Michelle Scibiwolk, SRT
Palliative care is a patient centered holistic approach to care that aims to improve the quality of life for patients and their families who suffer from terminal illnesses (Goodridge & Peters, 2019). The aims of palliative care include prevention, identification, and management of physical, psychological, social, cultural, emotional, and spiritual needs of the individual and the family (Goodridge & Peters, 2019). In recent years it has been established that patients with chronic respiratory disease, defined as a group of diseases that affect the airways and lungs, can benefit the most from palliative care (Rajnoveanu et al, 2020). Under the umbrella term of chronic respiratory disease, the most common disease is chronic obstructive pulmonary disease (COPD), which by 2030 is expected to become the third cause of mortality in the world (Rajnoveanu et al, 2020). As the population ages, the need for palliative care services increases for patients with COPD, but unfortunately this has not been addressed in practice (Rajnoveanu et al., 2020).
Respiratory Health Professionals (RHP) who care for patients with advanced respiratory diseases have seen that these patients experience less access to palliative care than other patients with similar disease burden, such as lung cancer (Goodridge & Peters, 2019). One study which distributed an online survey nationally using the database of the lung association respiratory educator training program, found that out of 123 surveys completed there was significant variability in the frequency of palliative care conversations that RHPs have with patients, despite 65% of respondents stating they were comfortable discussing this topic (Goodridge & Peters, 2019). Evidence suggests that patients with COPD therefore have poor quality palliative care due to barriers that occur with the patient and the RHP.
Barriers for the patient and family involved difficulty accepting prognosis, lack of capacity, fear of abandonment for accessing care, difficulty accepting limitations and complications, and disagreement with caregivers over palliative care planning (Goodridge & Paters, 2019). This is significant for patients because it displays the need for education in palliative care, particularly in five key areas including diagnosis, disease process, treatment, prognosis, process of death, and advance care planning (Curtis, 2008). Understanding these aspects allows for patients to have well-informed conversations with the RHP leading to better quality of care. Another reason the patient might experience lack of palliative care is due to barriers from the RHP which include uncertainty in predicting prognosis, lack of time to discuss palliative care, and lack of training towards palliative care discussions (Curtis, 2008). Rather than the RHP offering palliative care to individuals who have more life-threatening conditions such as lung cancer, the RHP should offer more advanced care planning for conditions that are life long and involve periods of exacerbation and improvement, such as what is seen in patients with a diagnosis of COPD.
In current palliative care models, there is a more linear approach to palliative care where the RHP remains idle until there is a terminal illness to initiate the palliative care. By changing this system to a more accessible model with collaborative, multi-disciplinary services that allow for bilateral education and future planning, patients with COPD can access better quality palliative care (Smallwood et al., 2018). Allowing for the integration of palliative care and chronic disease management for patients helps to bridge the gaps in palliative care (Harrington, Rogers & Davis, 2017). Providing a clear focus on the needs of the patient and not the prognosis of the patient allows for better management of symptoms and for less mismatch between practice and knowledge (Goodridge & Peters, 2019). Further research on this proposed model should be conducted within a larger scale of both provincial and national professional licensing bodies, to provide new insights into the power of proactive palliative care for advanced respiratory conditions (Goodridge & Peters, 2019).
References
Curtis J. R. (2008). Palliative and end-of-life care for patients with severe COPD. The European Respiratory Journal, 32(3), 796–803. https://doi.org/10.1183/09031936.0012610
Goodridge, D., & Peters, J. (2019). Palliative care as an emerging role for respiratory health professionals: Findings from a cross-sectional, exploratory Canadian survey. Canadian Journal of Respiratory Therapy: CJRT = Revue canadienne de la therapie respiratoire : RCTR, 55, 73–80. https://doi.org/10.29390/cjrt-2019-010
Harrington, S. E., Rogers, E., & Davis, M. (2017). Palliative care and chronic obstructive pulmonary disease: where the lines meet. Current Opinion in Pulmonary Medicine, 23(2), 154–160. https://doi.org/10.1097/MCP.0000000000000358
Rajnoveanu, R. M., Rajnoveanu, A. G., Fildan, A. P., Todea, D. A., Man, M. A., Motoc, N. S., & Mosoiu, D. (2020). Palliative Care Initiation in Chronic Obstructive Pulmonary Disease: Prognosis-Based, Symptoms-Based or Needs-Based? International Journal of Chronic Obstructive Pulmonary Disease, 15, 1591–1600. https://doi.org/10.2147/COPD.S254104
Smallwood, N., Currow, D., Booth, S., Spathis, A., Irving, L., & Philip, J. (2018). Attitudes to specialist palliative care and advance care planning in people with COPD: a multi-national survey of palliative and respiratory medicine specialists. BMC Palliative Care, 17(1), 115. https://doi.org/10.1186/s12904-018-0371-8
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