A patient-centred model of care incorporating a palliative approach: A framework to meet the needs of people with advanced COPD?

Crawford, Gregory B.; Burgess, Teresa; Young, Mary; Brooksbank, Mary; Brown, Margaret

doi:10.1179/1743291x13y.0000000053

Cited by 7 publications

(11 citation statements)

References 26 publications

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“…Disease-focused care in COPD involves multifaceted assessments to monitor the disease and symptoms, reduce risk factors of smoking and air pollution exposure, slow disease progression, cope with exacerbations, and address the psychosocial needs of patients and caregivers. Disease-focused treatment is for symptom management, improving functional abilities, and ongoing surveillance to prevent exacerbations [ 38 ].…”

Section: Palliative Care and Copdmentioning

confidence: 99%

The potential of palliative care for patients with respiratory diseases

Narsavage¹,

Chen²,

Korn³

et al. 2017

Breathe

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Based on the demonstrated effectiveness of palliative care in the alleviation of symptoms and enhancement of life quality, it is important to incorporate palliative care early in the respiratory disease trajectory. Quality palliative care addresses eight domains that are all patient and family centred. Palliative care interventions in respiratory conditions include management of symptoms such as dyspnoea, cough, haemoptysis, sputum production, fatigue and respiratory secretion management, especially as the end-of-life nears. A practical checklist of activities based on the domains of palliative care can assist clinicians to integrate palliative care into their practice. Clinical management of patients receiving palliative care requires consideration of human factors and related organisational characteristics that involve cultural, educational and motivational aspects of the patient/family and clinicians.Educational aimsTo explain the basic domains of palliative care applicable to chronic respiratory diseases.To review palliative care interventions for patients with chronic respiratory diseases.To outline a checklist for clinicians to use in practice, based on the domains of palliative care.To propose recommendations for clinical management of patients receiving palliative care for chronic respiratory diseases.

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Section: Palliative Care and Copdmentioning

confidence: 99%

The potential of palliative care for patients with respiratory diseases

Narsavage¹,

Chen²,

Korn³

et al. 2017

Breathe

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“…The Strategy (2020) recommends the “phased introduction of supportive care” (p. 60) and availability of specialist palliative care consultation in hospital and outpatient settings to assist with advance care planning; relief of suffering and reduction of burdensome symptoms to improve patients' quality of life and optimize their function, regardless of the stage of disease or the need for other therapies. Furthermore, COPD supportive care is supported by other research asserting that supportive care approaches be incorporated concurrently with a chronic disease model of care that promotes active disease management for COPD including smoking cessation, standard pharmacotherapy, pulmonary rehabilitation, long‐term oxygen therapy and management of complications including respiratory failure and infection (Crawford, Burgess, et al, 2013; Maddocks et al, 2017; Vermylen et al, 2015). The model of care outlined in this paper aligns with other research that suggests supportive approaches be embedded into routine respiratory care to ensure it is regarded as ‘usual care’ by both clinicians and patients (Crawford, Brooksbank, et al, 2013; Philip et al, 2018).…”

Section: Discussionmentioning

confidence: 99%

“…While contemporary models of palliative care do address the biopsychosocial‐spiritual needs of patients, they have historically tended to be fairly homogenous, catering best to those with malignant diseases who have more predictable patterns of decline with care needs that typically last weeks or months (Luckett et al, 2014). The trajectory of COPD with its seasonal variability and unpredictable acute exacerbations over many years is not commensurate with existing palliative care service models or funding structures, as they cannot support patient care for prolonged periods of time (Crawford, Burgess, et al, 2013). Further barriers to timely palliative care in COPD are due to misperceptions from both healthcare professionals and patients alike.…”

Section: Introductionmentioning

confidence: 99%

Embedding nurse‐led supportive care in an outpatient service for patients with Chronic Obstructive Pulmonary Disease

