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Planning for the future - when does the future start?


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Presentation delivered by Dr Laura-Jane Smith, Respiratory Registrar in NorthEast London, at the Pan London Airways Network Winter Meeting 2015

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Planning for the future - when does the future start?

  1. 1. Planning for the future – when does the future start? Dr Laura-Jane E Smith Respiratory SpR, NorthEast London @drlaurajane November 2015 DISCLAIMER: The views and opinions expressed in this presentation are those of the authors and do not necessarily represent the views and policy of PLAN(Pan London Airways Network).
  2. 2. The Challenge of Palliative Care. Smith, LJE and Quint JK, in: Controversies in COPD, Publisher: European Respiratory Society. Editors: Antonio Anzueto, Yvonne Heijdra, John R Hurst, Chapter: 20 pp.297-322
  3. 3. YouGov poll 2014
  4. 4. Advance care planning Advance statement Advance decision to refuse treatment Lasting Power of Attorney Mental Capacity Act 2005
  5. 5. Why do ACP? How can we identify people nearing the end of life? How can we put this into practice?
  7. 7. Functional impairment Symptom burden (breathlessness, anorexia, pain, cough, insomnia, confusion, fatigue, low mood, anxiety, panic) Social isolation Impaired HRQoL Treatment preferences Invasive interventions near the end of life Advance care planning Access to specialist palliative care services Habraken JM et al. 2009 Edmonds P et al. 2001 Gore JM et al 2000 COPD Lung cancer
  8. 8. Mutual understanding Enhancing openness Enabling discussion of concerns Enhancing hope Relieving fear Strengthening family ties Debunking myths Providing practical advice/support Enhancing autonomy
  10. 10. COPD Heart failure Dementia Frailty Cancer
  11. 11. Group task
  12. 12. FEV1% Hypoxaemia Breathlessness Cor pulmonale Exacerbation frequency Hospitalisation Exercise tolerance Biomarkers Low BMI Older age RVSP Low serum albumin ICU admission Co-morbid CCF Functional status Use of NIV Nishimura 2002 Soler-Cataluña 2005 Knaus 1991, Almagro 2002 Ai-Ping 2005 Pinto-Plata 2004 Coxson 2013 Connors 1996 Connors 1996, Almagro 2002 Connors 1996Connors 1996 Connors 1996Dallari 1994 Anthonisen 1989 NOTT 1980 Plant 1998 Incalzi 1999
  13. 13. Declining functional status Complications eg LTOT, cor pulmonale High use of healthcare Symptom burden Patient choice Triggers eg hospitalisation, bereavement
  15. 15. @drlaurajane
  16. 16. • Anthonisen, Nicholas R. “Prognosis in Chronic Obstructive Pulmonary Disease: Results from Multicenter Clinical Trials.” American Review of Respiratory Disease 140, no. 3_pt_2 (September 1, 1989): S95–S99. • Christakis, Nicholas A., Elizabeth B. Lamont, Julia L. Smith, and Colin Murray Parkes. “Extent and Determinants of Error in Doctors’ Prognoses in Terminally Ill Patients: Prospective Cohort studyCommentary: Why Do Doctors Overestimate? Commentary: Prognoses Should Be Based on Proved Indices Not Intuition.” Bmj 320, no. 7233 (2000): 469–473. • Connors, A F, N V Dawson, C Thomas, F E Harrell, N Desbiens, W J Fulkerson, P Kussin, P Bellamy, L Goldman, and W A Knaus. “Outcomes Following Acute Exacerbation of Severe Chronic Obstructive Lung Disease. The SUPPORT Investigators (Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments).” American Journal of Respiratory and Critical Care Medicine 154, no. 4 (October 1, 1996): 959–967. • Donaldson, G. C., T. a. R. Seemungal, A. Bhowmik, and J. A. Wedzicha. “Relationship Between Exacerbation Frequency and Lung Function Decline in Chronic Obstructive Pulmonary Disease.” Thorax 57, no. 10 (October 1, 2002): 847–852. • Edmonds, Polly, Saffron Karlsen, Saba Khan, and Julia Addington-Hall. “A Comparison of the Palliative Care Needs of Patients Dying from Chronic Respiratory Diseases and Lung Cancer.” Palliative Medicine 15, no. 4 (2001): 287– 295. • Gore, J. M., C. J. Brophy, and M. A. Greenstone. “How Well Do We Care for Patients with End Stage Chronic Obstructive Pulmonary Disease (COPD)? A Comparison of Palliative Care and Quality of Life in COPD and Lung Cancer.” Thorax 55, no. 12 (2000): 1000–1006. • Habraken, Jolanda M., Gerben ter Riet, Justin M. Gore, Michael A. Greenstone, Els J.M. Weersink, Patrick J.E. Bindels, and Dick L. Willems. “Health-Related Quality of Life in End-Stage COPD and Lung Cancer Patients.” Journal of Pain and Symptom Management 37, no. 6 (June 2009): 973–981. • Landbo, Charlotte, Eva Prescott, Peter Lange, Jørgen Vestbo, and Thomas P. Almdal. “Prognostic Value of Nutritional Status in Chronic Obstructive Pulmonary Disease.” American Journal of Respiratory and Critical Care Medicine 160, no. 6 (December 1, 1999): 1856–1861. • Murray, S. A., and K. Boyd. “Using the ‘surprise Question’ Can Identify People with Advanced Heart Failure and COPD Who Would Benefit from a Palliative Care Approach.” Palliative Medicine 25, no. 4 (June 1, 2011): 382–382. • Parkes, C. Murray. “Accuracy of Predictions of Survival in Later Stages of Cancer.” British Medical Journal 2, no. 5804 (April 1, 1972): 29–31. • Small, N., C. Gardiner, S. Barnes, M. Gott, S. Payne, D. Seamark, and D. Halpin. “Using a Prediction of Death in the Next 12 Months as a Prompt for Referral to Palliative Care Acts to the Detriment of Patients with Heart Failure and Chronic Obstructive Pulmonary Disease.” Palliative Medicine 24, no. 7 (October 1, 2010): 740–741. • Smith, LJE and Quint JK. The Challenge of Palliative Care in: Controversies in COPD, Publisher: European Respiratory Society. Editors: Antonio Anzueto, Yvonne Heijdra, John R Hurst, Chapter: 20 pp.297-322 • Stage, K. B., T. Middelboe, and C. Pisinger. “Depression and Chronic Obstructive Pulmonary Disease (COPD). Impact on Survival.” Acta Psychiatrica Scandinavica 111, no. 4 (April 1, 2005): 320–323.