Patient-Clinician Communication About End-of-Life Care in Patients With Advanced Chronic Organ Failure During One Year

Houben, Carmen; Spruit, Martijn A.; Schols, Jos M. G. A.; Wouters, Emiel F.M.; Janssen, Daisy J.A.

doi:10.1016/j.jpainsymman.2014.12.008

Cited by 29 publications

(40 citation statements)

References 42 publications

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“…17 out of 37 papers highlighted that a variable percentage of COPD patients had discussed palliative care topics, this ranged from 0% to 56%, [5,19,21,24,25,29,30,[35][36][37][38][39][40][41][42][43][44]. Within this group, the majority (n=9), reported rates of discussion ⩽30% of patients [19,29,30,[35][36][37][38][39]43]. This information was generated from papers including qualitative and quantitative studies with moderate and high quality, papers which compared COPD patients and patients with other diseases and narrative reviews.…”

Section: Frequency Of Discussionmentioning

confidence: 99%

“…Several studies reported the most frequent and the least discussed topics during palliative care discussions, these are highlighted in table 3 [3,15,20,21,35,39,41,44,[46][47][48][51][52][53]. Overall, patient education about palliative care was ranked as one of the most important topics by patients with COPD [51].…”

Section: Content Of Discussionmentioning

confidence: 99%

“…Quality of communication appeared to remain poor as patients approached their end of lives, even after the use of interventions to improve the frequency and quality of these discussions [36,39]. Interventional studies demonstrated potential for improvement the quality of conversations, but only in two domains: patients' feelings about deterioration and spiritual beliefs [36,39].…”

Section: Quality Of Communicationmentioning

confidence: 99%

“…This will help to build a therapeutic relationship with the patient [30]. These opportunities/triggers can be: the presence of cor pulmonale [22]; the need for ventilation in the previous year [22]; arterial partial pressure of carbon dioxide >45 mmHg or FEV1 <30% [22]; recent hospital admission or consultation [26,30,39,50]; oxygen dependency or weight loss [22]; observed deterioration in the patient's condition [22,30,39,50]; age above 70 years [18,22]; assessment of therapy options [30,50].…”

Section: Improving Palliative Care Communicationmentioning

confidence: 99%

“…Any disagreements identified should be negotiated with the patient, to come to a shared decision [24,50,55]. [37] Lack of time in appointments to discuss all topics [18,37] Discussions may take away patients' hope [37] Lack of feedback and documentation [18,30,40,45] Lack of thorough knowledge of the patient [3,18] Difficulty to start conversations and to choose the right time [3,18,22,26,30,39,40,44,45] Difficulty for patients to understand and accept information in short periods of time [3,29,52] Vision of palliative care as confined to the last days of life and exclusive of life sustaining treatments [29,30] Uncertainty to prognose in COPD [5,18,22,39,40,45] Reluctance of palliative care services to care for patients with COPD [29] Complex discharge planning for COPD patients [18] Facilitators Patients who had relatives or friends who had died recently [37] Patients' trust in their physician [37] Patients interpret physicians' skills as very good [37] Patients' belief that physicians truly care about the patient [37] Good patient-physician relationship [29,37] Physicians who cared for many...…”

Section: Improving Palliative Care Communicationmentioning

confidence: 99%

See 4 more Smart Citations

Palliative and end of life care conversations in COPD - a systematic literature review

Tavares

Jarrett

Hunt

et al. 2017

Rehabilitation and Chronic Care

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Chronic obstructive pulmonary disease (COPD) is a chronic life-limiting disorder characterised by persistent airflow obstruction and progressive breathlessness. Discussions/conversations between patients and clinicians ensure palliative care plans are grounded in patients' preferences. This systematic review aimed to explore what is known about palliative care conversations between clinicians and COPD patients.A comprehensive search of all major healthcare-related databases and websites was performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies were quality assessed, employing widely used quality-assessment tools, with only papers scoring moderate-tohigh quality included. All relevant data were extracted. A narrative synthesis was used to analyse, process and present the final data.The findings indicated that the frequency and quality of palliative care conversations is generally poor. Patients and physicians identified many barriers and important topics were not discussed. Patients and clinicians reported tension between remaining hopeful and the reality of the patients' condition. When discussions did happen, they often occurred at an advanced stage of illness and in respiratory wards and intensive care units.In conclusion, current care practices do not facilitate satisfactory conversations about palliative care between COPD patients and clinicians. This impacts upon the fulfilment of patients' preferences at the end of life. @ERSpublications Conversations about palliative care in COPD http://ow.ly/NlKt307jgRs

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Section: Frequency Of Discussionmentioning

confidence: 99%

Section: Content Of Discussionmentioning

confidence: 99%

Section: Quality Of Communicationmentioning

confidence: 99%

Section: Improving Palliative Care Communicationmentioning

confidence: 99%

Section: Improving Palliative Care Communicationmentioning

confidence: 99%

See 3 more Smart Citations

Palliative and end of life care conversations in COPD - a systematic literature review

Tavares

Jarrett

Hunt

et al. 2017

Rehabilitation and Chronic Care

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Communication in Palliative Care

Lincoln

Chiarchiaro

2021

Respiratory Medicine

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Painting a Rational Picture During Highly Emotional End-of-Life Discussions: a Qualitative Study of Internal Medicine Trainees and Faculty

2020

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BACKGROUND: High-quality communication about endof-life care results in greater patient and family satisfaction. End-of-life discussions should occur early during the patient's disease trajectory and yet is often addressed only when patients become severely ill. As a result, end-oflife discussions are commonly initiated during unplanned hospital admissions, which create additional challenges for physicians, patients, and families. OBJECTIVE: To better understand how internal medicine attending physicians and trainees experience end-of-life discussions with patients and families during acute hospitalizations. DESIGN: We conducted an interview-based qualitative study using an interpretivist approach. We selected participants based on purposeful maximal variation and theoretical sampling strategies. We conducted an individual, in-depth, semi-structured interview with each participant. PARTICIPANTS: We recruited 15 internal medicine physicians with variable levels of clinical training and experience who worked in one of five university-affiliated academic hospitals. APPROACH: Interview transcripts were analyzed inductively and reflectively. Data were grouped by themes and categories. Data collection and analysis occurred concurrently, led to iterative adjustments of the interview guide, and continued until theoretical sufficiency was reached. KEY RESULTS: Physicians depicted end-of-life discussions as a process directed at painting a realistic picture of a clinical situation. By focusing their efforts on reaching a shared understanding of a clinical situation with patients/families, physicians self-delineated the boundaries of their professional responsibilities regarding endof-life care (i.e., help with understanding, not with accepting or making the "right" decisions). Information sharing took precedence over emotional support in most physicians' accounts of end-of-life discussions. However, the emotional impact of end-of-life discussions on families and physicians was readily recognized by participants.CONCLUSION: End-of-life discussions are complex, dynamic social interactions that involve multiple, complementary competencies. Focusing mostly on sharing clinical information during end-of-life discussions may distract physicians from providing emotional support to families and prevent improvements of end-of-life care delivered in acute care settings.

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Patient-Clinician Communication About End-of-Life Care in Patients With Advanced Chronic Organ Failure During One Year

Cited by 29 publications

References 42 publications

Palliative and end of life care conversations in COPD - a systematic literature review

Palliative and end of life care conversations in COPD - a systematic literature review

Communication in Palliative Care

Painting a Rational Picture During Highly Emotional End-of-Life Discussions: a Qualitative Study of Internal Medicine Trainees and Faculty

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