Might significant events have the potential to trigger assessment of the needs (palliative and supportive) of COPD patients and carers?

Background

Chronic Obstructive Pulmonary Disease (COPD) is a leading cause of morbidity and mortality. The prognostic uncertainty within the trajectory of severe COPD makes identification of a transition point to palliative care difficult. When to assess the needs of an individual with severe COPD, as well as the needs of their carer, is widely debated. Various triggers have been suggested, both palliative and supportive, such as post-acute, hospitalised exacerbations, low FEV1, long term oxygen therapy (LTOT) and low body mass index (BMI), but there is currently no agreed consensus. Coupled with this, is national and international literature highlighting the lack of formal palliative care pathways or models of care that are able to meet the challenge of palliation of symptoms, alongside optimised medical management.

Methods

The narrative accounts of individuals with severe COPD and their carers in a previous piece of primary, empirical research, were explored for events that could act as potential triggers for a holistic assessment of needs. Having identified events within the severe COPD disease trajectory, the potential for these events to act as triggers was explored through a consensus methodological approach, with health and social care professionals and then explored with patients and carers.

Results

The eight identified events from the secondary qualitative data analysis were discussed within a nominal group technique approach to attempt to gain consensus. Identifying triggers and events had some resonance with professionals, but patients and carers struggled with this approach. Patients and carers did however, welcome a holistic assessment of needs and how this could be integrated into current services.

7

Conclusions

The relatively unexplored area of trigger identification in aiding a holistic assessment of needs within severe COPD has been debated in this study with professionals, patients and carers alike. However, the acceptability and feasibility of this approach has had varied responses from the perspectives of the different stakeholders involved in this process, in particular those of patients and carers. In response, any approach to aid a holistic assessment of needs in severe COPD in the future, will require careful exploration with these stakeholders about the initial concept of the research, with the aim of linking their understanding of what will enhance the patient experience to the design of the research process.

Keywords: COPD, holistic assessment of needs, palliative, supportive