Advance care planning

The topical symposium ‘Palliative care in respiratory diseases’ addressed advance care planning, lessons to be learned by specialists, and integration of palliative care in clinical practice in non-malignant respiratory diseases: challenges and opportunities.

Instead of more studies on barriers and views on advance care planning, better evidence is needed to decrease barriers in advance care planning, with a clear need for randomised controlled trials addressing advance care planning in patients with respiratory diseases. “These randomised controlled trials should deliver realistic and clinically relevant outcomes, containing simple advance care planning-conservations. Relevant specialists should be involved,” Prof. Mette Asbjørn Neergaard (Aarhus University, Denmark) pointed out. “Furthermore, an international consensus guideline is needed [1].” Pulmonologists can learn valuable lessons from palliative care specialists, said Dr Reeta Piili (Tampere University, Finland). “Palliative care offers realistic opportunities aimed at the reduction of the overall symptom burden, and consequently enhancing the quality of life and increasing the patient-care giver satisfaction [2]. It is important to inquire about the patient’s expectations in this critical phase of life and hence, a smooth and clear communication is vital in this aspect of care. Topics to discuss can include defining goals of care and making an appropriate advance care plan [3–5].”

To successfully integrate palliative care in clinical practice in non-malignant respiratory diseases, various recommendations can be made. Firstly, palliative care needs to be accessible (including home visits) as well as flexible (over the disease trajectory including multidisciplinary involvement), and affordable. Regarding the latter aspect: limited resources usually urge the patient to stick to (standard) treatment/conditions, whereas in palliation, the treatment/conditions should suit the patient. Secondly, palliative care should be integrated into routine care: the balance between active disease management and palliation should be regarded as complementary, not opposing. Also, a multidisciplinary holistic assessment of physical, psychological, social, and spiritual needs using both objective measures and conversations on goals of care and timely advance care planning should be made. Cooperation/integration to specialist palliative care is important, as are the relationships with a very few trusted health care professionals which enable continuity of care. Finally, bereavement and caregiver support should not be forgotten amongst all other items as an integral part of good palliative care [6].

1. Asbjørn Neergaard M. Advance care planning in chronic respiratory diseases – Does it matter? Nordic Lung Congress 2022, 01–03 June, Copenhagen, Denmark.
2. Maddocks M, et al. Lancet. 2017;390:988-1002.
3. Au DH, et al. Chest. 2012 Mar; 141(3):726–735.
4. Curtis JR, et al. Eur Respir J. 2008;32:796-803.
5. Piili R. What can pulmonologists learn from palliative care specialists?’ Nordic Lung Congress 2022, 01–03 June, Copenhagen, Denmark.
6. Marsaa K. Integration of palliative care in clinical practice in non-malignant respiratory diseases-challenges and opportunities. Nordic Lung Congress 2022, 01–03 June, Copenhagen, Denmark.

 

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Posted on 17 August, 202216 August, 2022