms.[30,31] This strategy results in patients struggling to live with high levels of poorly controlled symptoms. Patients who died from COPD typically received inadequate monitoring and services from both primary and secondary care providers during the year before they died.[38]

While it has been demonstrated that patients with COPD have a symptom burden that matches or surpasses that of lung cancer patients, their healthcare needs apparently are not as well met. In the United Kingdom, people dying from respiratory diseases received a lower level of service provision than people dying from cancer.[30] Significantly more patients with lung cancer than those with chronic lung disease received help from district nurses (P = .037) or from palliative care nurses (P < .001).[31] While 30% of lung cancer patients had access to help from specialist palliative care services, none of the COPD patients had such access.[11] People with COPD received only limited support from health and social agencies,[33] and only one third received a home visit from a nurse, which was usually to perform a technical task and did not include addressing emotional or social needs.

The final days of people with COPD are also different from those of people with lung cancer. While patients with lung cancer were more likely to die at home or in hospice, people with COPD were more likely to die in a hospital.[30] The same study found that relatives of COPD patients were less likely than families of lung cancer patients to have been present when the patient died, although most relatives wished they had been there. APNs may be able to explore the patient's wishes for where they want to die, and may work with other providers to facilitate the best quality of dying possible.

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