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Ethics in Moderate To Severe Chronic Obstructive Pulmonary Disease FREE TO VIEW

Michel Chalhoub, MD; Tarek Dernaika, MD; Melhem Imad, MD
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Staten Island University Hospital, Staten Island, NY


Chest. 2003;124(4_MeetingAbstracts):84S. doi:10.1378/chest.124.4_MeetingAbstracts.84S
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PURPOSE:  The purpose of this study is to determine whether patients with significant chronic obstructive pulmonary disease (COPD) had their wishes regarding end of life care discussed with them.

METHODS:  All pulmonary function tests (PFT) performed at a university hospital between year 2000 and 2002 were reviewed. Patients with a forced expiratory volume in 1 second (FEV1) less than 50% of predicted were included. Patients with a smoking history of less than 20 pack years, cancer, asthma, or less than 50 years of age were excluded. Data collected included age, sex, smoking history, and FEV1. Patients were then contacted for a phone interview. Patients who agreed to participate were asked a set of 8 questions.

RESULTS:  A total of 102 patients were contacted. 83 agreed to participate. The following tables summarize the results.Results shown are mean values, p/y=pack/years, % pred=percent predicted.69 patients (83%) have not had their wishes regarding end of life care or the use of mechanical ventilation (MV) discussed with them. Out of those, 51 (74%) believe that they should have been given the opportunity to discuss their wishes. The mean number of hospitalizations and office visits were 1 and 2.7 respectively within the 6 months prior to the phone interview. Out of the 12 subjects who had previous MV, 10 (83%) did not have prior discussion, and 6 (50%) do not want to be intubated again. 43 subjects (52%) did not have a pulmonologist.

CONCLUSION:  More than 80% of patients with moderate to severe COPD have not had their wishes regarding end of life care or the use of mechanical ventilation discussed with them. Half of the patients who had previous MV do not wish to have that experience again.CLINICAL IMPLICATION: End of life care should be an integral part of a comprehensive management plan of patients with moderate to severe COPD. This should improve patients satisfaction and autonomy. Age (years)Men (%)Women (%)Smoking (p/y)FEV1(%pred)64.528 (33.7)55 (66.3)54.50.76 (36.6)Do you know your Dx?(%)Do you know how severe(%)Did you discuss your wishes(%)Did you want to discuss wishe(%)H/O Mechanical Ventilation (%)Yes: 62 (74)Yes: 28 (45)Yes: 14 (17)Yes: 65 (78)Yes: 12 (14)No: 21 (26)No: 34 (55)No: 69 (83)No: 12 (14)No: 71 (86)

DISCLOSURE:  T. Dernaika, None.

Monday, October 27, 2003

2:30 PM - 4:00 PM




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