Clinician perspectives on how to hold earlier discussions about palliative and end of life care with COPD patients - a qualitative study

COPD is associated with progressive symptoms and increased treatment burden, especially at the end of life. However, most patients do not receive palliative care until late in their lives or discuss their end of life preferences with clinicians. This study explored clinicians’ perspectives on the timing and nature of palliative care discussions.

Qualitative interviews were conducted with seven physicians and seven nurses working in primary and secondary care settings. Data was analysed using a thematic analysis.

Participants advocated for early, gradual and informed palliative and future care discussions, as these discussions were thought to be less traumatic and better accepted by patients. Despite this, patient and clinician-related barriers severely affected clinicians’ ability to start discussions at earlier stages. Participants felt many patients were not ready for these discussions and feared damaging hope if the subject was broached. Therefore, clinicians delayed discussions until patients approached the end of life.

Stand-alone conversations about and near the end of life were described as current practice, however clinicians believed these discussions reduced patients’ hope and were potentially upsetting. Instead, individualised early, regular and gradual discussions about immediate and long-term care plans were thought to be less negative and be better accepted.