Respiratory practitioners’ experience of end-of-life discussions in COPD

UNLABELLED: 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. AIM: 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). METHOD: 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. FINDINGS: 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.