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KMID : 1141720180060010022
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폐쇄성폐질환
2018 Volume.6 No. 1 p.22 ~ p.27
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Park So-Young
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Abstract
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Chronic obstructive pulmonary disease (COPD) is one of major cause of death. Similar to patients with end-stage cancer, patients with COPD also suffer from serious symptoms- pain, dyspnea, fatigue and anxiety. However, COPD is not as clear as it is for cancer, especially, predicting prognosis has been difficult in COPD due to the variable illness trajectory. Given such uncertainty, the National Health Care System (NHS) in England promotes medical and welfare professionals to identify potential patients at risk of death in an aggressive manner and to initiate communications to help those patients use the Advance Care Plan (ACP) services. Recently, “Hospice, Palliative Care (HPC), and Life-sustaining Treatment Decision-making Act” has enacted in Korea. This legislation addresses application of hospice, palliative care to patients with end stage COPD. However, HPC utilization for patients with COPD is extremely difficult in Korea. Discussion on the final stage of life with non-cancer patients would be particularly difficult in the Korean society. One reason is the public perception that HPC is considered termination of treatment. Also, in Korean society which has Confucian cultural background, there is a wide reluctance to talk about death. In addition, a lack of attention among medical professionals is another key factor that makes implementing HPC difficult for patients with end-stage COPD. To help these patients and families relieve their depression and anxiety and decide on the best option for them as part of the preparation for death, medical professionals are required to play more active roles beyond their current focus on dyspnea management. The changes in public perception is also required to enable sufficient discussion among patients, physicians, and patients’ families regarding the disease status, prognosis, treatment, and even death.
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KEYWORD
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End stage COPD, Hospice and palliative care, Advance care planning
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