COPD patients’ preferences for palliative conversations with clinicians

COPD is a chronic disorder that causes persistent airflow obstruction and progressive breathlessness. Although mortality rates are high, predicting mortality risk is complex and so there is uncertainty on how/when to initiate relevant conversations about appropriate care plans with patients. Patients receive less palliative care and more aggressive treatments at the end of life. The study explored patients’ preferences for the timing and nature of palliative care discussions with clinicians.

A total of 33 COPD patients in four different stages of their disease were interviewed using a semi-structured approach. Interview data analysis was guided by interpretative phenomenological analysis.

Different factors influenced patients’ preferences for palliative care discussions with clinicians, such as clinicians’ competencies and power and practicalities of discussions. The preferred timing for discussions was somewhere in the future. The timing was associated with self-prognosis, since discussions should be initiated after a considerable deterioration. Patients delayed conversations with clinicians as their disease progressed and preferred to focus on “living the moment.” Patients waited for clinicians to initiate discussions, however the proportion of patients with this preference decreased as their disease progressed. Patients that preferred to initiate conversations themselves, also seemed to delay and avoid discussions.

Patients’ preferences for palliative care discussions are influenced by intrinsic factors -patient and disease-related - and by extrinsic factors - clinician and service-related. Current service rationing prevents discussions about palliative care between COPD patients and clinicians.