Chronic illness remains a major public health challenge in today's health-care system. Most of individuals with chronic health sickness spend the last moments of life in and out of the hospital setting with half of those who die do so in the acute health care settings. The individual, caregivers, and friends are all experiencing mental discomfort, which is interfering with their ability to perform. Individual health treatment throughout the final days of life can help alleviate psychological anguish. Aside from cancer, end-of-life care is available for other chronic conditions such as dementia, cardiovascular and respiratory health issues. This form of care aims at providing health care with the main aim of meeting the health needs of the individuals whose life expectancy is reduced as a result of a life limiting condition and also where the primary role of care is shifted from prolonging the life to the provision of quality life.
Quality of end of life care primary aims at assessing the progression of life limiting illness all through the physical impairment to the psychological impacts it has on the family members. It is important for the end of life care to be instigated whenever death is imminent. The end of life care doses not hasten the death but rather incorporate the different treatment options that aims at prolonging life through quality improvement. Provision of high quality end of life care provides physical, psychological and spiritual need of both the patient and the care givers. They do this by involving the patients in decision making pertaining their health through respecting their choice and autonomy as well as team work through the collaboration to the multidisciplinary team in the provision of care. As such the main principle during the end of life includes provisions where the patients are involved in decisions pertaining to their own care. In addition to involving patients in the decision making process, there are other guidelines that govern that process of caring for patients with COPD. These guidelines are known as the NICE guidelines. They advocate for high quality care for the patients arguing that when delivered to the patient, end of life care should at least contribute to improving of the safety, effectiveness and effectiveness of the care for adults in their last days. These guidelines state that care for such adults should be done in the following ways;
Making sure that patients get a positive experience of care
Improving the overall quality of life for patients with long term conditions
Treating patients in a safe environment and keeping them away from healthcare related harm.
The NICE guidelines act in unison with wide range of policies such as the palliative care competence policy and palliative care for children suffering from life limiting conditions among others. Together, these policies and guidelines ensure that patients are given high quality care.
Majority of patients who have chronic illness deteriorate in the health since they are their end of their lives and also due to the inappropriate health are provided. As a result, there is the need for the healthcare system to provide a system which provides end of life care which is quality. Palliative care is mainly provided to those patients who are their end of life. According to the World Health Organization “Palliative care aims at improving the quality of life for patients and their families. They are associated with life threatening illness through the prevention, relief of suffering and treatment of pain and other physical, psychological and spiritual problems.
In the past, palliative care was given to cancer patients; however, due to age advancements there has been an increase in the incidence of major chronic illness and therefore requiring palliative care. Over the recent past, there has been emergence of groups requiring palliative care and therefore, there is the need for increasing the quality and the effectiveness of palliative health care services. Quality care provision has been a priority in the health care system over the past few decades. While there has been a drastic increase in the cases of chronic illness in the society, there is the need for medical advancements to help in controlling the incidences. Provision of End-of-life care optimises the quality of care among patient with incurable diseases. The principles of the end of care for a patient with a terminal illness are similar to palliative care. It is, therefore, the role of all healthcare professionals to provide quality and compassionate care from the time the diagnosis of the terminal illness is made, to the time of death.
The Chronic Obstructive Pulmonary disease represents a significant public health challenge leading to chronic morbidity and significant mortality throughout the world. In the current incidence of COPD, it is considered as the significant lung disease. It is the fourth leading cause of death in the world and projected to be the third by 2020. In 2012, it was estimated that 6% of the total mortality was a result of chronic obstructive pulmonary disease. For the majority of patients with COPD, they experience the better part of their life marked with progressive dyspnea, reduced functionality as well as social isolation.
Owing to the increased prevalence of COPD in the society, it has significant individual, social and economic burden as it is expensive to manage. The burden is expected to grow further due to the continued exposure to the risk as well as the aging population. The non-pharmacological therapy yields better symptomatic improvement as well as better quality of life. Some of the factors associated with the development of COPD include environmental exposure to tobacco. The symptoms of the disease include a cough, slow and progressive dyspnea with the symptoms being insidious and nonspecific. As a result, there is a late diagnosis of the disease which limits the interventions and the treatment options.
Quality care provision has been a priority in the health care system over the past few decades. While there has been a drastic increase in the cases of chronic illness in the society, there is the need for medical advancements to help in controlling the incidences. Provision of End-of-life care aims at optimising the quality of care among patients with incurable diseases. The principles of the end of care for a patient with a terminal illness are similar to palliative care. It is, therefore, the role of all healthcare professionals to provide quality and compassionate care from the time the diagnosis of the terminal illness is made, to the time of death.
