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Wang SY, Lee PY, Sun YJE, Liu JF. The decision-making process of palliative care among male caregivers of chronically ill patients-A grounded theory study. Int J Nurs Pract 2024:e13280. [PMID: 38932439 DOI: 10.1111/ijn.13280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 03/07/2024] [Accepted: 05/18/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Family caregivers have a vital role to play in palliative care for chronically ill patients. In Taiwan, caregiver demographics are evolving, with the number of male caregivers increasing. Gender differences influence psychosocial behaviours, thought processes and communication styles. In healthcare, acknowledgement of gender differences facilitates effective delivery of high-quality care. AIM The aim of this study is to explore male caregivers' decision-making process for palliative care for chronically ill family members. METHODS This study employed grounded theory to generate a substantive theory of male caregivers' decision-making process for palliative care for chronically ill family members. We recruited 22 male participants from three inner-city teaching hospitals in Taiwan. FINDINGS Regarding the decision-making process of palliative care of chronic ill family, where male caregivers do not want their loved ones suffering anymore, the male caregivers' decision-making process was impacted, first, by caregivers' views on the last stage of life; second, by their wish for good care during the end of life; and third, by their conviction that the patients' wishes should be respected. Furthermore, caregivers' philosophy of life and death is also a supportive ground for decision-making. This philosophy was influenced by their education in palliative care, financial status and religious beliefs and practices. The core category emerging from this study is encapsulated by a participant's assertion, 'How difficult is it? There are no male and female differences'. CONCLUSION We found that palliative care experiences of male caregivers are important for the decision-making process for palliative care for their chronically ill family members. Caregivers want their loved ones to receive good care as the last step in life, to respect their wishes and no more suffering for the patient. Therefore, health professionals should be familiar with the palliative care process that caregivers go through to offer updated information when needed.
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Affiliation(s)
- Shou-Yu Wang
- Discipline of Nursing, School of Health, University of New England, Armidale, New South Wales, Australia
| | - Pei-Yu Lee
- Department of Long-term Care and Health Management, Cheng Shiu University, Kaohsiung City, Taiwan
| | - Yong-Jhu Emily Sun
- Nursing Service and Residential Aged Care, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Ju-Fen Liu
- Department of Nursing, Kuang Tien General Hospital, Taichung City, Taiwan
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Younas A, Zeb H, Durante A, Vellone E. Sex based differences in depression, anxiety, and quality of life and predictors of quality of life among South Asian individuals with chronic obstructive pulmonary disease: A Bayesian analysis. Soc Sci Med 2024; 351:116989. [PMID: 38788430 DOI: 10.1016/j.socscimed.2024.116989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 04/19/2024] [Accepted: 05/15/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND COPD can affect both men and women leading to deteriorating impact on general well-being, personal, and family life and decreased quality of life. Anxiety, depression, and self-care behaviours can affect the quality of life of individuals with COPD. There is a dearth of sex-based comparative analyses of anxiety, depression, quality of life, and predictors of quality of life among South Asian individuals with COPD. PURPOSE To identify the sex-based differences in depression, anxiety, and quality of life and the predictors of quality of life among South Asian individuals with COPD. METHODS A cross-sectional survey of 294 men and 114 women with COPD was conducted in Khyber Pakhtunkhwa, Pakistan. Hospital Anxiety and Depression scale, World Health Organization Quality of Life-brief version, Self-Care of Chronic Obstructive Pulmonary Disease Inventory, the Self-Care Self-Efficacy in COPD Scale were used for data collection. Bayesian independent sample t-test was used to compare mean differences in depression, anxiety, and quality of life among men and women. Two regression models were examined to determine if age, years of living with COPD, anxiety, depression, self-care self-efficacy, self-care monitoring, management, and maintenance were predictors of quality of life among men and women. FINDINGS Bayesian analysis showed anecdotal evidence that women had higher levels of depression, but lower levels of anxiety compared to men. Anecdotal evidence indicated that the physical quality of life of men was better than women, but strong evidence that their social relationship and environmental quality of life was better than women. Years of living with COPD, anxiety, depression, self-care self-efficacy, self-care management, self-care monitoring, and self-care maintenance were stronger predictors of women's quality of life. Anxiety and depression only predicted men's psychological quality of life, but predicted women's psychological, social relationships, and environmental quality of life. CONCLUSIONS The findings contribute to literature highlighting sex-based differences in anxiety, depression, and quality of life among South Asian men and women with COPD. Men generally reported higher levels of quality of life than women across all domains. Women's social relationships and environmental quality of life were greatly impacted by anxiety and depression. Quality of life interventions for women should be targeted at improving their social relationships and environmental satisfaction and addressing anxiety and depression.
