Exploring the care needs of patients with advanced COPD: an overview of the literature.

School of Nursing and Midwifery, The University of Sheffield, Sykes House, Sheffield, UK.
Respiratory medicine (Impact Factor: 2.33). 10/2009; 104(2):159-65. DOI: 10.1016/j.rmed.2009.09.007
Source: PubMed

ABSTRACT Chronic obstructive pulmonary disease (COPD) is a highly prevalent condition worldwide and is associated with significant mortality. This paper gives an overview of the relevant literature regarding care needs in advanced COPD from the perspective of the patient or carer, and aims to explore the appropriateness of a palliative care approach in this group. Publications revealed that patients with COPD have a high symptom burden that impacts on quality of life and social functioning. Information provision in COPD is often lacking and the implications of diagnosis and prognosis are not routinely discussed. The impact on families and carers is considerable, many patients have significant care requirements which can affect family relationships. Although patients with COPD have regular contact with health services, access to specialist services and palliative care is poor. This paper highlights the need for increased provision for palliative care in COPD, alongside dedicated education and training for health professionals, and continued research to identify the most appropriate ways of delivering this care.

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    ABSTRACT: Context. Breathlessness is a distressing symptom in advanced disease. Understanding its patterns, burden and palliative care (PC) needs over time is important to improve patients` quality of life. Objectives To describe and compare the courses of refractory breathlessness, functional status, distress and PC needs in patients with advanced chronic obstructive pulmonary disease (COPD) or lung cancer (LC) over time. Methods This was a cohort study of patients with COPD (stage III/IV) or LC. Data were assessed monthly with up to 12 telephone interviews, using the modified Borg Scale, Karnofsky Performance Status Scale, Distress Thermometer and Palliative care Outcome Scale as outcomes measures. Descriptive analysis compared all outcomes between COPD and LC at baseline and over time (forward from study entry and backward from death). Results Eighty-two patients (50 COPD, 32 LC), mean (SD) age 67.2 (7.8) and 36% female were included (8 COPD, 23 LC deceased). COPD patients perceived higher levels of breathlessness and distress at lower functional status steadily over time. LC patients’ breathlessness, distress and PC needs increased while functional status decreased towards death. PC needs were similar between disease groups. Breathlessness was negatively correlated with functional status (COPD -0.20, P=0.012; LC -0.277, P=0.029) AU: SHOULD, E.G., -0.20, HAVE AN r = IN FRONT OF IT? and positively correlated with PC needs in COPD patients (0.343, P<0.001). Death was significantly predicted by diagnosis (LC: HR=7.84, P<0.001) and functional status (10% decline: HR=1.52, P=0.001). Conclusion PC needs of patients with advanced COPD are comparable to LC patients and breathlessness severity and distress are even higher. PC for COPD patients needs further improvement to address symptom burden and needs.
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    ABSTRACT: The aim of the study was to gain insight into intensive care nurses’ perspectives on compassionate care for patients with exacerbated chronic obstructive pulmonary disease. Patients who experience acute exacerbation are vulnerable because they experience a life-threatening situation and are wholly dependent on health-care interventions to relieve breathlessness. A hermeneutic phenomenological approach was used. Three focus group interviews with intensive-care nurses were conducted at two hospitals in western Norway in the autumn of 2009. One group had five participants, and two groups had six participants each (N=17). A collaborative practice was regarded as essential to provide compassionate care in these situations. Three main themes emerged from the data: (a) preparing to care for breathlessness; (b) establishing a trusting relationship; (c) to approach each patient as a person with unique needs. These were experienced as important in rendering compassionate care for patients with exacerbation of chronic obstructive pulmonary disease. The study showed that compassionate care involves interventions at different levels with particular attention to simple comforting care and technical adjustments. The study also showed a need for enhanced multidisciplinary cooperation in planning the subsequent clinical pathway.
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    ABSTRACT: Abstract Objective: This study explores the perspectives of both patients and family members regarding the impact of chronic obstructive pulmonary disease (COPD) in their family life. Design: An exploratory qualitative study was conducted with patients and their family members in the chronic phase of COPD. Individual interviews were performed to explore participants' perspectives and submitted to thematic analysis. Results: Six major themes emerged from patients' perspective: (1) impact of COPD symptoms on personal and family daily life; (2) (over)protective family support; (3) difficulties in couple communication; (4) sense of identity loss; (5) fear of COPD progression; and (6) coping resources. Five main themes emerged from the family members' perspective: (1) restrictions in family's social life; (2) emotional distress related to COPD exacerbations; (3) tension in couple relationship; (4) financial strain of COPD and (5) coping resources. Conclusions: The overall findings illustrate the complex interaction between the experience of living with COPD and communication patterns, emotional states, social support and social roles within the family. The results highlight the need to develop family-based interventions to facilitate a functional adjustment to COPD. However, these interventions in COPD remain undeveloped and empirical evidence is needed.
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