Palliative care for patients with chronic obstructive pulmonary disease: current perspectives

Stakeholders' Views on Reducing Psychological Distress in Chronic Obstructive Pulmonary Disease

CONTEXT

Psychological distress is highly prevalent among patients with chronic obstructive pulmonary disease (COPD), the top palliative care priority identified by such patients, and associated with poor outcomes. However, patients with COPD rarely receive care for psychological distress.

OBJECTIVES

To identify the barriers and opportunities to reducing psychological distress among patients with COPD in the specialty pulmonary setting.

METHODS

We conducted semi-structured interviews based on Consolidated Framework for Implementation Research constructs with key stakeholders at two pulmonary clinics, including clinicians, staff, patients, and caregivers. We focused on the relevance, identification, and management of psychological distress in COPD care. We identified emergent patterns and concepts, developed and applied codes to the text, and examined the content in each code to identify key themes.

RESULTS

Thirty-one stakeholders participated in interviews (RR=64.6%). Nearly all pulmonary clinicians felt that psychological well-being was a critical, unmet patient need. Yet, most pulmonary clinicians reported that they lacked sufficient training and available resources to support patients, prioritized physical symptoms and medication management over emotional concerns, and perceived limited cultural support for such efforts in the pulmonary clinic setting. Patient and caregiver participants desired integration and prioritization of care addressing psychological distress into routine pulmonary care.

CONCLUSION

Mitigating psychological distress is a palliative care priority in COPD. Integrating efficient, effective resources, such as tools or programs that address psychological distress, into pulmonary clinic settings serving a high volume of patients with COPD may improve the provision of supportive care to patients typically underserved by specialty palliative care.

Self-management support? Listening to people with complex co-morbidities

OBJECTIVES

The study aimed to explore how people with complex, established co-morbidities experience long-term condition care in New Zealand. Despite the original conception as appropriate for people with early stage disease, in New Zealand the self-management approach dominates the care provided to people at all stages of diagnosis with long-term conditions, something reinforced through particular funding mechanisms.

METHODS

A multiple case study followed the lives of 16 people with several long-term conditions. Data collection comprised two interviews, four weekly contacts with patients over an 18-month period and an interview with their primary health care clinicians.

RESULTS

This paper reveals a cohort of tired, distracted patients struggling to manage their lives in the face of multiple conflicting challenges, with insufficient energy for the level of personal agency required to deal with the self-management approach.

DISCUSSION

Participants described aspects of care received, which does meet their needs but sit outside the self-management approach, that resonate with the ideas behind current approaches to palliative care. The potential of an approach to care built upon these ideas is explored as a more compassionate, effective way of meeting the needs of people with advanced, multiple long-term conditions. Further research is warranted to explore the acceptability of such an approach.

Challenges in the Provision of End-of-Life and Palliative Care to Ethnic Nepali Refugees

After over a decade of resettlement of ethnic Nepali refugees in the U.S., a significant population of seriously ill refugees will require palliative care and hospice care. The refugee experience and culturally specific factors affect the end-of-life care of this population. Challenges in the end-of-life care of Nepali refugees include challenges related to social and health inequities, such as significant chronic respiratory disease burden; lack of protocols for deferral of illness disclosure; lack of support for group decision making; unfamiliarity with spiritual, religious, and traditional health practices; and difficulty with cross-cultural communication. Culturally competent care of ethnic Nepali refugees can be accomplished through respectful exploration of patients' and families' preferences regarding the challenges identified. This article presents recommendations that can guide primary and specialist palliative care for this population.