Hospice news

Despite the fact that the five-year mortality rate for COPD is 50 to 60 percent, in a recent study 83 percent of patients with advanced chronic obstructive pulmonary disease (COPD) had never discussed end-of-life plans with their physicians. A team of researchers at Staten Island University in New York reviewed the pulmonary function tests of all patients admitted to their hospital over a two-year period. Inclusion was based on a forced expiratory volume at 1 second (FEV1) that was 50 percent less than predicted. Smokers, patients with asthma or cancer, and patients younger than 50 were excluded. Eighty-three patients in all completed the study. According to lead researcher Michel Chalhoub, MD, one quarter (26 percent) of patients not only were unaware of their diagnosis but had no idea what it meant. “These patients have worse mortality than patients with stage 1 lung cancer,” Dr. Chalhoub said. “Telling a patient ‘you have emphysema’ is not good news; it’s bad news.” Fully 83 percent of patients in the study had not discussed end-of-life issues with their physicians, although 78 percent would have welcomed such a discussion. “We discuss [endof-life] issues with cancer patients and AIDS patients but not with COPD patients,” said Dr. Chalhoub. Dr. Chalhoub presented his results at the 69th Annual Conference of the American College of Chest Physicians in October (CHEST 2003). “There is a problem on both sides,” said session moderator Robert McCaffree, MD, from the Veterans Affairs Medical Center in Oklahoma City, Oklahoma. “There is a mistrust on the part of many populations for the medical system, and studies show that physicians don’t initiate the discussion often enough. We may need to push it a little bit.” (Source: CHEST 2003 slide presentation, October 27, 2003.)