The preferences of patients with chronic obstructive pulmonary disease are to discuss palliative care plans with familiar respiratory clinicians, but to delay conversations until their condition deteriorates: A study guided by interpretative phenomenological analysis
The preferences of patients with chronic obstructive pulmonary disease are to discuss palliative care plans with familiar respiratory clinicians, but to delay conversations until their condition deteriorates: A study guided by interpretative phenomenological analysis
Background:
Chronic obstructive pulmonary disease is associated with an uncertain trajectory, which challenges prognostication and means that most patients are not involved in advance care planning and do not receive palliative and end-of-life care.
Aim:
To understand the preferences of patients with chronic obstructive pulmonary disease for discussions about palliative and advance care planning with clinicians.
Design:
Semi-structured interviews were conducted with patients with chronic obstructive pulmonary disease. Data analysis was guided by principles of interpretative phenomenological analysis, of which symbolic interactionism and interpretation principles were employed throughout.
Setting/Participants:
A total of 33 British patients with chronic obstructive pulmonary disease at different stages of their disease trajectory were recruited.
Results:
Patients preferred to discuss palliative care with clinicians they perceived had greater levels of competency and authority in care and with whom they had an established relationship, usually a specialist. Patients favoured large amounts of information about treatments and care, but reported a lack of illness-related information and problems accessing appointments with clinicians. Consequently, patients deferred discussions to the future, usually once their condition had deteriorated significantly or planned to wait for clinicians to initiate conversations. This was not rooted in patient preferences, but related to clinicians’ lack of time, absence of an established relationship and belief that appointments were for managing current symptoms, exacerbations and disease factors rather than future care and preferences.
Conclusion:
Different perceptions, competing priorities and service rationing inhibit patients from initiating early discussions with clinicians, so palliative care conversations should be initiated by respiratory-expert clinicians who know the patient well. After a sudden deterioration in the patient’s condition may be a suitable time.
Chronic obstructive pulmonary disease, communication, palliative care, patients’ preferences, patient–clinician communications, primary and secondary care, qualitative research
1361-1373
Tavares, Nuno
44acd73d-55fa-49bd-8b9d-82ee081ac419
Hunt, Katherine J
5eab8123-1157-4d4e-a7d9-5fd817218c6e
Jarrett, Nikki
2127f54c-9a95-4b04-a7f4-c1da8b21b378
Wilkinson, Tom Ma
9c51b529-00ce-45d2-b6e0-b623f61fdf82
1 December 2020
Tavares, Nuno
44acd73d-55fa-49bd-8b9d-82ee081ac419
Hunt, Katherine J
5eab8123-1157-4d4e-a7d9-5fd817218c6e
Jarrett, Nikki
2127f54c-9a95-4b04-a7f4-c1da8b21b378
Wilkinson, Tom Ma
9c51b529-00ce-45d2-b6e0-b623f61fdf82
Tavares, Nuno, Hunt, Katherine J, Jarrett, Nikki and Wilkinson, Tom Ma
(2020)
The preferences of patients with chronic obstructive pulmonary disease are to discuss palliative care plans with familiar respiratory clinicians, but to delay conversations until their condition deteriorates: A study guided by interpretative phenomenological analysis.
Palliative Medicine, 34 (10), .
(doi:10.1177/0269216320937981).
Abstract
Background:
Chronic obstructive pulmonary disease is associated with an uncertain trajectory, which challenges prognostication and means that most patients are not involved in advance care planning and do not receive palliative and end-of-life care.
Aim:
To understand the preferences of patients with chronic obstructive pulmonary disease for discussions about palliative and advance care planning with clinicians.
Design:
Semi-structured interviews were conducted with patients with chronic obstructive pulmonary disease. Data analysis was guided by principles of interpretative phenomenological analysis, of which symbolic interactionism and interpretation principles were employed throughout.
Setting/Participants:
A total of 33 British patients with chronic obstructive pulmonary disease at different stages of their disease trajectory were recruited.
Results:
Patients preferred to discuss palliative care with clinicians they perceived had greater levels of competency and authority in care and with whom they had an established relationship, usually a specialist. Patients favoured large amounts of information about treatments and care, but reported a lack of illness-related information and problems accessing appointments with clinicians. Consequently, patients deferred discussions to the future, usually once their condition had deteriorated significantly or planned to wait for clinicians to initiate conversations. This was not rooted in patient preferences, but related to clinicians’ lack of time, absence of an established relationship and belief that appointments were for managing current symptoms, exacerbations and disease factors rather than future care and preferences.
Conclusion:
Different perceptions, competing priorities and service rationing inhibit patients from initiating early discussions with clinicians, so palliative care conversations should be initiated by respiratory-expert clinicians who know the patient well. After a sudden deterioration in the patient’s condition may be a suitable time.
Text
The preferences of patients with chronic obstructive pulmonary disease are to discuss palliative care plans with familiar respiratory clinicians, but to delay conversations until their condition deteriorates: a study guided by interpretative phenomenology
- Accepted Manuscript
More information
Accepted/In Press date: 27 March 2020
e-pub ahead of print date: 28 July 2020
Published date: 1 December 2020
Additional Information:
Funding Information:
The authors are grateful to all clinicians that signposted patients to the study, especially the clinicians working at Portsmouth Hospitals NHS Trust. The author(s) received no financial support for the research, authorship and/or publication of this article.
Publisher Copyright:
© The Author(s) 2020.
Keywords:
Chronic obstructive pulmonary disease, communication, palliative care, patients’ preferences, patient–clinician communications, primary and secondary care, qualitative research
Identifiers
Local EPrints ID: 444229
URI: http://eprints.soton.ac.uk/id/eprint/444229
ISSN: 0269-2163
PURE UUID: 30b73113-5d91-415f-946d-87494a28a2f4
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Date deposited: 02 Oct 2020 16:30
Last modified: 17 Mar 2024 03:21
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Contributors
Author:
Nuno Tavares
Author:
Nikki Jarrett
Author:
Tom Ma Wilkinson
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