[Pulmonologist perceptions and practices of palliative care for people with chronic obstructive pulmonary disease]

Rev Mal Respir. 2020 Jun;37(6):451-461. doi: 10.1016/j.rmr.2020.04.011. Epub 2020 Jun 3.
[Article in French]

Abstract

Introduction: Numerous studies about poor communication and altered quality of life of patients with chronic obstuctive pulmonary disease (COPD) lead to the conclusion that overall palliative management of COPD remains to be improved. The aim of this study was to describe pulmonologists' practice of palliative care for COPD patients in order to identify obstacles to it.

Material and method: A survey was sent to all pulmonologists whose email appeared in the 2017 French-language Respiratory Medicine Society's directory.

Results: A total of 294 responses were obtained, among which 287 were analysed. Overall, 81.6% of the pulmonologists said that they identify a distinct palliative phase from "sometimes to often" in the care of COPD patients. When not identified, the most common reason given (68.8%) was the difficulty of defining when to start palliative care. Aspects of the palliative approach, which were considered the most problematic for pulmonologists, were the discussion of end of life care, and the impression that COPD patients have a low demand for information. 31% of pulmonologists reported that they gathered information about patients' wishes to undergo resuscitation and endotracheal intubation in 61 % to 100% of patients who they judged to have the most severe disease.

Conclusion: Uncertainty as to when to begin a palliative approach for COPD patients and perceptions around communication in chronic diseases appear to be the main obstacles to a palliative approach.

Keywords: Advance directive; Bronchopneumopathie chronique obstructive; Chronic obstructive pulmonary disease; Communication; Directives anticipées; Dyspnoea; Dyspnée; Palliative care; Soins palliatifs.

MeSH terms

  • Adult
  • Advance Directives / psychology
  • Advance Directives / statistics & numerical data
  • Aged
  • Female
  • France / epidemiology
  • Humans
  • Male
  • Middle Aged
  • Palliative Care / psychology*
  • Palliative Care / standards
  • Palliative Care / statistics & numerical data*
  • Perception*
  • Physician-Patient Relations
  • Practice Patterns, Physicians' / standards
  • Practice Patterns, Physicians' / statistics & numerical data*
  • Pulmonary Disease, Chronic Obstructive / epidemiology
  • Pulmonary Disease, Chronic Obstructive / psychology
  • Pulmonary Disease, Chronic Obstructive / therapy*
  • Pulmonary Medicine / standards
  • Pulmonary Medicine / statistics & numerical data
  • Pulmonologists* / psychology
  • Pulmonologists* / statistics & numerical data
  • Quality of Life
  • Terminal Care / methods
  • Terminal Care / psychology
  • Terminal Care / statistics & numerical data