This article describes health and social care professionals’ perceptions of palliative care and facilitators and barriers to the delivery of such care for patients with advanced chronic obstructive pulmonary disease. Health professionals participated in semi structured interviews and focus groups which were analysed using content analysis. According to participants, care of patients with chronic obstructive pulmonary disease is focused upon the management of symptoms, with emphasis focused predominately on an acute model of care. Key barriers towards the delivery of palliative care included the reluctance to negotiatie end-of-life decisions and a perceived lack of understanding among patients and carers regarding the illness trajectory. Consequently the delivery of palliative care was viewed as a specialist role rather than an integral component of care. There is a need for education and training for health and social care professions to plan and provide high quality end-of-life care.
1 Almagro P Calbo E Ochoa de Echaguen A Barreiro B Quintana S Heredia L . Mortality after hospitalization for COPD. Chest2002; 121: 1441–1448.
2.
2 Mannino DM Holguin F . Epidemiology and global impact of chronic obstructive pulmonary disease. Respir Med: COPD Update2006; 1: 114–120.
3.
3 British Lung Foundation. Lost in translation — bridging the communication gap in COPD.London: British Lung Foundation; 2006.
4.
4 Department of Health, Social Services and Public Safety.A healthier future, a strategic framework for respiratory conditions.Belfast: DHSSPS; 2006.
5.
5 National Institute for Clinical Excellence. Chronic obstructive pulmonary disease: management of chronic obstructive pulmonary disease in primary and secondary care.London: NICE; 2004.
6.
6 Department of Health. The national services framework for long term conditions.London: Department of Health; 2005.
7.
7 Shah S Blanchard M Tookman A Jones L Blizard R King M . Estimating needs in life threatening illness: a feasibility study to assess the views of patients and doctors. Palliat Med2006; 20: 205–210.
8.
8 Curtis RJ Engelberg R Wenrich M . Communication about palliative care for patients with Chronic obstructive pulmonary disease. J Palliat Care2005; 21: 157–164.
9.
10.
10 Dharmasena HP Forbes K . Palliative care for patients with non-malignant disease: will hospital physicians refer. Palliat Med2001; 15: 413–418.
11.
11 Ahmed N Bestall J Ahmedzai S Payne S Clark D Noble B . Systematic review of the problems and issues of accessing specialist palliative care by patients, carers and health and social care professionals. Palliat Med2004; 18: 525–542.
12.
12 Claessens MT Lynn J Zhong Z Desbiens NA Phillips RS Wu AW . Dying with lung cancer or chronic obstructive pulmonary disease: insights from SUPPORT. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments. J Am Geriatr Soc2000; 48(5 Suppl): S146–S153.
13.
13 Au DH Urdis EM Fihn SD McDonell MB Curtis JR . Differences in health care utilization at the end of life among patients with chronic obstructive pulmonary disease and patients with lung cancer. Arch Intern Med2005; 166: 326–331.
14.
14 Seamark DA Seamark C Halpin D . Palliative care in chronic obstructive pulmonary disease: a review for clinicians. J R Soc Med2007; 100: 225–233.
15.
15 Elkington H White P Higgs R Pettinari CJ . GPs views of discussions of prognosis in severe COPD. Fam Pract2001; 18: 440–444.
16.
16 Lynn J Ely W Zhong Z McNiff KL Dawson NV Connors A . Living and dying with chronic obstructive pulmonary disease. J Am Geriatr Soc2000; 48: 91–100.
17.
17 Nohria A Lewis E Stevenson LW . Medical management of advanced heart failure. JAMA2002; 287: 628–640.
18.
18 Aldred H Gott M Gariballa S . Exploring the palliative care needs of an older cohort with chronic heart failure. Age Ageing2002; 31(Suppl. 2): 12.
19.
19 Price B . Illness career: the chronic illness experience. J Adv Nurs1996; 24: 275–279.
20.
20 Lo B . [Editorial; comment] Improving care near the end of life. Why is it so hard. JAMA1995; 274: 1634–1636.
21.
21 Whittemore R . Consequences of not knowing the patient. Clin Nurse Spec2000; 14: 75–81.
22.
22 McCarthy M Addington-Hall JM Lay M . Communication and choice in dying from heart disease. J R Soc Med1997; 90: 128–131.
23.
23 Exley C Field D Jones L Stokes T . Palliative care in the community for cancer and end-stage cardiorespiratory disease: the views of patients, lay-carers and healthcare professionals. Palliat Med2005; 19: 76–83.
24.
24 Curtis JR Engelberg RA Nielsen EL Au DH Patrick DL . Patient-physician communication about end-of-life care for patients with severe COPD. Eur Respir J2004; 24: 200–205.
25.
25 McIlfatrick S . Assessing palliative care needs: views of patients, informal carers and health professionals. J Adv Nurs2007; 57: 77–86.
26.
26 Yohannes AM . Palliative care provision for patients with chronic obstructive pulmonary disease. Health Qual Life Outcomes2007; 5: 17.
27.
27 Loftus L . A Collaborative. nursing model for advanced non-malignant disease. Int J Palliat Nurs1998; 6: 454–458.
28.
28 O’Brien T . Neurodegenerative disease. In: J Addington-Hall IJ Higginson , (eds), Palliative care for non-cancer patient.Oxford: Oxford University Press; 2001. p. 44–53.
29.
29 Dudgeon JD Raubertas FR Doerner K O’Connor T Tobin M Rosenthal S . When does palliative care begin? A needs assessment of cancer patients with recurrent disease. J Palliat Care1995; 11: 5–9.
30.
30 Miles MB Huberman AM . Qualitative data analysis.Newbury Park: Sage Publications; 1994.
