Respiratory practitioners' experience of end-of-life discussions in COPD.
The importance of palliative care and implementing end-of-life tools nationally is well recognized, yet inequalities in care between patients with malignant and non-malignant disease are well documented. There is little evidence that open discussions regarding end-of-life decision-making are taking place routinely with patients who have non-malignant disease, so it seemed appropriate to investigate health professionals' perspectives.


OBJECTIVE
This study aimed to explore and provide insight into respiratory health professionals' experiences of their discussions with patients with life-limiting chronic obstructive pulmonary disease (COPD).


METHODS
A qualitative phenomenology approach was used. In-depth, face-to-face interviews were conducted with a purposive sample of three respiratory nurses, two lung cancer nurse specialists, and two respiratory physicians.


RESULTS
The seven in-depth interviews were thematically analysed so that the data could be categorized. The themes that emerged were: choosing the right time; the skill of picking up and receiving cues; deciding when, what and how to tell; boundaries to discussion; and working with emotions.


CONCLUSIONS
The main findings highlighted the difference in approach in discussions between patients with cancer and those with non-malignant disease. The emotional phenomena that emerged could have significant implications for clinical practice. The findings suggest that the emotional dimension plays a crucial part in engaging with patients and involving them in end-of-life care planning.
Crawford
Anne
A
Community Respiratory Services, Outer North East London Community Services, NHS Waltham Forest.
D000223:Adaptation, Psychological; D032722:Advance Care Planning / Q000458:organization & administration*; D001291:Attitude of Health Personnel; D002755:Choice Behavior; D003142:Communication; D003463:Cues; D004644:Emotions; D006801:Humans; D008131:London; D009720:Nurse Clinicians / Q000523:psychology; D015404:Nursing Methodology Research; D011369:Professional-Patient Relations; D029424:Pulmonary Disease, Chronic Obstructive / Q000451:nursing / Q000523:psychology; D015272:Pulmonary Medicine; D036301:Qualitative Research; D011795:Surveys and Questionnaires; D013997:Time Factors