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Progressive respiratory disease: the importance of prognostic conversations and advance care planning

D. Robin Taylor
Breathe 2017 13: 269-273; DOI: 10.1183/20734735.012917
D. Robin Taylor
Wishaw General Hospital, NHS Lanarkshire, Wishaw and Usher Institute of Population Health Sciences, University of Edinburgh, Edinburgh, UK
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  • For correspondence: rtaylorscot@gmail.com
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    Figure 1

    The value of a medical intervention (x-axis) in relation to the diminishing potential for benefit from a “curative” medical intervention that is offered during the last days/weeks/months of life. Note the unchanging probability and magnitude of harm. First created by Avedis Donabedian (1919–2000). Reproduced from [38] with permission.

Tables

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  • Table 1

    Items for inclusion in an advance care plan

    Preferred place of death
    Appointment of health/welfare power of attorney
    Care arrangements if/when dependent
    Will and funeral arrangements
    Future crisis management: treatment escalation/limitation boundaries in the event of acute deterioration
    Do not resuscitate preference
    Information about how and when to use palliative treatments (e.g. opioids, benzodiazepines, “Just in case” prescribing)
    End-of-life goals: spiritual, relational (“What matters to me?”; the bucket list)
  • Table 2

    Triggers for initiating an ACP for patients with COPD or ILD

    Has had 1 or more admission with acute respiratory failure
    Has reached a significant milestone (e.g. commenced long-term oxygen therapy, moved to a care home)
    Is initiating health/welfare power of attorney
    Is exhibiting rapidly progressive function decline [33]
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Vol 13 Issue 4 Table of Contents
Breathe: 13 (4)
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Progressive respiratory disease: the importance of prognostic conversations and advance care planning
D. Robin Taylor
Breathe Dec 2017, 13 (4) 269-273; DOI: 10.1183/20734735.012917

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Progressive respiratory disease: the importance of prognostic conversations and advance care planning
D. Robin Taylor
Breathe Dec 2017, 13 (4) 269-273; DOI: 10.1183/20734735.012917
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