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End-of-Life Care in Patients With Lung Cancer^*

^* From the From the Division of Pulmonary and Critical Care Medicine (Drs. Griffin and Thompson), Division of Hematology/Oncology (Dr. Niell), Department of Medicine, the Department of Human Values and Ethics (Dr. Ackerman), the Section of Thoracic and Cardiovascular Surgery (Dr. Cole), Department of Surgery, College of Medicine, The University of Tennessee Health Science Center, Memphis, TN; the Division of Pulmonary and Critical Care Medicine (Dr. Nelson), Department of Medicine, Mount Sinai Medical Center, New York, NY; and the Division of Pulmonary and Critical Care Medicine (Dr. Koch), Department of Internal Medicine, University of Florida Health Science Center, Jacksonville, FL.

Correspondence to: John P. Griffin, MD, FCCP, Division of Pulmonary and Critical Care Medicine, University of Tennessee, 956 Court Ave, Room H 314, Memphis, TN 38163; e-mail: jpgriffin{at}utmem.edu

Evidence-based practice guidelines for end-of-life care for patients with lung cancer have been previously available only from the British health-care system. Currently in this setting, there has been increasing concern in attaining control of the physical, psychological, social, and spiritual distress of the patient and family. This American College of Chest Physicians’-sponsored multidisciplinary panel has generated recommendations for improving quality of life after examining the English-language literature for answers to some of the most important questions in end-of-life care. Communication between the doctor, patient, and family is central to the active total care of patients with disease that is not responsive to curative treatment. The advance care directive, which has been slowly evolving and is presently limited in application and often circumstantially ineffective, better protects patient autonomy. The problem-solving capability of the hospital ethics committee has been poorly utilized, often due to a lack of understanding of its composition and function. Cost considerations and a sense of futility have confused caregivers as to the potentially important role of the critical care specialist in this scenario. Symptomatic and supportive care provided in a timely and consistent fashion in the hospice environment, which treats the patient and family at home, has been increasingly used, and at this time is the best model for end-of-life care in the United States.

Key Words: advance directive • communication • critical care • end-of-life care • hospice • hospital ethics committee • lung cancer • practice guidelines

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