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Communications to the Editor |

Another View of End-of-Life Care FREE TO VIEW

Catherine K. Nakayama, RN
Author and Funding Information

University of North Carolina at Chapel Hill Graduate School Chapel Hill, NC

Correspondence to: Catherine K. Nakayama, RN e-mail: cathyklein@juno.com



Chest. 2003;124(2):771-772. doi:10.1378/chest.124.2.771-a
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To the Editor:

I am a graduate student in nursing at the University of North Carolina at Chapel Hill in the Adult Nurse Practitioner program, with a focus on Cancer/HIV/AIDS. I am responding to the article by Curtis et al in the July 2002 issue.1 I would like to commend the authors for providing a much-needed patient perspective on end-of-life (EOL) care. All health-care providers need to learn more about the issues involved in EOL care and, particularly, to pay attention to the patient/family perspective that was provided in this article.

The authors’ findings that patient needs and treatment vary depending on the disease process of the patient who is dying is very necessary information for those of us involved in EOL care. The similarities found concerning the issues that are important to patients, no matter what their disease process, such as the importance of emotional support, communication, accessibility, and continuity, will help to guide our future EOL care. It was unfortunate that the authors found that the group of patients with COPD was dissatisfied with education about EOL care by their physicians, including advance care planning. These patients also thought that physicians did not understand their EOL medical care preferences. Tammelleo2 found that a quarter of all nurses who responded to his survey had seen clinicians purposely ignore patients’ wishes as stated in their advance directives, even when these wishes were understood. Therefore, it is of the utmost importance that all clinicians (ie, nurse practitioners, doctors, physicians’ assistants, and nurses) give special attention to this area of education and care; starting in primary care settings when patients are well, and including inpatient hospital care and hospice care.

There have been many studies performed concerning EOL care; however, there have not been as many giving the perspectives of the patients, thus making this a highly valuable study, as the authors state. It is important as health-care practitioners that we not only discuss how we feel about this subject among ourselves, but is also highly necessary that we hear the patients’ opinions on it. It is also important to examine their families’ experiences in the hopes that health-care personnel can “avoid miscommunications and decisional conflict and facilitate more positive outcomes.”3This would, in turn, help to improve patient satisfaction with EOL care. We must, as practitioners wishing to improve care, include family satisfaction as well as that of the patients in the process of care. Haddad4 has said that it is important that families feel that their loved ones received their last wishes “because it was their right.” It is our duty as clinicians to hold our patients’ rights in high regard.

The findings concerning how doctors can improve EOL care are equally important to those concerning advanced practice nurses who work in this area, as we all have the same goal of improving EOL care. During the dying process, the principle of autonomy would suggest that it is essential that families and patients be in control.5 In our findings and our practice, we must collaborate with physicians in this highly sensitive area of patient care in order to best discover and implement EOL care that will enable our patients to achieve autonomy. I urge all clinicians, whether they are doctors, nurse practitioners, physician’s assistants, or nurses, to learn as much as they can about EOL care and to share and implement their findings in this area with each other. We must remember that our first priority is to the patients and their families, and that we are truly privileged to share this most sensitive time of their lives with them.

References

Curtis, JR, Wenrich, MD, Carline, JD, et al (2002) Patients’ perspectives on physician skill in end-of-life care: differences between patients with COPD, cancer, and AIDS.Chest122,356-362
 
Tammelleo, AD Protecting patients’ end-of-life choices.RN2000;63,75-77
 
Tilden, V, Tolle, S, Nelson, C, et al Family decision making in foregoing life-extending treatments.J Fam Nurs1999;5,426-442
 
Haddad, A Acute care decisions: ethics in action.RN1997;60,17-19
 
Stewart, A, Teno, J, Patrick, D, et al The concept of quality of life of dying persons in the context of health care.J Pain Symptom Manage1999;17,93-108
 

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References

Curtis, JR, Wenrich, MD, Carline, JD, et al (2002) Patients’ perspectives on physician skill in end-of-life care: differences between patients with COPD, cancer, and AIDS.Chest122,356-362
 
Tammelleo, AD Protecting patients’ end-of-life choices.RN2000;63,75-77
 
Tilden, V, Tolle, S, Nelson, C, et al Family decision making in foregoing life-extending treatments.J Fam Nurs1999;5,426-442
 
Haddad, A Acute care decisions: ethics in action.RN1997;60,17-19
 
Stewart, A, Teno, J, Patrick, D, et al The concept of quality of life of dying persons in the context of health care.J Pain Symptom Manage1999;17,93-108
 
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