Barriers to Palliative Care Referral and Advance Care Planning (ACP) for Patients With COPD: A Cross-Sectional Survey of Palliative Care Nurses.

Disler, R; Pascoe, A; Luckett, T; Donesky, D; Irving, L; Currow, DC; Smallwood, N

Barriers to Palliative Care Referral and Advance Care Planning (ACP) for Patients With COPD: A Cross-Sectional Survey of Palliative Care Nurses.

Disler, R Pascoe, A Luckett, T Donesky, D Irving, L Currow, DC Smallwood, N

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Publisher:: SAGE PUBLICATIONS INC
Publication Type:: Journal Article
Citation:: The American journal of hospice & palliative care, 2021, pp. 10499091211018192
Issue Date:: 2021-05-20

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Field	Value	Language
dc.contributor.author	Disler, R
dc.contributor.author	Pascoe, A
dc.contributor.author	Luckett, T
dc.contributor.author	Donesky, D
dc.contributor.author	Irving, L
dc.contributor.author	Currow, DC
dc.contributor.author	Smallwood, N
dc.date.accessioned	2021-09-10T04:00:56Z
dc.date.available	2021-09-10T04:00:56Z
dc.date.issued	2021-05-20
dc.identifier.citation	The American journal of hospice & palliative care, 2021, pp. 10499091211018192
dc.identifier.issn	1049-9091
dc.identifier.issn	1938-2715
dc.identifier.uri	http://hdl.handle.net/10453/150449
dc.description.abstract	<h4>Background</h4>Chronic obstructive pulmonary disease (COPD) is a progressive, life-limiting illness that requires end-of-life care planning, yet remains under-served. Understanding barriers to advance care planning (ACP) from different specialties' perspectives will enable a co-ordinated, cross-disciplinary approach to improving ACP access.<h4>Methods</h4>Australia and New Zealand palliative care nurses were invited to complete an anonymous online cross-sectional survey. Questions tested knowledge of validated ACP-related practice indicators and canvassed perspectives on barriers to ACP in COPD. Data are described and free-text thematically analyzed.<h4>Results</h4>The 90 participants had high knowledge and positive attitudes to ACP in COPD, however, lacked consensus as to whether patients want to know their prognosis or discuss treatment options and end-of-life wishes. 59% discussed ACP in more than half their patients with COPD, and 77% and 73% routinely initiated or followed-up these discussions. Key barriers included: lack of confidence and training in COPD; reluctance to distress patients and families; referral late in the disease course; lack of consensus on referral timing; and lack of patient and clinician understanding of COPD prognoses. Many reported that lack of consensus in the treating team, paired with prognostic uncertainty, precluded timely ACP engagement.<h4>Conclusions</h4>Palliative care nurses have substantial knowledge and positive beliefs regarding ACP, however, some beliefs and practices lack alignment with qualitative data on patients' wishes in COPD. While palliative care nurses are well placed to facilitate early implementation for patients with advanced COPD, ACP training and practice guidelines specific to COPD may increase implementation in this life-limiting disease.
dc.format	Print-Electronic
dc.language	eng
dc.publisher	SAGE PUBLICATIONS INC
dc.relation.ispartof	The American journal of hospice & palliative care
dc.relation.isbasedon	10.1177/10499091211018192
dc.rights	info:eu-repo/semantics/closedAccess
dc.subject	1110 Nursing
dc.subject.classification	Gerontology
dc.title	Barriers to Palliative Care Referral and Advance Care Planning (ACP) for Patients With COPD: A Cross-Sectional Survey of Palliative Care Nurses.
dc.type	Journal Article
utslib.location.activity	United States
utslib.for	1110 Nursing
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
pubs.organisational-group	/University of Technology Sydney/Faculty of Health/IMPACCT
utslib.copyright.status	closed_access	*
dc.date.updated	2021-09-10T04:00:56Z
pubs.publication-status	Published

Abstract:

Background

Chronic obstructive pulmonary disease (COPD) is a progressive, life-limiting illness that requires end-of-life care planning, yet remains under-served. Understanding barriers to advance care planning (ACP) from different specialties' perspectives will enable a co-ordinated, cross-disciplinary approach to improving ACP access.

Methods

Australia and New Zealand palliative care nurses were invited to complete an anonymous online cross-sectional survey. Questions tested knowledge of validated ACP-related practice indicators and canvassed perspectives on barriers to ACP in COPD. Data are described and free-text thematically analyzed.

Results

The 90 participants had high knowledge and positive attitudes to ACP in COPD, however, lacked consensus as to whether patients want to know their prognosis or discuss treatment options and end-of-life wishes. 59% discussed ACP in more than half their patients with COPD, and 77% and 73% routinely initiated or followed-up these discussions. Key barriers included: lack of confidence and training in COPD; reluctance to distress patients and families; referral late in the disease course; lack of consensus on referral timing; and lack of patient and clinician understanding of COPD prognoses. Many reported that lack of consensus in the treating team, paired with prognostic uncertainty, precluded timely ACP engagement.

Conclusions

Palliative care nurses have substantial knowledge and positive beliefs regarding ACP, however, some beliefs and practices lack alignment with qualitative data on patients' wishes in COPD. While palliative care nurses are well placed to facilitate early implementation for patients with advanced COPD, ACP training and practice guidelines specific to COPD may increase implementation in this life-limiting disease.

Please use this identifier to cite or link to this item:

http://hdl.handle.net/10453/150449