Intended for healthcare professionals

Letters Living and dying with COPD

End of life trajectories across conditions

BMJ 2011; 342 doi: https://doi.org/10.1136/bmj.d989 (Published 15 February 2011) Cite this as: BMJ 2011;342:d989
  1. Fliss E M Murtagh, clinical senior lecturer in palliative care1,
  2. Katie Vinen, consultant nephrologist2,
  3. Ken Farrington, consultant nephrologist3,
  4. Donal O’Donoghue, national clinical director for kidney care4
  1. 1King’s College London, Cicely Saunders Institute, London SE5 9PJ, UK
  2. 2King’s College Hospital NHS Foundation Trust, London SE5 9RS, UK
  3. 3Stevenage Lister Hospital, Stevenage, Hertfordshire SG1 4AB, UK
  4. 4Department of Health (England), London, UK
  1. fliss.murtagh{at}kcl.ac.uk

The findings of Pinnock and colleagues’ study on the longitudinal perspectives of people with severe chronic obstructive pulmonary disease (COPD) have implications for other non-malignant conditions.1 Some of the findings echo strongly with the experience of people with advanced chronic kidney disease, although there are also notable differences.2

We need to understand more about the longitudinal perspectives and the similarities and differences between conditions. We also need to move away from considering end of life care mainly within disease specific groups. As the numbers of deaths in older people increase, a growing proportion of people are dying with multiple comorbid conditions. This is not reflected in death registration statistics, which still give one dominant cause and poorly reflect the realities of complex multiple conditions.3

Although only about 2% of all UK deaths are from end stage renal disease,4 they provide a model for multiple comorbidities, because so many of these mostly older patients have cardiac or vascular disease (or both), diabetes, and other conditions. Whatever the condition or (increasingly) mix of conditions, there should be multiple entry points into palliative care; end of life care needs will only be met if there is proactive and timely assessment and reassessment of palliative care needs.

Notes

Cite this as: BMJ 2011;342:d989

Footnotes

  • Competing interests: None declared.

References