Palliative and end-of-Iife care for patients with chronic heart failure and chronic lung disease

摘要

Although UK specialist palliative care (SPC) services originated for patients dying from cancer, patients with non-malignant disease also have significant supportive and palliative care needs. SPC services are now extending care to those with chronic heart failure (CHF) and chronic lung disease (OLD). In spite of the observation, 'Discomfort was not necessarily greatest in those dying from cancer; patients dying of heart failure, or renal failure, or both, had most physical distress'. The medical profession has been quicker to recognise the palliative care needs of patients with cancer and there is still a reluctance to refer patients with these other conditions for palliative care. Despite a prolonged symptom burden, patients with CHF or CLD understand less about their illness, have fewer choices regarding end-of-life care and more limited access to supportive and palliative care than those with cancer. One explanation suggested for this inequality is the unpredictable illness trajectory of organ failure.