Discussions With Outpatients With Chronic Obstructive Pulmonary Disease Regarding Mechanical Ventilation as Life-Sustaining Therapy

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Abstract
Patients with acute exacerbations of chronic obstructive pulmonary disease (COPD) are often too sick to make informed decisions regarding the use of mechanical ventilation (MV). Prior knowledge of their wishes regarding this form of therapy, therefore, is essential in order to preserve their autonomy. In order to characterize this group of patients with respect to their knowledge of mechanical ventilation as a potential treatment for their disease, we surveyed 40 stable outpatients with the diagnosis of COPD. All patients attended either the general medical clinic or the pulmonary clinic of a university and veterans' hospital. The median age of the patients was 67 years, and the median forced expiratory volume in 1 second was 1.26 L. Consecutive patients were asked to participate in a survey that examined the following questions: (1) Was there an awareness of MV as a treatment modality? (2) Had there been prior discussions with their physicians concerning MV? (3) Were the patients able to express a decision concerning MV as indefinite life-sustaining therapy? Our results showed that 35% of patients were not aware of MV. Only 14% had previously discussed MV with their physicians; 40% indicated a decision to use MV, 22% would decline MV, and 38% were unsure. Patients who had discussions were more likely to specify a choice concerning MV when compared with those patients who had no prior discussions. We conclude that discussions between patients with COPD and their physicians occur infrequently, but when they do occur, they help patients formulate a decision.

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