Design and sample: A sequential mixed method design was used. Three focus groups provided data describing the EOL care
provided to patients with COPD dying in the intensive care unit (ICU). Nurses caring for patients who died in the ICU completed
a previously validated, cross-sectional survey (Quality of Dying and Death) rating the quality of dying for 103 patients.
Data analysis: Thematic analysis was used to analyse the focus group data. Total and item scores for 34 patients who had died in
the ICU with COPD were compared with those for 69 patients who died from other causes.
Results: Three primary themes emerged from the qualitative data are as follows: managing difficult symptoms, questioning the
appropriateness of care and establishing care priorities. Ratings for the quality of dying were significantly lower for patients with COPD
than for those who died from other causes on several survey items, including dyspnoea, anxiety and the belief that the patient had been
kept alive too long. The qualitative data allowed for in-depth explication of the survey results.
Conclusions: Attention to the management of dyspnoea, anxiety and treatment decision-making are priority concerns when
providing EOL care in the ICU to patients with COPD.