CHEST Guidelines-The-“Good”-Home-Death-in-Pulmonary-D

The-“Good”-Home-Death-in-Pulmonary-D

Pdf Summary

The place of death for patients with pulmonary diseases, such as COPD, interstitial lung disease (ILD), and cystic fibrosis (CF), has changed significantly from 2003 to 2017, as examined in research by Cross et al., highlighted in an editorial by Anand S. Iyer, MD, MSPH. The study observed a reduction in hospital deaths from 44% to 28%, while hospice facility deaths increased dramatically, and home deaths rose from 23% to 35%. Although there is a trend towards home deaths, this does not fully align with American preferences, where 70% prefer to die at home.<br /><br />Factors influencing these trends include age, race, and disease type. Older adults are more likely to die in hospice care, and minority groups are more likely to die in hospitals. CF and ILD patients have higher hospital death rates than those with COPD. The need to develop systems in the U.S. similar to Denmark's, which offers robust home nursing care, may help meet the preference for dying at home.<br /><br />Addressing challenges with home deaths involves ensuring adequate support and preparation for patients and family caregivers. The distress caused by conditions like refractory breathlessness highlights the importance of having emergency plans involving low-dose opioids and anxiolytics through hospice care. To prevent situations becoming overwhelming for families, advancing palliative care efforts is vital. This involves integrating palliative care services earlier in the treatment timeline, which could be done through dedicated referrals or training frontline pulmonary clinicians in palliative care principles ("pallipulm" approach). This comprehensive care plan should include symptom management, cultural considerations, and providing caregivers with necessary support, thus aligning patient and family preferences at the end of life. This shift emphasizes the growing necessity for integrated palliative care in managing chronic pulmonary diseases.

Keywords

pulmonary diseases

COPD

interstitial lung disease

cystic fibrosis

place of death

palliative care

home deaths

hospice care

caregiver support

symptom management