scholarly journals Palliative care integration for patients with advanced chronic obstructive pulmonary disease (COPD): Identifying essential components using participatory action research

2021 ◽  
pp. 026921632110289
Author(s):  
Tanja Fusi-Schmidhauser ◽  
Katherine Froggatt ◽  
Nancy Preston
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Palliative Care ◽  
Action Research ◽  
Participatory Action Research ◽  
Pulmonary Disease ◽  
Healthcare Professionals ◽  
Chronic Obstructive ◽  
Care Model ◽  
Participatory Action ◽  
Obstructive Pulmonary Disease

Background: Chronic obstructive pulmonary disease (COPD) is a life-limiting condition with palliative care needs. Despite increasing awareness about the role palliative care can play in care provision for patients with advanced COPD, integration in standard care remains underdeveloped. The unpredictability of the disease progression and misconceptions about palliative care being equivalent to end-of-life care often prevent a timely integrated approach in advanced COPD. Aim: To identify practices designed to increase integration of palliative care in the management of patients with advanced COPD in a respiratory service in Southern Switzerland. Design: A participatory action research approach was chosen and key stakeholders were involved to develop new knowledge and practices, supported by a Theory of Change framework. Data from each cycle and retrospective analysis at the end of the whole research were analysed using thematic analysis. Setting/participants: Five action research cycles with seven healthcare professionals working in palliative or respiratory care settings were conducted. Results: Three elements of integrated palliative care in advanced COPD were identified: multidimensional assessment, healthcare professionals’ education and interdisciplinary team meetings, which are the pillars of a new integrated palliative care model for patients with advanced COPD. Conclusions: The new integrated palliative care model in advanced COPD includes essential elements with a focus on patients, healthcare professionals and care delivery. Further research on testing this model in clinical practice, service development, implementation processes and possible outcomes, including evaluation of the financial impact of integrated palliative care is necessary to foster this care approach across all possible settings.

scholarly journals Integrated palliative care networks from the perspectives of patients: A cross-sectional explorative study in five European countries

2018 ◽  
Vol 32 (6) ◽  
pp. 1103-1113 ◽  
Author(s):  
Marlieke den Herder-van der Eerden ◽  
Anne Ebenau ◽  
Sheila Payne ◽  
Nancy Preston ◽  
Lukas Radbruch ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Palliative Care ◽  
Confidence Interval ◽  
Pulmonary Disease ◽  
Odds Ratio ◽  
Healthcare Professionals ◽  
Chronic Obstructive ◽  
Cross Sectional ◽  
Obstructive Pulmonary Disease ◽  
Lower Odds

Background: Although examining perspectives of patients on integrated palliative care organisation is essential, available literature is largely based on administrative data or healthcare professionals’ perspectives. Aim: (1) Providing insight into the composition and quality of care networks of patients receiving palliative care and (2) describing perceived integration between healthcare professionals within these networks and its association with overall satisfaction. Design: Cross-sectional explorative design. Setting/participants: We recruited 157 patients (62% cancer, 25% chronic obstructive pulmonary disease, 13% chronic heart failure, mean age 68 years, 55% female) from 23 integrated palliative care initiatives in Belgium, Germany, the United Kingdom, Hungary and the Netherlands. Results: About 33% reported contact with a palliative care specialist and 48% with a palliative care nurse. Relationships with palliative care specialists were rated significantly higher than other physicians ( p < 0.001). Compared to patients with cancer, patients with chronic obstructive pulmonary disease (odds ratio = 0.16, confidence interval (0.04; 0.57)) and chronic heart failure (odds ratio = 0.11, confidence interval (0.01; 0.93)) had significantly lower odds of reporting contact with palliative care specialists and patients with chronic obstructive pulmonary disease (odds ratio = 0.23, confidence interval (0.08; 0.71)) had significantly lower odds of reporting contact with palliative care nurses. Perceptions of main responsible healthcare professionals or caregivers in patient’s care networks varied across countries. Perceived integration was significantly associated with overall satisfaction. Conclusion: Palliative care professionals are not always present or recognised as such in patients’ care networks. Expert palliative care involvement needs to be explicated especially for non-cancer patients. One healthcare professional should support patients in understanding and navigating their palliative care network. Patients seem satisfied with care provision as long as continuity of care is provided.

scholarly journals OPTImising the implementation of pulMonary rehAbiLitation in people with chronic obstructive pulmonary disease (the OPTIMAL study): mixed methods study protocol

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Sarah Hug ◽  
Vinicius Cavalheri ◽  
Daniel F. Gucciardi ◽  
Richard Norman ◽  
Kylie Hill
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Mixed Methods ◽  
Pulmonary Disease ◽  
Study Protocol ◽  
Western Australia ◽  
Pulmonary Rehabilitation ◽  
Healthcare Professionals ◽  
Mixed Methods Study ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease

