Abstract
COPD is nowadays the main indication for lung transplantation. In appropriately selected patients with end stage COPD, lung transplantation may improve quality of life and prognosis of survival. However, patients with end stage COPD may die while waiting for lung transplantation. Palliative care is important to address the needs of patients with end stage COPD. This case report shows that in a patient with end stage COPD listed for lung transplantation offering palliative care and curative-restorative care concurrently may be problematic. If the requirements to remain a transplantation candidate need to be met, the possibilities for palliative care may be limited. Discussing the possibilities of palliative care and the patient's treatment preferences is necessary to prevent that end-of-life care needs of COPD patients dying while listed for lung transplantation are not optimally addressed. The patient's end-of-life care preferences may ask for a clear distinction between the period in which palliative and curative-restorative care are offered concurrently and the end-of-life care period. This may be necessary to allow a patient to spend the last stage of life according to his or her wishes, even when this implicates that lung transplantation is not possible anymore and the patient will die because of end stage COPD.
Highlights
The prevalence and burden of Chronic Obstructive Pulmonary Disease (COPD) are expected to increase in the coming decades [1]
The patient's preferences for end-of-life care may ask for a clear distinction between the period in which palliative and curative-restorative care are offered concurrently and the end-of-life care period. This may be necessary to allow a patient to spend the last stage of life according to his or her wishes, even when this implicates that lung transplantation is not possible anymore and the patient will die because of end stage COPD
This case report shows that in a patient with end stage COPD listed for lung transplantation offering palliative care and curative-restorative care concurrently may be problematic
Summary
The prevalence and burden of Chronic Obstructive Pulmonary Disease (COPD) are expected to increase in the coming decades [1]. The possibilities of palliative care and her treatment preferences were discussed According to her wishes, goal of the interdisciplinary patient-centred management program remained improving functional status. She could hardly stand the burden of exercise training and the adherence to her strict diet affected her quality of life even more At that moment her nursing home physician discussed again with her the expected poor prognosis of survival, the things that were important in her life and the possibilities for palliative care. They decided that the small chance for surviving to transplantation would not outweigh the burden of continuing curative-restorative treatment At that moment she could be offered optimal end-of-life care, aimed at reducing suffering and improving quality of dying. In December 2008, two months after discontinuation of curative-restorative care, two-and-a-half year after admission to the nursing home and 3,5 years after listing for lung transplantation, she died quietly in the nursing home in the presence of her loved ones
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