You wonder whether or not this patient should be intubated. It is concluded that this patient has a severe exacerbation of his COPD with acute-on-chronic respiratory insufficiency. Furthermore, he was diagnosed with osteoporosis with spontaneous vertebral fractures 2 years ago for which he uses painkillers and osteoporosis medication. Since his operation, the patient has not had any complaints of angina. Furthermore, he is on long-term oxygen therapy (flow 1.0 L O 2 per min).Ī medical history reveals coronary artery bypass surgery 5 years ago because of unstable angina pectoris. His regular medication consists of long-acting β 2-agonists and long-acting anticholinergic agents together with high-dose inhaled corticosteroids and 10 mg oral prednisolone. During the last 2 years, he developed chronic respiratory failure and he has had three periods of exacerbations of his COPD, treated with oral corticosteroids and antibiotics with acceptable results. He has known the patient for >10 years due to his COPD. The patient has previously been seen by your colleague in the out-patient pulmonary department of your hospital. Hb: haemoglobin Ht: haematocrit CRP: C-reactive protein P CO 2: carbon dioxide tension BE: base excess P O 2: oxygen tension S aO 2: arterial oxygen saturation.
This sometimes confronts doctors and their patients with difficult questions, especially in those cases where the end of the patient’s life is approaching. Furthermore, the possibilities of medical treatment are certainly not unlimited and most often also come with sometimes serious side-effects. Nevertheless, we all know that the only certainty when we are born is that we eventually will die too. It also responds to a feeling most people around the world have, that one’s health is one of the most important possessions an individual can have. This undoubtedly enforces the public’s belief in the possibilities of medical science to cure many diseases.
In a timely matter or manner series#
This is, for example, also reflected in many television series around the world where doctors are depicted as heroes saving patients from virtually every life-threatening illness. Fortunately, in contrast to a century ago, we now live in an era where medical science has contributed much to treatment options and has improved the prognosis of many diseases greatly. The training sessions consist of reflection on the caregivers’ personal choices with regard to end-of-life care (research has shown that caregivers choose less intensive medical treatments at the end of life) and of practising with the known complicating factors of timing, reserve and hope, and the different ways of thinking and talking about death and dying (typology of death and dying).Īs medical professionals, to help and cure our patients is our greatest passion. For caregivers, information was provided ( via symposia and an app) and specifically designed training sessions were developed. Meetings were organised for patients and informal caregivers to foster awareness and to provide information. In the second phase of the project, several approaches were developed to help caregivers, patients and informal caregivers with the planning and execution of conversations aboutĮnd-of-life care. This yielded as the most important causes of the delay of these conversations: the factors of timing (when is the right moment?), reserve (because of the potential emotional despair of the patient) and hope (who am I to rob a patient of their hope?). The first phase of the project consisted of research: a study of the relevant literature on previous projects on the matter and a small empirical study in the Eindhoven region. The project aimed to prevent unnecessary admissions and treatments for these frail patients by stimulating physicians, patients and informal caregivers to start conversations about end-of-life care together at an earlier stage.
Just like others in the country, the Eindhoven group noticed that regularly, very frail elderly people were admitted to hospital in acute situations without there ever having been conversations about their wishes concerning treatment options at the end of life. In 2014, a group of physicians of the Catharina Hospital in Eindhoven (The Netherlands) started a project called “Talking about end-of-life care in a timely manner”.
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