Advance care planning for patients with chronic obstructive pulmonary disease on home non-invasive ventilation: A qualitative study exploring barriers, facilitators and patients' and healthcare professionals' recommendations.

Autor:	Kavanagh E; Health Education North East, Newcastle-upon-Tyne, UK., Rowley G; Health Education North East, Newcastle-upon-Tyne, UK., Simkiss L; Health Education North East, Newcastle-upon-Tyne, UK., Woods E; Health Education North East, Newcastle-upon-Tyne, UK., Gouldthorpe C; Health Education North East, Newcastle-upon-Tyne, UK., Howorth K; Health Education North East, Newcastle-upon-Tyne, UK., Charles M; Health Education North East, Newcastle-upon-Tyne, UK., Kiltie R; Health Education North East, Newcastle-upon-Tyne, UK., Billett H; Health Education North East, Newcastle-upon-Tyne, UK., Mastaglio F; Health Education North East, Newcastle-upon-Tyne, UK., Dewhurst F; Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne, UK.; Department of Palliative Care, St Oswald's Hospice, Newcastle-upon-Tyne, UK.
Jazyk:	angličtina
Zdroj:	Palliative medicine [Palliat Med] 2023 Oct; Vol. 37 (9), pp. 1413-1423. Date of Electronic Publication: 2023 Sep 12.
DOI:	10.1177/02692163231192130
Abstrakt:	Background: Although home non-invasive ventilation for patients with chronic obstructive pulmonary disease and persisting hypercapnia prolongs time to hospital readmission and prognosis, they retain a poor long-term prognosis. Requiring non-invasive ventilation in this population should trigger advance care planning, yet only 50% of patients are engaged in such discussions. Aim: This study aimed to explore the barriers and facilitators to advance care planning for patients with chronic obstructive pulmonary disease on home non-invasive ventilation and generate recommendations for improving practice. Study Design: A cross-sectional interview study took place with 10 patients with chronic obstructive pulmonary disease on home non-invasive ventilation and 12 North East Assisted Ventilation Service healthcare professionals from the North East of England. Results: Three themes ('overlooked', 'disjointed care' and 'awareness and expertise') were identified. Patients with chronic obstructive pulmonary disease are a 'forgotten about' population, exacerbated by prejudice and unpredictable disease trajectories. Recognition as a distinct and underserved population may improve care and advance care planning. All participants recognised a lack of care continuity, including limited collaboration and communication between services, as a significant barrier to advanced care planning. Additionally, lacking understanding of the rationale and positive impacts of advance care planning, exacerbated by a lack of expertise in difficult conversations, was a barrier to advance care planning. Conclusions: Patients and healthcare professionals highlighted the need for individualised and ongoing advance care planning, particularly around prognosis and care preferences. Discussions should be initiated by familiar clinicians. Effective communication between services, clear agreements and protocols and upskilling healthcare professionals may ensure continuity of care. Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Databáze:	MEDLINE
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