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Affiliation(s)
- Ahtisham Younas
- Memorial University of Newfoundland, Canada; Swat College of Nursing, Swat, Pakistan.
| | - Hussan Zeb
- Swat College of Nursing, Swat, Pakistan; Tor Vergata University of Rome, Italy
| | - Angela Durante
- Health Science Interdisciplinary Center, Scuola Superiore Sant'Anna, Pisa, Italy; Health Science Interdisciplinary Center, Scuola Superiore Sant'Anna, Pisa, Italy
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Antonio MG, Veinot TC. From illness management to quality of life: rethinking consumer health informatics opportunities for progressive, potentially fatal illnesses. J Am Med Inform Assoc 2024; 31:674-691. [PMID: 38134954 PMCID: PMC10873853 DOI: 10.1093/jamia/ocad234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 10/31/2023] [Accepted: 11/28/2023] [Indexed: 12/24/2023] Open
Abstract
OBJECTIVES Investigate how people with chronic obstructive pulmonary disease (COPD)-an example of a progressive, potentially fatal illness-are using digital technologies (DTs) to address illness experiences, outcomes and social connectedness. MATERIALS AND METHODS A transformative mixed methods study was conducted in Canada with people with COPD (n = 77) or with a progressive lung condition (n = 6). Stage-1 interviews (n = 7) informed the stage-2 survey. Survey responses (n = 80) facilitated the identification of participants for stage-3 interviews (n = 13). The interviews were thematically analyzed. Descriptive statistics were calculated for the survey. The integrative mixed method analysis involved mixing between and across the stages. RESULTS Most COPD participants (87.0%) used DTs. However, few participants frequently used DTs to self-manage COPD. People used DTs to seek online information about COPD symptoms and treatments, but lacked tailored information about illness progression. Few expressed interest in using DTs for self- monitoring and tracking. The regular use of DTs for intergenerational connections may facilitate leaving a legacy and passing on traditions and memories. Use of DTs for leisure activities provided opportunities for connecting socially and for respite, reminiscing, distraction and spontaneity. DISCUSSION AND CONCLUSION We advocate reconceptualizing consumer health technologies to prioritize quality of life for people with a progressive, potentially fatal illness. "Quality of life informatics" should focus on reducing stigma regarding illness and disability and taboo towards death, improving access to palliative care resources and encouraging experiences to support social, emotional and mental health. For DTs to support people with fatal, progressive illnesses, we must expand informatics strategies to quality of life.
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Affiliation(s)
- Marcy G Antonio
- School of Information, University of Michigan, Ann Arbor, MI 48109, United States
- School of Health Information Science, University of Victoria, Victoria, BC V8W 2Y2, Canada
| | - Tiffany C Veinot
- School of Information, University of Michigan, Ann Arbor, MI 48109, United States
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI 48109, United States
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Ekdahl A, Söderberg S, Holmström Rising M. Being met as a person and not as a diagnosis - Meanings of healthcare encounters for women with chronic obstructive pulmonary disease stage III or IV. Health Care Women Int 2024:1-13. [PMID: 38334989 DOI: 10.1080/07399332.2024.2310068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 01/19/2024] [Indexed: 02/10/2024]
Abstract
Our study seeks to elucidate meanings of healthcare encounters for women with chronic obstructive pulmonary disease stage III or IV. We conducted 12 narrative interviews which were analyzed using phenomenological hermeneutic interpretation. Our analysis revealed one theme; being met as a person and not as a diagnosis with three subthemes: getting sufficient time and feeling involved in care; fulfillment of personal needs; and experiencing disrespect and injustice. We found that meanings of healthcare encounters center on the expectation of being seen as a person. Feeling disrespected and injust leaves women unsupported and could pose serious health risks.