Breathlessness clinics
Patients with COPD experience fatigue and breathlessness, therefore the need for a program to help them cope with the symptoms. Breathlessness is the feeling of being out of breath especially for patients with chronic respiratory illness. In most cases, the feeling is experienced with less exertion than what is expected. The primary role of the clinics and provide support to the patients as well as their families. The breathlessness clinic is designed to help patients be in a position to help them carry on with their daily activities in their own homes. These clinics often carry on for up to six months. The breathlessness clinics are different from the rehabilitation programs since they are tailored to individuals other than groups focusing more on increasing the confidence and the strategies to help patients with breathlessness.
Traditional modalities for COPD
Smoking Cessation has been used over the years for management of patients with COPD who have a decline in their lung function. Research shows that, among these patients, there is a reduction in the rate at which the lungs are destroyed, and as a result, there is an increase in the quality of life. Another therapy in the management of COPD includes the Long-Term Oxygen Therapy. The LTOT is one of the long-standing therapies used in the management of patients with COPD. The main aim is to increase the baseline arterial oxygen tension through the use of continuous administration of oxygen. The use of oxygen among these patients helps in improving the oxygen endurance as controlling the level of dyspnea. Research shows that administration of oxygen during the exercise training enables individuals with COPD to be in a position to tolerate higher levels of exercise and therefore experience fewer exertion symptoms, and thus, there is the ultimate improvement of the quality of life
Current non-pharmacological modalities for COPD
Pulmonary Rehabilitation
Among patients with COPD, pulmonary rehabilitation is designed to optimise physical and social functioning. It is a multidisciplinary and comprehensive intervention for patients who have reduced quality of life and those who are symptomatic. Main activities in this program include exercise training, behavioural and psychosocial interventions and nutritional therapy. The physical exercise program provides strength and endurance training individualised with the primary aim of increasing the capacity and the strength of the patients. The rehabilitation program is often aimed at breaking the vicious cycle of COPD and therefore improving the exercise capability as well as the conditioning of the affected patients.
Pulmonary rehabilitation has for long been associated with several benefits such as improvement of exercise tolerance, reduction in dyspnea, improvement of the quality of life, decrease in social isolation, anxiety and depression. Research shows that the subsequent rehabilitation, there is enhanced troll among patients with COPD over their condition. Exercise training is considered as the cornerstone of pulmonary rehabilitation. As such, research shows that among patients who are involved in pulmonary rehabilitation programs, there is the increased probability of the reduction in the exacerbations as well as the number of hospitalisation among these patients.
Breathing exercises
Among patients with COPD, a variety of breathing exercises are employed. The main aim of the practices is to reduce the case of dyspnea through alteration of the respiratory muscle recruitment, reduction in the lung hyperventilation, improvement of the respiratory muscle functioning as well as the optimisation of the thoraces-abdominal motion.
Chest physiotherapy (Airway Clearance Techniques)
Patients who have COPD more often than not present with chronic bronchitis, co-existence bronchiectasis and others exacerbation of COPD symptoms. The use of ACT’s enables the patients to clear the sputum with the aim of reducing paroxysmal coughing , reduce the lung function decline as well as reduce the frequency of exacerbations, therefore enhancing recovery from the cases of exacerbations. Different techniques are employed for airway clearance. They include the active cycle breathing techniques, the positive expiratory pressure therapy and the autogenic drainage. In autogenic treatment, the principle applied in this form of therapy aims at achieving the highest possible airflow for the different bronchioles. It is crucial for patients who are positive for chronic sputum reduction to be referred to a physiotherapist for the purpose of assessment and education regarding the best appropriate form of actions based on the manifestations of the patient.
Non-invasive positive pressure ventilation
Patients with COPD have associated hypercapnia and increased respiratory acidosis. Therefore, implementation of the NPPV helps in the reduction of the acidosis and hypercapnia. In this form of modality, the NPPV is delivered via a face mask or nasal cannula with the aim of achieving hyperventilation and providing respiratory muscle rest among patient with COPD. In the past, the NPPV was used for managing patients with severe exacerbations of COPD, however, in the recent past; the therapy has been seen to be beneficial among patients with associated comorbidities such as sleep apnea or obesity hypoventilation syndrome.
Advance Care Planning
Provision of the end of life care among patients with advanced, progressive and incurable diseases enables the patients to live in comfortably until they die. Further, both the palliative and support needs are identified and met throughout from the time the diagnosis is made and into bereavement. Management of pain includes all aviation of symptoms as well as the provision of psychological, social and spiritual support. Patients and family members are involved through and handled with respect and compassionate so as to produce the best possible outcomes.
