100 Integrating palliative care; impact of a 5 year strategy from the makerere and mulago palliative care unit

Abstract

Background Chronic obstructive pulmonary disease (COPD) is a disease of the lungs that is characterised by a consistent airflow obstruction. It is associated with persistent, progressive and irreversible breathlessness. COPD remains the fifth most common cause of death in England and Wales, accounting for about 25 000 deaths a year. Despite this, only 30% of patients with COPD have had a discussion about palliative care with their clinician. When conversations do take place, they usually happen during a hospital admission when patients are very unwell and are unable to fully express their preferences, and with clinicians who do not know the patients. Furthermore, recent research has shown that clinicians do not know when and how to start and conduct conversations with COPD patients. Aim To explore COPD patients' preferences for the timing and nature of palliative care conversations with healthcare professionals. Methods Interviews and case-note review of COPD patients. Patients were recruited into 3 different groups according to their disease severity: mild, moderate and severe. A total of 33 patients were recruited into the study and the topics discussed during the interviews included: understanding about COPD and palliative care, care preferences and preferences for palliative and advance care planning discussions with doctors and nurses. Patients were recruited from GP practices and respiratory outpatients' clinics in the south of England from April to September 2017. The methodology for data analysis encompasses interpretative phenomenology analysis. Results Preliminary themes of the study include: healthcare professional discussing palliative care; timing for palliative care discussions; approaches to discuss palliative care; patients' understanding about COPD; patients' understanding about palliative care; patients' care preferences. Conclusion Greater understanding of patients' preferences and understanding of palliative care and end of life conversations will be discussed.