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Affiliation(s)
- Ann Ekdahl
- Department of Health Sciences, Mid Sweden University, Sweden
| | - Siv Söderberg
- Department of Health Sciences, Mid Sweden University, Sweden
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Doran C, Duits AJ, Gerstenbluth I, Tami A, Bailey A. Adaptive coping strategies among individuals living with long-term chikungunya disease: a qualitative study in Curaçao. BMJ Open 2024; 14:e076352. [PMID: 38326245 PMCID: PMC10860096 DOI: 10.1136/bmjopen-2023-076352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 01/19/2024] [Indexed: 02/09/2024] Open
Abstract
OBJECTIVE Long-term chikungunya disease is characterised by persistent rheumatic symptoms following chikungunya virus infection. As there is no specific treatment available, affected individuals need strategies to adapt. However, research on these is scarce. This study aimed to explore which adaptive coping strategies are employed to manage persistent rheumatic symptoms in daily life. SETTING The study was conducted in Curaçao. DESIGN AND PARTICIPANTS An explorative qualitative study was conducted between September and October 2020, among a purposive sample of adults, 19 women and 4 men affected by long-term chikungunya disease. In-depth interviews were semi-structured and transcribed verbatim. The data were analysed using inductive thematic analysis. RESULTS The disease duration for all participants ranged between 68 and 74 months (6 years). In narrating their experiences of coping with long-term chikungunya disease, four themes were identified: (1) learning to live with the disease; (2) resilience for dealing with pain; (3) maintaining positive self-image and attitude; and (4) coping through spirituality. CONCLUSION To live with long-term chikungunya disease with dignity in spite of physical pain and discomfort, participants tried to retain a sense of control of oneself and one's lives, to not let the disease take over, focusing on the positive in their lives, and finding strength and remain hopeful. Interventions such as cognitive-behavioural therapy and mindfulness exercises may be effective in strengthening or regain affected individual's sense of competence and control by fostering adaptive coping skills and resilience. Subsequently, these interventions may improve health-related quality of life when rheumatic symptoms persist following chikungunya virus infection.
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Affiliation(s)
- Churnalisa Doran
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, Groningen, The Netherlands
| | - Ashley J Duits
- Department of Immunology, Curaçao Biomedical and Health Research Institute, Willemstad, Curaçao
| | - Izzy Gerstenbluth
- Department of Epidemiology, Curaçao Biomedical and Health Research Institute, Willemstad, Curaçao
| | - Adriana Tami
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, Groningen, The Netherlands
| | - Ajay Bailey
- Department of Human Geography and Spatial Planning, University of Utrecht, Utrecht, The Netherlands
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Ekdahl A, Söderberg S, Holmström Rising M. Striving for moments of easier breathing despite being trapped in breathlessness: meanings of feeling well for women with chronic obstructive pulmonary disease stage III or IV. Int J Qual Stud Health Well-being 2023; 18:2225937. [PMID: 37331013 DOI: 10.1080/17482631.2023.2225937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 06/12/2023] [Indexed: 06/20/2023] Open
Abstract
BACKGROUND Living with chronic obstructive pulmonary disease stage III or IV means living an everyday life, severely restricted by breathlessness. AIM The aim of this study was to elucidate meanings of feeling well for women with chronic obstructive pulmonary disease stage III or IV. METHOD The study has used a phenomenological hermeneutical design. Individual narrative interviews were conducted with 14 women with chronic obstructive pulmonary disease at stages III or IV. RESULTS The results revealed one theme: striving for moments of easier breathing despite being trapped in breathlessness with four subthemes: acting in rhythm with breathing, taking care of oneself, taking advantage of better moments, and being in togetherness in everyday life. CONCLUSION This study shows that women with chronic obstructive pulmonary disease at stages III or IV strived for moments of feeling well despite living with a severe illness. Feeling well meant that when connected to nature, they felt alive, free, and less trapped in breathlessness, which provided a sense of being unconscious of their breathing rhythm. They could do what healthy people tend to take for granted during everyday life. To feel well, the women found it important to receive tailored support from their close relatives.