Palliative and end of life care are essential to the improvement of the quality of care among the terminally ill patients. In spite of this, there exist unclear circumstances on some of the ways that seem best in the development of the quality of care. Research shows that, despite the different studies, there has been no significant improvement in the provision of care. As a result, there is the need for further research to determine some of the advancements that should be arrived out for the improvement of care among patients who have terminal illness such as COPD. Research shows that, for patients with COPD, the end of life care provided is often worse than those with other chronic diseases such as lung cancer. Variations in the care provided are due to the patient’s attitudes and preferences, changes in disease trajectories as well as the difference in the healthcare provider’s preferences and opinions.Chronic Obstructive Disease is symptomatic with patients presenting with elements of fatigue, dyspnea, insomnia and depression and majorly requires symptom-based palliative treatment. In this context palliative approaches are essential for the end of life are as well as hospice care.
Advance care planning is an essential component in the provision of end of life care among patients with COPD. Research results provide evidence of the associated benefits of advanced care planning. Among patients with COPD, there is increased patient satisfaction, improvement in the sense of control, as well as improvement in the psychosocial life through the reduction of the fear, anxiety and emotional distress. Majority of those with COPD, in the past, have preferred to undertake this due to its associated benefits. Despite the desire for the majority of the patients with COPD to be involved in advance care planning, few undergo through the process. Some of the challenges that have hindered the efficient advance care planning delivery include the perception of the patients on the quality of communication. Previous research shows that, in the majority of the cases, patients have often rated their physicians poorly in terms of the discussion of the prognosis, spirituality as well as the process of dying.
Provision of care for patients with advanced COPD remains an excellent challenge for majority of the healthcare professionals. Over the years, number of people suffering from COPD continues to rise drastically as compared to other chronic illness. As a result, there is need for advanced care for patients with chronic obstructive pulmonary disease. As aforementioned, advance care planning is a process of communication where patients are informed of their diagnosis, prognosis, and treatment options. ACP is regarded as an effective approach to dealing with patients with COPD because, unlike other methods, it allows them to give their goals and preferences for life sustaining treatments throughout the course of the disease. It also enables them to engage in conversations about hopes and fears making them surrogate medical decision makers. In addition to Advance Care Planning (ACP), to overcome challenges associated with dealing with patient suffering from COPD, there is need to integrate spiritual care for the patients. Researchers indicate that integration of spiritual practices in the care for COPD patient enables the patient to not only relieve stress and have a sense of control and hope but also a feeling of greater purpose. In fact, researchers find that where spiritual care is used, patients with COPD tend to cope well with the remaining days of their life.
Conclusion
Severe chronic obstructive disease leads to the economic and social burden. Despite the poor prognosis among these patients, they can as well benefit from non-pharmacological therapies. The primary goal of treatment is to help in the reduction of the symptoms as well as the improvement in the quality of life. Smoking cessation is one of the therapies that have been known to help in the reduction of the decline of the lung function and therefore, there is the need for all the healthcare professionals to implement and tailoring it for individuals Maintaining nutritional status helps in contributing to a sense of well being as well as improving the respiratory health status.
Summary
Chronic Pulmonary Disease is among the leading causes of respiratory death in the world. Provision of the end of life care among patients with chronic illness can help in the reduction of the psychological distress experienced not only by the patients but also the caregivers. End of life care aims at incorporating the different treatment modalities with the aim of prolonging the life through quality improvement. The care provided is determined by providing holistic care through the integration of the physical, psychological and the spiritual needs of both the patients and the caregivers. Concurrently, achievement of the best possible outcomes should ensure there is the incorporation of the patients during the decision making process. More importantly, all healthcare providers including the nurses, doctors, specialist and the physiotherapists should work in collaboration with one another.
Management of patients with COPD entails the pharmacological and the nonpharmacological therapies. Research indicates that the use of nonpharmacological treatments helps in yielding better symptomatic improvement and therefore an increase in the quality f life for the affected patients. Majority of the patients with COPD presents with dyspnea, cough, and fatigue. Since the symptoms of COPD are progressive and insidious, the diagnosis is made late, and this limits the interventions and the treatment options for the patients.
Breathlessness clinic is put in place with the aim of reducing the symptoms of those patients with COPD. They are run in collaboration with palliative specialists, physiotherapists, and nurses. Some of the traditional modalities for the management of COPD include smoking cessation and long-term oxygen therapy. Smoking cessation has for long been utilised for the management of patients with COPD due to the associated decline in the deterioration of lung function. Other interventions that have been put in place in the current healthcare sector include the pulmonary rehabilitation, chest physiotherapy, and noninvasive positive pressure ventilation. Advance care planning is an essential competent to end of life care. As such, patients and their families are communicated to the expected outcomes and thereafter decisions are made depending on their desire. As such, there is the incorporation of the psychological and the spiritual care of the respective individuals. Therefore, there is the need for integration of care that takes care of both the physical and the mental wellbeing of the patient.
