Description:

A great variability in end-of-life practice is observed in the terminally ill mainly because physicians are not always able to correctly predict survival. There is a need for a clear discussion about decision making earlier than when acute respiratory failure ensues, especially in patients with chronic respiratory diseases. Indeed, a perceived poor quality of life does not necessarily correlate with a clear willingness to refuse invasive or noninvasive mechanical ventilation. The overall incidence of end-of-life practices in Europe is only partially known, but there are important differences between countries or regions, reflecting the absence of a common strategy even within the European community. Concerning the problem of patients affected by chronic pulmonary disorders, it was shown that only 13% of units provide information to patients with severe COPD when they are stable, and 25% of patients with oxygen dependence have discussed care with medical staff.

Learning Objectives:

•Describe the terminology of end-of-life decision (E-o-L).

•Illustrate the different approach in different geographic locations (ie, EU vs US and within the EU).

•Discuss the potential timing to start speaking about E-o-L.

•Explore tricks and tips to improve patient/clinician communication about E-o-L issues.