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Affiliation(s)
- Ann Ekdahl
- Department of Health Sciences Mid Sweden University, Sundsvall, Sweden
| | - Siv Söderberg
- Department of Health Sciences Mid Sweden University, Sundsvall, Sweden
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Swain R, Forsyth F, Bowers B, Early F, Kuhn I, Shrivastva S, Tufnell R, Fuld J. A critical interpretive synthesis of the lived experiences and health and patient-reported outcomes of people living with COPD who isolated during the COVID-19 pandemic. Eur Respir Rev 2023; 32:230031. [PMID: 37495249 PMCID: PMC10369166 DOI: 10.1183/16000617.0031-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 05/23/2023] [Indexed: 07/28/2023] Open
Abstract
AIMS To determine the lived experiences of people with COPD who isolated at home during the coronavirus disease 2019 (COVID-19) pandemic, and explore how these experiences affected health and patient-reported outcomes. METHODS Keyword searches were performed in five bibliographic databases. Critical interpretative synthesis (CIS) methods were used to interrogate and understand patterns across studies. RESULTS 23 studies were identified; three employed qualitative methods and 20 quantitative methods. Application of CIS methods highlighted a core synthetic concept that appeared to underpin experiences and outcomes, that of a heightened perception of risk. Using the Risk Perception Model as a framework, we found that cognitive factors such as knowledge of underlying health status and the transmissibility of COVID-19; experiential factors including previous episodes of breathlessness and hospitalisation; and sociocultural factors such as access to trusted sources of information, influenced perceptions of risk. In turn, this influenced behaviour, which translated to outcomes such as reduced hospitalisations, deconditioning and social isolation as people avoided "high-risk" situations and settings. CONCLUSIONS Patients with COPD who isolated at home during the COVID-19 pandemic had a heightened perception of risk which was influenced by cognitive, experiential and sociocultural factors. The consequences of this were varied and included both positive (reduced exacerbations and hospitalisations) and negative (social isolation, deconditioning, diminished capacity for self-care) outcomes. Understanding risk and the impacts it can have could help clinicians to support people with COPD return to their pre-pandemic way of living and enable better communication of ongoing risk from respiratory viral illness.
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Affiliation(s)
- Rose Swain
- Department of Infection and Inflammation Research, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- These authors contributed equally to this work
| | - Faye Forsyth
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- These authors contributed equally to this work
| | - Ben Bowers
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Queen's Nursing Institute, London, UK
| | - Frances Early
- Department of Respiratory Medicine, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Isla Kuhn
- Medical Library, University of Cambridge, Cambridge, UK
| | - Sagar Shrivastva
- Department of Respiratory Medicine, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Rachel Tufnell
- Cambridge Breathlessness Intervention Service, Cambridge University Hospitals NHS Foundation, Cambridge, UK
| | - Jonathan Fuld
- Department of Respiratory Medicine, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Ekdahl A, Söderberg S, Holmström Rising M. The Experiences of Close Relatives to Women with Chronic Obstructive Pulmonary Disease Stages III or IV: A Qualitative Study. NURSING REPORTS 2023; 13:982-989. [PMID: 37489408 PMCID: PMC10366874 DOI: 10.3390/nursrep13030086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 07/06/2023] [Accepted: 07/13/2023] [Indexed: 07/26/2023] Open
Abstract
Chronic obstructive pulmonary disease stage III or IV is a progressive and incurable disease. The hallmark of the disease is breathlessness, and it is graded into four different stages, from mild to severe. Living with chronic obstructive pulmonary disease impacts almost every aspect of everyday life for an affected person. As the illness progresses to stages III and IV, the need for support from close relatives increases. The aim of this study was to explore and describe the experiences of close relatives of women with chronic obstructive pulmonary disease stage III or IV and it used qualitative content analysis of individual, semi-structured interviews. Close relatives (n = 9) were interviewed about their experience of being close to a woman with chronic obstructive pulmonary disease stage III or IV. They experienced stress and uncertainty in an unpredictable everyday life. Close relatives supported the women both practically and emotionally and they called for tailored information about the illness, considering it as an essential tool for support. The results highlighted that healthy close relatives had difficulty in understanding the experience of living with chronic obstructive pulmonary, as they take the simple fact of breathing for granted most of the time.
