Abstract
Patients with chronic heart failure or chronic lung disease understand less about their illness, have fewer choices regarding end-of-life care and more limited access to supportive and palliative care than patients with cancer Most palliative care problems suffered by these patients should be within the abilities of the usual medical team. All clinicians involved should have good palliative and communication skills Complex or persistent problems (eg intractable pain, difficult breathlessness) should trigger referral to specialist palliative care services - these are not only for the dying patient Recognition of dying can be difficult and there is a risk of inappropriate and futile interventions Breathlessness is a neglected and 'invisible' symptom which is a risk factor for emergency hospital admission and caregiver distress.
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