Abstract Background Chronic obstructive pulmonary disease (COPD) is a common respiratory condition characterised by dyspnoea during daily life. As the disease progresses, people with COPD can experience poor quality of life, reduced exercise capacity, worsening of symptoms and increased hospital admissions. Pulmonary rehabilitation, which includes exercise training, optimises both psychological and physical function, reduces symptoms and mitigates healthcare utilisation in people with COPD. There is, however, a gap in implementation of pulmonary rehabilitation programs, with global access limited to a small fraction of people with COPD. The overall aim of this study is to gather evidence that will optimise the implementation of pulmonary rehabilitation in people with COPD living in Perth, Western Australia. Methods This is a mixed methods study protocol informed by a critical realist perspective. The study will comprise four phases. In Phase 1, we will quantify target behaviours of healthcare professionals and people with COPD which are related to the implementation of pulmonary rehabilitation at three tertiary hospitals. In Phase 2, we will conduct semi-structured interviews to explore the determinants of these target behaviours from the perspectives of healthcare professionals, people with COPD and their primary support person. In Phase 3, knowledge gained in Phases 1 and 2 will be used by healthcare professionals and people with COPD to co-create, field test and apply strategies that optimise these target behaviours. In Phase 4, we will re-quantify these target behaviours to determine the influence of co-created strategies. The cost effectiveness of implementing the co-created strategies will be explored by an economic analysis. Discussion Understanding current clinical practice and the determinants of target behaviours pertaining to the implementation of pulmonary rehabilitation is crucial when developing strategies that successfully bridge the pulmonary rehabilitation implementation gap. If co-created strategies are effective, more people with COPD living in Perth, Western Australia will have access to pulmonary rehabilitation enabling them to derive the health benefits associated with this intervention.

Self-management support preferences of people with asthma or chronic obstructive pulmonary disease: A systematic review and meta-synthesis of qualitative studies

2019 ◽  
pp. 174239531986944 ◽  
Author(s):  
Selena O’Connell ◽  
Vera JC McCarthy ◽  
Eileen Savage
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Healthcare Professionals ◽  
Qualitative Studies ◽  
Self Management ◽  
Chronic Obstructive ◽  
Management Support ◽  
Obstructive Pulmonary Disease ◽  
The Individual ◽  
Behavioural Sciences

Objectives To synthesise findings from qualitative studies on the preferences of people with asthma or chronic obstructive pulmonary disease (COPD) for self-management support. Methods A thematic synthesis of literature was carried out. Six databases (ASSIA, CINAHL, MEDLINE, PsycINFO, Psychology and the Behavioural Sciences and SSCI) were used to search for qualitative studies eliciting perspectives of adults with asthma and/or COPD on self-management support, published between May 2008 and April 2018. Results A total of 968 articles were retrieved across databases, with 15 articles included in the synthesis. Three themes were identified: Types of Support described the range of supports valued by participants in the studies, particularly education provided by competent healthcare professionals; The Support Relationship highlighted the importance of a collaborative relationship with one’s healthcare professional which was characterised by communication, trust and continuity over time and Accessibility identified the considerations of participants relating to physically accessible, prompt support which is provided in a format preferred by the individual. Discussion Increased understanding of patients’ preferences may provide insight which can be used to enhance engagement with self-management support. Further research needs to examine self-management support preferences outside the context of evaluating interventions for people with asthma/COPD and needs to address the optimal means of enhancing accessibility.

Comparison of end-of-life care in people with chronic obstructive pulmonary disease or lung cancer: A systematic review

2020 ◽  
Vol 34 (8) ◽  
pp. 1030-1043 ◽  
Author(s):  
Stacey J Butler ◽  
Lauren Ellerton ◽  
Andrea S Gershon ◽  
Roger S Goldstein ◽  
Dina Brooks
Keyword(s):  
Lung Cancer ◽  
Chronic Obstructive Pulmonary Disease ◽  
Palliative Care ◽  
Pulmonary Disease ◽  
Symptom Burden ◽  
Chronic Obstructive ◽  
Health Related Quality ◽  
Obstructive Pulmonary Disease ◽  
Related Quality ◽  
Health Related

Background: Palliative care has been widely implemented in clinical practice for patients with cancer but is not routinely provided to people with chronic obstructive pulmonary disease. Aim: The study aims were to compare palliative care services, medications, life-sustaining interventions, place of death, symptom burden and health-related quality of life among chronic obstructive pulmonary disease and lung cancer populations. Design: Systematic review with meta-analysis (PROSPERO: CRD42019139425). Data sources: MEDLINE, EMBASE, PubMed, CINAHL and PsycINFO were searched for studies comparing palliative care, symptom burden or health-related quality of life among chronic obstructive pulmonary disease, lung cancer or populations with both conditions. Quality scores were assigned using the QualSyst tool. Results: Nineteen studies were included. There was significant heterogeneity in study design and sample size. A random effects meta-analysis ( n = 3–7) determined that people with lung cancer had higher odds of receiving hospital (odds ratio: 9.95, 95% confidence interval: 6.37–15.55, p < 0.001) or home-based palliative care (8.79, 6.76–11.43, p < 0.001), opioids (4.76, 1.87–12.11, p = 0.001), sedatives (2.03, 1.78–2.32, p < 0.001) and dying at home (1.47, 1.14–1.89, p = 0.003) compared to people with chronic obstructive pulmonary disease. People with lung cancer had lower odds of receiving invasive ventilation (0.26, 0.22–0.32, p < 0.001), non-invasive ventilation (0.63, 0.44–0.89, p = 0.009), cardiopulmonary resuscitation (0.29, 0.18–0.47, p < 0.001) or dying at a nursing home/long-term care facility (0.32, 0.16–0.64, p < 0.001) than people with chronic obstructive pulmonary disease. Symptom burden and health-related quality of life were relatively similar between the two populations. Conclusion: People with chronic obstructive pulmonary disease receive less palliative measures at the end of life compared to people with lung cancer, despite a relatively similar symptom profile.

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