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Affiliation(s)
- Ann Ekdahl
- Department of Health Sciences, Mid Sweden University, SE-852 33 Sundsvall, Sweden
| | - Siv Söderberg
- Department of Health Sciences, Mid Sweden University, SE-852 33 Sundsvall, Sweden
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Christiansen CF, Løkke A, Bregnballe V, Prior TS, Farver-Vestergaard I. COPD-Related Anxiety: A Systematic Review of Patient Perspectives. Int J Chron Obstruct Pulmon Dis 2023; 18:1031-1046. [PMID: 37304765 PMCID: PMC10257401 DOI: 10.2147/copd.s404701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 05/30/2023] [Indexed: 06/13/2023] Open
Abstract
Background Anxiety in patients with chronic obstructive pulmonary disease (COPD) is prevalent but often unidentified and therefore not adequately managed. Clinicians find it difficult to detect anxiety symptoms and to differentiate subclinical anxiety from anxiety disorders, because of the considerable overlap between symptoms of COPD and anxiety. Purpose We synthesized existing qualitative research on patients' experiences of COPD-related anxiety with the purpose of gaining a richer understanding and proposing a model of the construct. Methods Searches for qualitative studies of patients' experiences of COPD-related anxiety were conducted independently by two authors in the databases of PubMed (MEDLINE), CINAHL (EBSCO), and PsycInfo (APA). English-language studies including patients diagnosed with COPD were reviewed, and data were analyzed using thematic analysis. Results A total of 41 studies were included in the review. Four themes related to COPD-related anxiety were identified: initial events; internal maintaining factors; external maintaining factors; and behavioral maintaining factors. Based on the identified four themes, a conceptual model of COPD-related anxiety from the patient perspective was developed. Conclusion A conceptual model of COPD-related anxiety from the patient perspective is now available, with the potential to inform future attempts at improving identification and management of COPD-related anxiety. Future research should focus on the development of a COPD-specific anxiety questionnaire containing domains that are relevant from the patient perspective.
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Affiliation(s)
- Camilla F Christiansen
- Department of Medicine, Lillebaelt Hospital, Vejle, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Anders Løkke
- Department of Medicine, Lillebaelt Hospital, Vejle, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | | | - Thomas Skovhus Prior
- Center for Rare Lung Diseases, Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | - Ingeborg Farver-Vestergaard
- Department of Medicine, Lillebaelt Hospital, Vejle, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
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Skär L, Borg C, Emtner M, Ekström M. Thoughts on the end of life in patients with oxygen-dependent chronic obstructive pulmonary disease: A qualitative interview study. Nurs Open 2023; 10:2158-2164. [PMID: 36334046 PMCID: PMC10006665 DOI: 10.1002/nop2.1463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 09/19/2022] [Accepted: 10/22/2022] [Indexed: 11/07/2022] Open
Abstract
AIM The aim of the study was to deepen the current knowledge of how patients with chronic obstructive pulmonary disease and long-term oxygen treatment think about and expect end-of-life. DESIGN A qualitative design was used. METHODS A purposeful sample of 19 patients with oxygen-dependent chronic obstructive pulmonary disease was obtained from the Swedish National Registry on Respiratory Failure (Swedevox). Data was collected with semi-structured interviews and analysed using a hermeneutic approach. RESULTS The analysis revealed three themes: Living in the present without a future; difficulty talking about the uncertainty; and feeling anxious about leaving family behind. Participants indicated that healthcare professionals should invite them to mutual discussions as it was easier to reject an invitation if they could not talk right then, than to initiate a discussion themselves. Start of home oxygen or a deteriorating health status may be an important time to clinically address existential and end-of-life issues.
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Affiliation(s)
- Lisa Skär
- Department of Health, Blekinge Institute of Technology, Karlskrona, Sweden
| | - Christel Borg
- Department of Health, Blekinge Institute of Technology, Karlskrona, Sweden
| | - Margareta Emtner
- Department of Medical Sciences, Respiratory-, allergy- and sleep research, Uppsala University, Uppsala, Sweden
| | - Magnus Ekström
- Faculty of Medicine, Department of Clinical Sciences Lund, Respiratory Medicine and Allergology, Lund University, Lund, Sweden
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