Advance care planning for patient with chronic obstructive pulmonary disease: An evolutionary concept analysis

AIM

This study aimed to analyze the concept of advance care planning (ACP) for patients with chronic obstructive pulmonary disease (COPD), by systematically clarifying the attributes, antecedents, consequences, surrogate terms, related concepts, and historical transition of the concept.

METHODS

Following Rodgers' method of concept analysis, the academic development of concepts related to ACP for patients with COPD, as well as changes in the concept over time, is comprehensively organized and described. A search formula for relevant literature was created using the two keywords "chronic obstructive pulmonary disease" and "advance care planning". The databases of CENTRAL, PubMed, CINAHL Plus with Full Text, Embase, and PsycInfo were searched without limitation by the year of publication and restricted to English and Japanese languages.

RESULTS

Of the 3433 retrieved articles, 30 peer-reviewed articles were included in the analysis. Data extraction was conducted to identify concepts relevant to ACP for patients with COPD, resulting in the identification of four antecedents (COPD progression, decline in QOL, attitude toward facing death and dying, and interdisciplinary team approach); four attributes (discussion process, documentation, support for facing death, and dying, holistic approach); and four consequences (dialogical process, improved support of decision-making, physical impacts, and psychological impacts).

CONCLUSIONS

This conceptual framework, identified through this analysis, shows an evolution from a medical perspective to encompassing humanistic perspectives in addressing patient needs and emphasizes the importance of nursing practices. The elucidated concept characteristics may enhance its application, practice promotion, and interdisciplinary understanding across healthcare professions in the end-of-life field.

Advance Care Planning for Individuals With Chronic Obstructive Pulmonary Disease: A Scoping Review of the Literature

CONTEXT

Individuals with chronic obstructive pulmonary disease (COPD) typically experience a gradual worsening of the illness in the years before death. Owing to difficulties in predicting the disease trajectory or the timing of acute exacerbations, advance care planning (ACP) may be of particular importance for individuals with COPD.

OBJECTIVES

The objective of this study was to review and summarize the available literature on current practices around ACP in COPD.

METHODS

A scoping review of the literature was conducted following the Arksey and O'Malley framework. Original research studies of any design were included.

RESULTS

Twenty-eight studies were included. Across studies, there was agreement that ACP should be incorporated into routine COPD management. There was evidence that this does not occur in everyday practice, with conversations tending to focus on day-to-day symptom management. Barriers included prognosis uncertainty, insufficient time and training, and a lack of protocols for who is responsible for initiating ACP. Facilitators included the use of transition points for identifying the appropriate time to initiate ACP, and an increased focus on ACP in professional education. The occurrence of repeated episodes of acute care was identified as a key transition point for identifying the palliative stage of COPD and an appropriate time to initiate ACP.

CONCLUSION

The findings of this review confirm agreement among health care professionals and patients with COPD and their carers that ACP should be incorporated into routine COPD management. The use of transition points may help health care professionals overcome the barrier of prognosis uncertainty and identify patients who might benefit from ACP.

Advance care planning: A systematic review about experiences of patients with a life-threatening or life-limiting illness

BACKGROUND

Advance care planning is seen as an important strategy to improve end-of-life communication and the quality of life of patients and their relatives. However, the frequency of advance care planning conversations in practice remains low. In-depth understanding of patients' experiences with advance care planning might provide clues to optimise its value to patients and improve implementation.

AIM

To synthesise and describe the research findings on the experiences with advance care planning of patients with a life-threatening or life-limiting illness.

DESIGN

A systematic literature review, using an iterative search strategy. A thematic synthesis was conducted and was supported by NVivo 11.

DATA SOURCES

The search was performed in MEDLINE, Embase, PsycINFO and CINAHL on 7 November 2016.

RESULTS

Of the 3555 articles found, 20 were included. We identified three themes in patients' experiences with advance care planning. 'Ambivalence' refers to patients simultaneously experiencing benefits from advance care planning as well as unpleasant feelings. 'Readiness' for advance care planning is a necessary prerequisite for taking up its benefits but can also be promoted by the process of advance care planning itself. 'Openness' refers to patients' need to feel comfortable in being open about their preferences for future care towards relevant others.

CONCLUSION

Although participation in advance care planning can be accompanied by unpleasant feelings, many patients reported benefits of advance care planning as well. This suggests a need for advance care planning to be personalised in a form which is both feasible and relevant at moments suitable for the individual patient.

Advance care planning for patients with chronic respiratory diseases: a systematic review of preferences and practices

Background

Advance care planning (ACP) supports patients in identifying and documenting their preferences and timely discussing them with their relatives and healthcare professionals (HCPs). Since the British Thoracic Society encourages ACP in chronic respiratory disease, the objective was to systematically review ACP practice in chronic respiratory disease, attitudes of patients and HCPs and barriers and facilitators related to engagement in ACP.

Methods

We systematically searched 12 electronic databases for empirical studies on ACP in adults with chronic respiratory diseases. Identified studies underwent full review and data extraction.

Results

Of 2509 studies, 21 were eligible: 10 were quantitative studies. Although a majority of patients was interested in engaging in ACP, ACP was rarely carried out. Many HCPs acknowledged the importance of ACP but were hesitant to initiate it. Barriers to engagement in ACP were the complex disease course of patients with chronic respiratory diseases, HCPs’ concern of taking away patients’ hopes and lack of continuity of care. The identification of trigger points and training of HCPs on how to communicate sensitive topics were identified as facilitators to engagement in ACP.

Conclusions

In conclusion, ACP is surprisingly uncommon in chronic respiratory disease, possibly due to the complex disease course of chronic respiratory diseases and ambivalence of both patients and HCPs to engage in ACP. Providing patients with information about their disease can help meeting their needs. Additionally, support of HCPs through identification of trigger points, training and system-related changes can facilitate engagement in ACP.

Systematic review registration number

CRD42016039787.

Palliative and end-of-life care conversations in COPD: a systematic literature review

Chronic obstructive pulmonary disease (COPD) is a chronic life-limiting disorder characterised by persistent airflow obstruction and progressive breathlessness. Discussions/conversations between patients and clinicians ensure palliative care plans are grounded in patients' preferences. This systematic review aimed to explore what is known about palliative care conversations between clinicians and COPD patients.

A comprehensive search of all major healthcare-related databases and websites was performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies were quality assessed, employing widely used quality-assessment tools, with only papers scoring moderate-to-high quality included. All relevant data were extracted. A narrative synthesis was used to analyse, process and present the final data.

The findings indicated that the frequency and quality of palliative care conversations is generally poor. Patients and physicians identified many barriers and important topics were not discussed. Patients and clinicians reported tension between remaining hopeful and the reality of the patients' condition. When discussions did happen, they often occurred at an advanced stage of illness and in respiratory wards and intensive care units.

In conclusion, current care practices do not facilitate satisfactory conversations about palliative care between COPD patients and clinicians. This impacts upon the fulfilment of patients' preferences at the end of life.

Conversations about palliative care in COPDhttp://ow.ly/NlKt307jgRs