Bibliography
Carlucci, Annalisa, Aldo Guerrieri, and Stefano Nava. “Palliative Care in COPD Patients: Is It Only an End-of-Life Issue?” European Respiratory Review, 2012. doi:10.1183/09059180.00001512.
Disler, Rt, Sc Inglis, and Pm Davidson. “Non-_x0090_pharmacological Management Interventions for COPD: An Overview of Cochrane Systematic Reviews.” The Cochrane Library, no. 2 (2013). doi:10.1002/14651858.CD010384.
Gaspar, C., S. Alfarroba, L. Telo, C. Gomes, and C. Bárbara. “End-of-Life Care in COPD: A Survey Carried out with Portuguese Pulmonologists.” Revista Portuguesa de Pneumologia 20, no. 3 (2014): 123–30. doi:10.1016/j.rppneu.2014.01.008.
GOLD. “Global Strategy for the Diagnosis, Managment, and Prevention of Cronic Obstuctive Pulmonary Disease.” GOLD Guidelines, 2015.
Holley, Jean L. “Advance Care Planning in CKD/ESRD: An Evolving Process.” Clinical Journal of the American Society of Nephrology 7, no. 6 (2012): 1033–38. doi:10.2215/CJN.00580112.
Iley, Karen. “Improving Palliative Care for Patients with COPD.” Nursing Standard 26, no. 37 (2012): 40–46. doi:10.7748/ns2012.05.26.37.40.c9108.
Janssen, D. J A, J. R. Curtis, D. H. Au, M. A. Spruit, L. Downey, J. M G A Schols, E. F M Wouters, and R. A. Engelberg. “Patient-Clinician Communication about End-of-Life Care for Dutch and US Patients with COPD.” European Respiratory Journal 38, no. 2 (2011): 268–76. doi:10.1183/09031936.00157710.
Leung, Janice M., Edmunds M. Udris, Jane Uman, and David H. Au. “The Effect of End-of-Life Discussions on Perceived Quality of Care and Health Status among Patients with COPD.” Chest 142, no. 1 (2012): 128–33. doi:10.1378/chest.11-2222.
Mulhall, Patrick, and Gerard Criner. “Non-Pharmacological Treatments for COPD.” Respirology, 2016. doi:10.1111/resp.12782.
Nici, Linda, and Richard L. ZuWallack. “Pulmonary Rehabilitation: Definition, Concept, and History.” Clinics in Chest Medicine, 2014. doi:10.1016/j.ccm.2014.02.008.
———. “Pulmonary Rehabilitation: Future Directions.” Clinics in Chest Medicine 35, no. 2 (2014): 439–44. doi:10.1016/j.ccm.2014.02.015.
Patel, Kevin, Daisy J A Janssen, and J. Randall Curtis. “Advance Care Planning in COPD.” Respirology, 2012. doi:10.1111/j.1440-1843.2011.02087.x.
Postolache, Paraschiva, Corina Silvia Pop, Roxana Maria Nemeş, and Floarea Mimi Niţu. “Pulmonary Rehabilitation in COPD.” Archives of the Balkan Medical Union, 2015. doi:10.1212/WNL.0b013e3181ef0533.
Reinke, Lynn F., Christopher G. Slatore, Jane Uman, Edmunds M. Udris, Brianna R. Moss, Ruth A. Engelberg, and David H. Au. “Patient–Clinician Communication about End-of-Life Care Topics: Is Anyone Talking to Patients with Chronic Obstructive Pulmonary Disease?” Journal of Palliative Medicine 14, no. 8 (2011): 923–28. doi:10.1089/jpm.2010.0509.
Simon, Steffen T., Irene J. Higginson, Hamid Benalia, Marjolein Gysels, Fliss E M Murtagh, James Spicer, and Claudia Bausewein. “Episodic and Continuous Breathlessness: A New Categorization of Breathlessness.” Journal of Pain and Symptom Management 45, no. 6 (2013): 1019–29. doi:10.1016/j.jpainsymman.2012.06.008.
Simpson, C. “Advance Care Planning in COPD: Care Versus ‘code Status.’” Chronic Respiratory Disease 9, no. 3 (2012): 193–204. doi:10.1177/1479972312445897.