Ora

Wilkes

Mannix

et al. 2023

Journal of Advanced Nursing

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AimTo describe a small multidisciplinary team's experience of the process of embedding nurse‐led supportive care into an existing Chronic Obstructive Pulmonary Disease outpatient service.DesignCase study methodologyMethodsData were collected from multiple sources including key documents and semi‐structured interviews with healthcare professionals (n = 6) conducted between June and July 2021. A purposive sampling strategy was used. Content analysis was applied to key documents. Interviews were transcribed verbatim and analysed using an inductive approach.ResultsSubcategories under the four‐stage process were identified from the data. Assessment: evidence of needs of patients with Chronic Obstructive Pulmonary Disease; gaps in care and evidence of other models of supportive care. Planning: setting the supportive care service structure and intention; resources and funding; leadership, specialization and respiratory/palliative care roles. Implementation: relationships and trust; embedding supportive care and communication. Evaluation: benefits and positive outcomes for staff and patients, and, improvements and future considerations for supportive care in the COPD service.ConclusionA collaboration between respiratory and palliative care services resulted in successfully embedding nurse‐led supportive care in a small outpatient service for patients with Chronic Obstructive Pulmonary Disease. Nurses are well placed to lead new models of care that aim to address unmet biopsychosocial‐spiritual needs of patients. More research is needed to evaluate nurse‐led supportive care in Chronic Obstructive Pulmonary Disease and other chronic illness settings; the effectiveness of nurse‐led supportive care from the perspective of patients and caregivers and the impact of nurse‐led supportive care on health service usage.Patient or Public ContributionThe development of the model of care is informed by ongoing discussions with patients with COPD and their caregivers.Data availability statement: Research data are not shared (due to ethical restrictions).Impact Embedding nurse‐led supportive care in an existing Chronic Obstructive Pulmonary Disease outpatient service is achievable. Nurses with clinical expertise can lead innovative models of care that address the unmet biopsychosocial‐spiritual needs of patients with conditions such as Chronic Obstructive Pulmonary Disease. Nurse‐led supportive care may have utility and relevance in other chronic disease contexts.

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“…Despite this, anxiety and quality of life of people with ILD and burden and depression of informal caregivers was shown to improve with palliative care interventions. [98][99][100] No serious to very serious limitations were found in the GRADE evaluation.…”

Section: Justificationmentioning

confidence: 99%

European Respiratory Society clinical practice guideline: palliative care for people with COPD or interstitial lung disease

Janssen,

Bajwah,

Boon

et al. 2023

Eur Respir J

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There is increased awareness of palliative care needs in people with chronic obstructive pulmonary disease (COPD) or interstitial lung disease (ILD). This European Respiratory Society (ERS) task force aimed to provide recommendations for initiation and integration of palliative care into the respiratory care of adult people with COPD or ILD.The ERS task force consisted of 20 members, including representatives of people with COPD or ILD and informal caregivers. Eight questions were formulated, four in the ‘Population, Intervention, Comparison, Outcome’ (PICO) format. These were addressed with full systematic reviews and application of Grading of Recommendations Assessment, Development and Evaluation (GRADE) for assessing the evidence. Four additional questions were addressed narratively. An ’evidence-to-decision’ framework was used to formulate recommendations.The following definition of palliative care for people with COPD or ILD was agreed: A holistic and multidisciplinary, person-centred approach aiming to control symptoms, and improve quality of life of people with serious health-related suffering because of COPD or ILD, and to support their informal caregivers. Recommendations were made regarding people with COPD or ILD and their informal caregivers to: consider palliative care when physical, psychological, social, or existential needs are identified through holistic needs assessment; offer palliative care interventions, including support for informal caregivers, in accordance with such needs; offer advance care planning in accordance with preferences; and integrate palliative care into routine COPD and ILD care. Recommendations should be reconsidered as new evidence becomes available.

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A patient-centred model of care incorporating a palliative approach: A framework to meet the needs of people with advanced COPD?

Abstract: Background: Current models of care for people with advanced chronic obstructive pulmonary

Cited by 7 publications

References 26 publications

The potential of palliative care for patients with respiratory diseases

The potential of palliative care for patients with respiratory diseases

Embedding nurse‐led supportive care in an outpatient service for patients with Chronic Obstructive Pulmonary Disease

European Respiratory Society clinical practice guideline: palliative care for people with COPD or interstitial lung disease

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