title: A qualitative study of unmet healthcare needs in chronic obstructive pulmonary disease. A potential role for specialist palliative care?
abstract: BACKGROUND
  Patients with chronic obstructive pulmonary disease (COPD) have high symptom burdens and poor health-related quality of life. The American Thoracic Society issued a consensus statement outlining the need for palliative care for patients with chronic respiratory diseases. A better understanding of the unmet healthcare needs among patients with COPD may help determine which aspects of palliative care are most beneficial.
  
  
  OBJECTIVE
  To identify the unmet healthcare needs of patients with COPD hospitalized for exacerbation using qualitative methods.
  
  
  METHODS
  We conducted 20 semistructured interviews of patients admitted for acute exacerbations of COPD focused on patient understanding of diagnosis and prognosis, effect of COPD on daily life and social relationships, symptoms, healthcare needs, and preparation for the end of life. Transcribed interviews were evaluated using thematic analysis.
  
  
  RESULTS
  Six themes were identified. (1) Understanding of disease: Most participants correctly identified their diagnosis and recognized their symptoms worsening over time. Only half understood their disease severity and prognosis. (2) SYMPTOMS: Breathlessness was universal and severe. (3) Physical limitations: COPD prevented participation in activities. (4) Emotional distress: Depressive symptoms and/or anxiety were present in most participants. (5) Social isolation: Most participants identified social limitations and felt confined to their homes. (6) Concerns about the future: Half of participants expressed fear about their future.
  
  
  CONCLUSIONS
  There are many unmet healthcare needs among patients hospitalized for COPD exacerbation. Relief of symptoms, physical limitations, emotional distress, social isolation, and concerns about the future may be better managed by integrating specialist palliative care into our current care model.
authors.affiliation: 1 Division of Pulmonary and Critical Care Medicine.
authors.forename: Clara J
authors.initials: CJ
authors.lastname: Schroedl
authors.forename: Susan E
authors.initials: SE
authors.lastname: Yount
authors.forename: Eytan
authors.initials: E
authors.lastname: Szmuilowicz
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Hutchison
authors.forename: Sharon R
authors.initials: SR
authors.lastname: Rosenberg
authors.forename: Ravi
authors.initials: R
authors.lastname: Kalhan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003863:Depression / Q000209:etiology; D004417:Dyspnea / Q000209:etiology; D005239:Fear; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006301:Health Services Needs and Demand; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D051346:Mobility Limitation; D010166:Palliative Care; D029424:Pulmonary Disease, Chronic Obstructive / Q000503:physiopathology* / Q000523:psychology*; D012934:Social Isolation; D013315:Stress, Psychological / Q000209:etiology
keywords: chronic obstructive pulmonary disease; dyspnea; end of life; quality of life; symptoms