Palliative Care for Patients with Chronic Obstructive Pulmonary Disease: Current Perspectives

Definition of palliative care adopted by the World Health Organization [7] is defined as "patient-centered care that optimizes quality of life by predicting, preventing and treating pain" It is. And the spiritual need is to promote patient autonomy, access to information, and selection throughout the continuum of diseases. In contrast, "end of life" care focuses on the care of the patient at the final stage of life and its family members. Therefore, although the terms "palliative care" and "hospice care" may seem like synonyms, the former has a broader meaning and not only needs to improve quality of life but comprehensive care includes. Focuses on the final stage of the disease. Depending on the illness, it will be the number of days before death, weeks weeks, or months. Recognizing this difference in the context of COPD is important, as it may be difficult to establish 'hospice care' early rather than palliative care. [8]

Differences in opinion among medical professionals in determining appropriate COPD palliative care patients are ambiguous [9, 10], which can be explained by the concept of disease trajectory. The concept of disease trajectory accounts for three distinctive functions and a pattern of happiness in disease [11]: (i) diseases with high levels of function like cancer and diseases with a short-term decline; Requiring urgent hospitalization such as organ failure; (iii) associated problems such as low-level function and diseases with long-term decline such as stroke, dementia. Depending on the type of disease trajectory, the patient's physical, social and psychological needs vary greatly. COPD fits the second type of trajectory and is characterized by a functional decline with an acute attack. The reasons for disagreement among medical professionals in determining the applicability of palliative care to patients with COPD are the multiple "entrance" trajectories in COPD. Sporadic acute attacks are included in the trajectory of "reentry", and frequent hospitalization is required before stabilization. This is usually difficult to point to palliative care, as it obscures a steady decline in the patient's condition.

Furthermore, unlike end-stage cancer patients, there is no prognostic tool to help clinicians assess COPD survival. Since there is a strong correlation between hospice care and actual life expectancy, it is necessary to make a reliable prognostic prediction for COPD. This can identify end-stage patients and ultimately benefit from hospice care [Table 1].

However, with the concept of "prognosis" [12], clinicians became confronted with aggressive illnesses and encouraged supportive care and discussion about issues dying in the face of diseases with undefined trajectories . Considering COPD as a disease with uncertain trajectory characteristics, this concept can be applied to palliative care at specific stages of the disease.

For patients with chronic obstructive pulmonary disease (COPD), high-quality palliative care remains a major challenge in modern healthcare systems. The World Health Organization (WHO) defines palliative care as "aggressive comprehensive care for patients who do not respond to curative treatment". This is a definition that definitely explains the care of patients with COPD. The World Health Organization says that such care is "to improve the quality of life for patients and their families ... to prevent and reduce suffering through early detection and satisfactory assessment and treatment of pain and other problems We should include a method of psychosocial and spiritual continuity. To relieve pain should also include effective patient and family-centered communication, identification of patient care goals, joint decisions and prior care planning.

Chronic Obstructive Pulmonary Disease (COPD) is a slowly disabling disease with functional restrictions and symptoms of high burden. Palliative care services are focused on the quality of life of people facing diseases limiting life. People at COPD often consider their diseases not as life-threatening diseases but as "lifestyle habits", making interfacing difficult. A qualitative approach is used to capture the patient's experience. After discharge, we recruited patients with non-invasive ventilation of COPD and interviewed at home. In the interview schedule, we will explore participants' understanding of their illnesses, concerns, plans, hospice concerns, and views on palliative care.

Patient's perception of severe COPD and mortality shift: qualitative research identifies milestones and important development opportunities