Advance care planning for patients with chronic respiratory diseases: a systematic review of preferences and practices

Jabbarian, Lea J.; Zwakman, Marieke; Heide, Agnes van der; Kars, Marijke C; Janssen, Daisy J.A.; Delden, Johannes J. M. van; Rietjens, Judith; Korfage, Ida J.

doi:10.1136/thoraxjnl-2016-209806

Cited by 106 publications

(129 citation statements)

References 43 publications

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“…Conversely, the expectation of ACP causing discomfort to either the patient or their relatives was more commonly cited as a block on having these discussions. This is similar to a previous review of healthcare professional practice which identified concern about taking away patient's hope (Jabbarian et al, ). Whether this is accurate or whether healthcare professionals use this fear of causing distress as an excuse for avoiding ACP is not possible to ascertain from survey research alone.…”

Section: Discussionsupporting

confidence: 87%

“…There is a requirement for greater education and training of nurses, and others, to help them understand both ADs and the ACP process. This has been a frequent recommendation of previous studies and reviews (Jabbarian et al, 2018;Ke et al, 2015;Kermel-Schiffman & Werner, 2017). In particular, it is important for nursing staff to be aware of their legal and professional obligations to protect patients, but also to ensure they do not face punishment themselves.…”

Section: Discussionmentioning

confidence: 98%

“…Several systematic reviews have focussed on either healthcare professionals' knowledge (Kermel-Schiffman & Werner, 2017), attitudes (Ke, Huang, O'Connor, & Lee, 2015) or practices (Jabbarian et al, 2018) towards ACP, mainly exploring these categories independently. The advantage of focussing on KAPs is that all domains of knowledge, attitude and practices are assessed, and these can be analysed in relation to each other, exploring potential interactions.…”

Section: Introductionmentioning

confidence: 99%

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Barriers to advance care planning with patients as perceived by nurses and other healthcare professionals: A systematic review

Blackwood

Walker

Mythen

et al. 2019

Journal of Clinical Nursing

110

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Introduction Advance care planning is a means for patients to communicate their wishes, fears and desires for future health decisions should they lose the ability to consider or communicate these. Despite being supported by governments and healthcare leaders, uptake amongst the general population remains low. Nurses play a crucial role in promoting and engaging with these discussions given their close relationship with patients and families in a range of clinical settings. Aim To describe the barriers that nurses and healthcare professionals believe prevent them from exploring advance care planning with their patients. Method We carried out a systematic review of peer‐reviewed journal articles from the databases MEDLINE, Embase, CINAHL Plus, Web of Science and ProQuest Central, guided by the PRISMA checklist. Results Eleven articles were identified: all were self‐reporting surveys using a mix of open and closed questions. They originated in the USA, Canada, Australia and Ireland. The participants included various healthcare professionals, with the majority of studies focussing on nurses. The two most important barriers to advance care planning are lack of education and insufficient time. Advance care planning appears to be well supported, and nurses and healthcare professionals report themselves to be comfortable and confident to take on the responsibility. Conclusion There is a need for greater education and training for nurses and healthcare professionals. In particular, there needs to be better understanding of professional and legal responsibilities. The need for sufficient time to be made available to allow these conversations, in often busy settings, will need institutional and financial support. Relevance to clinical practice Increased training and knowledge are likely to lead to more positive attitudes and greater confidence for nurses, and other healthcare professionals, which should help support and encourage patient engagement with advance care planning.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Barriers to advance care planning with patients as perceived by nurses and other healthcare professionals: A systematic review

Blackwood

Walker

Mythen

et al. 2019

Journal of Clinical Nursing

110

View full text Add to dashboard Cite

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“…One of the goals of the intervention was indeed to have patients understand the prognosis of their disorder and the possible futility of aggressive end-of-life managements. Very little data are available on ACP in COPD; and available data show that ACP is surprisingly uncommon in this population [42-45]. Paradoxically, ACP obtained most often expressed the desire of CPR and maximal treatment, patients failing to acknowledge their prognosis and the natural history of their disease [46].…”

Section: Discussionmentioning

confidence: 99%

Can Early Introduction of Palliative Care Limit Intensive Care, Emergency and Hospital Admissions in Patients with Severe Chronic Obstructive Pulmonary Disease? A Pilot Randomized Study

et al. 2019

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Background: Despite their poor prognosis, patients with severe chronic obstructive pulmonary disease (COPD) have little access to palliative care and tend to have a high rate of hospital and intensive care unit (ICU) admissions during their last year of life. Objectives: To determine the feasibility of a home palliative care intervention during 1 year versus usual care, and the possible impact of this intervention on emergency, hospital and ICU admissions, survival, mood, and health-related quality of life (HRQL). Methods: Prospective controlled study of patients with severe COPD (GOLD stage III or IV) and long-term oxygen therapy and/or home noninvasive ventilation and/or one or more hospital admissions in the previous year for acute exacerbation, randomized to usual care versus usual care with add-on monthly intervention by palliative care specialists at home for 12 months. Results: Of 315 patients screened, 49 (15.5%) were randomized (26 to early palliative care; 23 to the control group); aged (mean ± SD) 71 ± 8 years; FEV₁ was 37 ± 14% predicted; 88% with a COPD assessment test score > 10; 69% on long-term oxygen therapy or home noninvasive ventilation. The patients accepted the intervention and completed the assessment scales. After 1 year, there was no difference between groups in symptoms, HRQL and mood, and there was a nonsignificant trend for higher admission rates to hospital and emergency wards in the intervention group. Conclusion: Although this pilot study was underpowered to formally exclude a benefit from palliative care in severe COPD, it raises several questions as to patient selection, reluctance to palliative care in this group, and modalities of future trials.

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“…Jabbarian and colleagues74 performed a systematic review of preferences and practices of ACP in chronic respiratory diseases. They showed that a majority of patients are interested in engaging in ACP, but despite this, ACP is rarely done.…”

Section: Palliative Respiratory Care In Copdmentioning

confidence: 99%

Pulmonary rehabilitation, physical activity, respiratory failure and palliative respiratory care

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Rochester

Pitta

et al. 2019

Thorax

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Advance care planning for patients with chronic respiratory diseases: a systematic review of preferences and practices

Abstract: CRD42016039787.

Cited by 106 publications

References 43 publications

Barriers to advance care planning with patients as perceived by nurses and other healthcare professionals: A systematic review

Barriers to advance care planning with patients as perceived by nurses and other healthcare professionals: A systematic review

Can Early Introduction of Palliative Care Limit Intensive Care, Emergency and Hospital Admissions in Patients with Severe Chronic Obstructive Pulmonary Disease? A Pilot Randomized Study

Pulmonary rehabilitation, physical activity, respiratory failure and palliative respiratory care

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