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Disler R, Henwood B, Luckett T, Pascoe A, Donesky D, Irving L, Currow DC, Smallwood N. Knowledge and Attitudes of Allied Health Professionals Towards End-Of-Life and Advance Care Planning Discussions With People With COPD: A Cross-Sectional Survey Study. Am J Hosp Palliat Care 2022:10499091221134777. [PMID: 36266239 DOI: 10.1177/10499091221134777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a progressive, life-limiting condition. End-of-life (EOL) and Advance Care Planning (ACP) discussions are essential, yet access and support remain inadequate. Allied health professionals (AHPs) commonly have ongoing relationships with patients and opportunities to discuss care outside acute crises as is considered best practice. Australian and New Zealand AHPs were invited to complete an anonymous, online, cross-sectional survey that aimed to explore knowledge, attitudes and practices, and associated perceived triggers and barriers to EOL and ACP discussions with patients with COPD. Closed survey responses were summarized descriptively and free-text thematically analysed. One hundred and one AHPs (physiotherapists, social workers and occupational therapists) participated. Many held positive attitudes towards ACP but lacked procedural knowledge. Half (50%) of participants routinely discussed EOL care with patients when perceiving this to be appropriate but only 21% actually discussed ACP with the majority of their patients. Many cited lack of training to engage in sensitive EOL discussions, with barriers including: 1) clinician lack of confidence/fear of distressing patients (75%); 2) perceived patient and family reluctance (51%); 3) organizational challenges (28%); and 4) lack of role clarity (39%). AHPs commonly have ongoing relationships with patients with chronic conditions but lack the confidence and role clarity to utilise this position to engage ongoing EOL and ACP discussions. While AHPs may not traditionally consider EOL and ACP discussions as part of their role, it is crucial that they feel prepared to respond if patients broach the topic.
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Affiliation(s)
- Rebecca Disler
- Department of Immunology and Pathology, Monash University, Melbourne, VIC, AU.,Department of Rural Health, 2281The University of Melbourne, Shepparton, VIC, AU
| | - Brooke Henwood
- Department of Rural Health, 2281The University of Melbourne, Shepparton, VIC, AU
| | - Tim Luckett
- Faculty of Health, 1994University of Technology Sydney(UTS), Sydney, NSW, AU
| | - Amy Pascoe
- Department of Immunology and Pathology, Monash University, Melbourne, VIC, AU
| | - Doranne Donesky
- School of Nursing, University of California, San Francisco, CA, USA.,Department of Physiological Nursing, University of California, San Francisco, CA, USA
| | - Louis Irving
- Department of Respiratory and Sleep Medicine, 90134Royal Melbourne Hospital, Melbourne, VIC, AU
| | - David C Currow
- Medicine and Health, The University of Wollongong, Wollongong, VIC, AU
| | - Natasha Smallwood
- Department of Immunology and Pathology, Monash University, Melbourne, VIC, AU.,Department of Respiratory and Sleep Medicine, The Alfred Hospital, Melbourne, VIC, AU
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