The views of patients with severe chronic obstructive pulmonary disease on advance care planning: A qualitative study

MacPherson, Anna; Walshe, Catherine; O'Donnell, Valerie; Vyas, Aashish

doi:10.1177/0269216312440606

Cited by 64 publications

(94 citation statements)

References 22 publications

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“…An understanding of these issues has the potential to mitigate unwanted interventions, such as intubation and ventilation, and has been shown to reduce psychological stress for both patients and carers [93,94]. Despite the fact that chronic lung diseases, such as COPD, are a leading cause of mortality worldwide, the issue of advance care planning is often poorly addressed as part of their clinical management [95][96][97]. Advance care planning for people with end-stage cardiorespiratory disease is considered challenging, as the disease progression is often variable and gradual, hospitalisations are episodic, prognosis may be unclear and people may not recognise the seriousness of their condition [95].…”

Section: Advance Care Planningmentioning

confidence: 99%

The importance of components of pulmonary rehabilitation, other than exercise training, in COPD

Hill¹,

Vogiatzis²,

Burtin³

2013

Eur Respir Rev

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Comprehensive pulmonary rehabilitation is an important component in the clinical management of people with chronic obstructive pulmonary disease (COPD). Although supervised exercise training is considered the cornerstone of effective pulmonary rehabilitation, there are many other components that should be considered to manage the impairments and symptom burden, as well as the psychosocial and lifestyle changes imposed by COPD. These include approaches designed to: 1) facilitate smoking cessation; 2) optimise pharmacotherapy; 3) assist with early identification and treatment of acute exacerbations; 4) manage acute dyspnoea; 5) increase physical activity; 6) improve body composition; 7) promote mental health; 8) facilitate advance care planning; and 9) establish social support networks. This article will describe these approaches, which may be incorporated within pulmonary rehabilitation, to optimise effective chronic disease self-management. @ERSpublications This paper describes several components of comprehensive pulmonary rehabilitation, other than simply exercise training http://ow.ly/mMNRp Pulmonary rehabilitation for chronic obstructive pulmonary diseaseChronic obstructive pulmonary disease (COPD) is characterised by persistent airflow limitation due to chronic inflammation within the airways and lung in response to noxious particles or gases [1]. People with this condition are limited by dyspnoea and have impaired exercise capacity and health-related quality of life [1]. The prevalence of COPD amongst adults aged o40 years is ,10% [2], and increases to 21% in those with a significant smoking history who are visiting their family physician for any reason [3]. The natural course of COPD is punctuated with episodes of acute worsening, known as exacerbations, which contribute

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Section: Advance Care Planningmentioning

confidence: 99%

The importance of components of pulmonary rehabilitation, other than exercise training, in COPD

Hill¹,

Vogiatzis²,

Burtin³

2013

Eur Respir Rev

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“…Patients with COPD find it particularly difficult to make decisions in advance about ceilings of care [24] and even when they have had prior experience of interventions such as noninvasive ventilation they trust their doctor to make the right decision about its use in future in preference to making their own decision [25]. Nevertheless it is important that they are given the opportunity to discuss such issues.…”

