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Division of Pulmonary, Allergy and Critical Care Medicine

While 92% of Americans say it’s important to discuss their wishes for end-of-life care, only 32% have had such a conversation.1 As an intensivist and pulmonary assistant professor, Anand Iyer, M.D., knows this quite well. He’s been having conversations about serious illness with patients and their families for over a decade.

Early in his training, Iyer began integrating palliative care principles into his rotations in the ICU. Now, he is parlaying those efforts into a blended #pallipulm approach to the full tripartite mission: research, education, and care.

“People living with serious respiratory illnesses, such as COPD, suffer with many significant symptoms, like progressively debilitating breathlessness, and have poor prognostic awareness about the future. Over half of adults with COPD will be older than 75 years in the next decade, and many of them have significant care needs like functional issues, difficulty with mobility, and social isolation,” Iyer explains. “Plus, it’s really hard for them as they get older to lug a heavy oxygen tank around, which makes things like walking to the mailbox a difficult experience. COPD is much more than inhalers, and a patient’s family really feels the burden, too.”

Recognizing how often this chronically ill population experiences a chaotic end of life with frequent hospitalizations, Iyer joined forces with UAB Center for Palliative and Supportive Care to support UAB’s observance of National Healthcare Decision Day.

On April 16, patients across both UAB Hospital campuses were invited to learn more about how to begin those important conversations prior to an emergency or end-of-life crisis. Each one was given a simple booklet to guide them in thinking about future goals of care and serve as a reference when health decisions need to be made.

Iyer John 2593Anand Iyer, M.D. discusses end-of-life care plans with a UAB employee.

And that’s just the tip of the #pallipulm iceberg. As a Beeson Scholar and Emerging Leader in Aging, Iyer recently designed a #pallipulm intervention for patients and their families. “EPIC: Early Palliative Care in COPD,” is a first of its kind #pallipulm program that uses telephonic palliative care nurse coaching to guide patients living with COPD and their families through a curriculum of problem solving, symptom recognition and management, aging well with COPD, and planning for the future.

Iyer is now testing EPIC through a pilot randomized controlled trial at UAB. He hopes that EPIC can help patients and their families learn skills they need to take more control over their COPD, improve quality of life, grow older more successfully, and have those important conversations about the future long before the end of life.

“The population of older adults is growing fast, and we all need to be thinking outside the box on ways to help them plan for the future and live well, especially with complex serious respiratory illnesses that limit their quality of life,” Iyer says.

If you didn’t join the national observance of Healthcare Decision Day, it’s not too late to start the conversation. Visit theconversationproject.org to find plenty of resources for patients and providers alike.

1. The Conversation Project National Survey, 2018