Timing and nature of palliative care discussions are patient-specific according to clinicians: a qualitative study

BackgroundChronic obstructive pulmonary disease (COPD) is associated with an unpredictable and complex disease trajectory. Consequently, most patients are not involved in advance care planning and do not receive palliative care until the end of life. AimTo explore clinicians experiences, opinions and recommendations for the timing and nature of palliative care discussions in COPD. DesignQualitative interviews with nurses and doctors that provide direct care to COPD patients. Setting/Participants14 clinicians working across primary and secondary care in the UK were interviewed. ResultsParticipants suggested that those with the appropriate expertize and an established relationship with patients were best placed to initiate discussions about palliative and future care. Early, gradual and informed palliative and future care discussions were considered best practice, however they uncommon occurrence due to service, patient and clinician-related barriers. The unpredictable disease trajectory and fine balance between providing acute care and discussing palliative care options were suggested as key greatest barriers for discussions. However, damaging patient hope was a concern for clinicians and reduced their inclination to discuss palliative care. Clinicians did not seem to think that patients were ready for discussions, therefore they avoided broaching the subject leading early in the disease trajectory. ConclusionStand-alone conversations about and near the end of life was described as current usual practice by clinicians, however individualised early, regular and gradual discussions with patients about immediate and long-term future plans may make such discussions feel less negative and ordinary for patients and clinicians.