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confidence: 99%

Palliative care for people with COPD: effective but underused

Halpin

2018

Eur Respir J

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@ERSpublications Despite its effectiveness palliative care is underused in the majority of patients with COPD http://ow.ly/d0YH30hPKeuCite this article as: Halpin DMG. Palliative care for people with COPD: effective but underused. Eur Respir J 2018; 51: 1702645 [https://doi.org/10.1183/13993003.02645-2017.Nearly 100 000 men and over 65 000 women die from chronic obstructive pulmonary disease (COPD) in Europe each year [1]; more die from one of its comorbidities but face the challenges of living and dying with severe COPD during their last years and months. Globally, COPD is the third most common cause of death worldwide and the Global Burden of Disease project estimated that, in 2015, COPD caused 3.2 million deaths, an increase of 11.6% compared with 1990 [2].For the people that die of, or with, COPD, their final months are often characterised by a progressive decline in health status, increasing symptoms and increased reliance on family and carers to perform simply daily activities such as washing and dressing. Despite this burden of disease, the vast majority of patients with advanced COPD are not offered palliative care, an approach that centres on the management of symptoms, maintaining quality of life and good communication. The underuse of palliative care was first reported nearly 20 years ago [3] and, since then, national and international guidelines have tried to encourage its adoption. The importance and benefits of palliative care were emphasised in the National Institute for Health and Care Excellence (NICE) COPD guideline in the UK published in 2004 [4] and in the American Thoracic Society/European Respiratory Society position paper published the same year [5]. In the UK, the Department of Health also introduced an "End of Life Care Strategy" in 2008 which was a comprehensive framework aimed at promoting high quality care across the country for all adults approaching the end of life [6]. Against this background, it is particularly disappointing that the study by BLOOM et al. [7], published in this issue of the European Respiratory Journal, shows that between 2004 and 2015 only one in five people dying from COPD in the UK were recorded as having received any palliative care. Just under half of those that did get palliative care only received it during the last 6 months of their life and one third only in their last month of life. There was a progressive increase in the use of palliative care over the decade, indicating that awareness and use of palliative care in COPD is changing, but it is clear that palliative care is still much more likely to be used in people with cancer as in the study people with COPD and lung cancer were 40% more likely to be offered palliative care than those with COPD alone. A strength of the study is the large number of patients included from the Clinical Practice Research Datalink which covers 674 UK primary care practices, with representative demographics; however, the analysis does depend on practitioners having specifically documented the use of palliative care using on...

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“…Providers may have concerns about their patients' perceptions of the ACP discussion and possibly unmasking patient anxiety or depression about end of life issues (Curtis & Patrick, 1997;Gott et al, 2009;Knauft, Nielsen, Engelberg, Patrick, & Curtis, 2005). These barriers are similar to those expressed by providers treating other chronic diseases (Gott et al, 2009;MacPherson et al, 2012).…”

Section: Discussionmentioning

confidence: 99%

“…Recent studies have shown that ACP discussions correlate with better health-care outcomes and satisfaction with care among various chronic disease populations such as chronic obstructive pulmonary disease (COPD) and diabetes. Patients with COPD report that ACP improves their health care and that the process of discussion regarding prognosis, treatment concerns, and preferences for care involved in ACP is valuable (Janssen, Engelberg, Wouters, & Curtis, 2012;MacPherson, Walshe, O'Donnell, & Vyas, 2012). Similarly, insulin-dependent diabetics have expressed a desire to discuss ADs (Toth, Gill, Godkin, & Lee, 1998).…”

Section: Introductionmentioning

confidence: 99%

Advance directives among people living with HIV: room for improvement

et al. 2014

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While HIV has become a largely chronic disease, age-associated comorbidities are prevalent in people living with HIV (PLWH). Therefore, PLWH are appropriate for advance care planning (ACP) and advance directives (ADs) completion. We sought to characterize AD completion among outpatient PLWH. We conducted a retrospective chart review of PLWH who receive their routine care at the University of Wisconsin HIV clinic. Data were extracted from the electronic health record. Variables were entered into a stepwise multivariate logistic regression model to assess which factors were independently associated with AD completion. Five hundred and eighty eight charts were reviewed. Eighty-one percent of subjects were male and 72% were white; mean age was 46.8 years. ADs were completed by 134 subjects and 6.7% of those were completed at the HIV clinic. In the final multivariate model, those who had completed an AD were more likely to be older than age 45; ever been diagnosed with AIDS; have cardiovascular disease, neurologic disorder, chronic kidney disease, or malignancy. In this study, a small percentage of patients had documented ADs, with only a small proportion completed in the HIV clinic. The HIV clinic is an underutilized resource to offer ACP. Interventions are needed to provide the necessary ACP resources for PLWH.

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The views of patients with severe chronic obstructive pulmonary disease on advance care planning: A qualitative study

Cited by 64 publications

References 22 publications

The importance of components of pulmonary rehabilitation, other than exercise training, in COPD

The importance of components of pulmonary rehabilitation, other than exercise training, in COPD

Palliative care for people with COPD: effective but underused

Advance directives among people living with HIV: room for improvement

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