Discussing an uncertain future: end-of-life care conversations in chronic obstructive pulmonary disease. A systematic literature review and narrative synthesis.

BACKGROUND Guidelines recommend open discussions between patients and healthcare professionals as the end-of-life (EOL) approaches. Much of the knowledge about the EOL is based on the needs of patients with cancer and the applicability of this to other diseases is often queried. A literature review was undertaken concerning EOL care (EOLC) conversations in chronic obstructive pulmonary disease (COPD). DESIGN A systematic literature review and narrative synthesis obtained papers reporting on EOLC conversations between patients with COPD and their healthcare professionals with respect to the prevalence of conversations; each party's preferences for timing and content; and the facilitators and blockers. Inclusion criteria were articles published in peer-reviewed journals, written in English, reporting studies of adult patients with COPD and/or their healthcare professionals concerning discussions of care at the EOL. RESULTS 30 papers were identified. Most patients reported that they have not had EOLC discussions with healthcare professionals. While many patients would like these conversations, a potentially large minority would not; the proportions varied among studies. Healthcare professionals find these discussions difficult and many prefer patients to initiate them. CONCLUSIONS Patients' preferences for EOLC conversations vary greatly. Healthcare professionals need to respect the wishes of those not wanting to discuss EOLC and provide multiple opportunities for those who do wish to have these discussions. Recommendations on how to approach the conversation are made.