Tracy A Smith1,2, Rebecca T Disler3,4, Christine R Jenkins5,6, Jane M Ingham1,7, Patricia M Davidson3,8. 1. 1 St Vincent's Clinical School, Faculty of Medicine, UNSW Australia, Sydney, NSW, Australia. 2. 2 Department of Respiratory & Sleep Medicine, Westmead Hospital, Wentworthville, NSW, Australia. 3. 3 Sydney Nursing School, University of Sydney, Sydney, NSW, Australia. 4. 4 ImPaCCT (Improving Palliative Care through Clinical Trials) NSW Palliative Care Collaborative Clinical Trials Group, Liverpool, NSW, Australia. 5. 5 Faculty of Medicine, The University of Sydney, Sydney, NSW, Australia. 6. 6 The George Institute, Sydney, NSW, Australia. 7. 7 St Vincent's Health Network, Sydney, NSW, Australia. 8. 8 Department of Acute and Chronic Care, Johns Hopkins University, Baltimore, MD, USA.
Abstract
BACKGROUND: Patients requiring non-invasive ventilation for acute-on-chronic respiratory failure due to chronic obstructive pulmonary disease or heart failure exacerbations may have a poor prognosis underscoring the importance of advance care planning. AIM: We aimed to describe attitudes to, and experiences of, discussing the future among patients recently treated with non-invasive ventilation. DESIGN: Qualitative research using thematic analysis. SETTINGS AND PARTICIPANTS: Tertiary teaching hospital. Patients with acute hypercapnic respiratory failure requiring non-invasive ventilation. RESULTS: Individuals recently treated with non-invasive ventilation describe feeling the future is beyond their control and instead controlled by their illness. Participants often recognised their poor prognosis but avoided discussing some difficult topics. The majority preferred not to undergo cardiopulmonary resuscitation but most had not discussed this with healthcare professionals. When participants voiced concerns about their future health to family members, they were met with polarised responses. Some encountered willingness for further discussion, while others met deflection, deterring further conversation. An overarching narrative of 'Looking through my illness to an uncertain but concerning future' unites these themes. CONCLUSION: This study suggests opportunities and barriers for advance care planning in individuals with chronic disease. Patients' understanding of their prognosis and their attitudes to cardiopulmonary resuscitation suggests an opportunity for advance care planning. Structuring discussions around patients' preferences for care during future exacerbations may foster a sense of control over the future despite illness. The diversity of familial responses to patients' concerns about their future health has implications for advance care planning. These findings have the potential to improve care for patients with respiratory failure and suggest an important ongoing research agenda.
BACKGROUND:Patients requiring non-invasive ventilation for acute-on-chronic respiratory failure due to chronic obstructive pulmonary disease or heart failure exacerbations may have a poor prognosis underscoring the importance of advance care planning. AIM: We aimed to describe attitudes to, and experiences of, discussing the future among patients recently treated with non-invasive ventilation. DESIGN: Qualitative research using thematic analysis. SETTINGS AND PARTICIPANTS: Tertiary teaching hospital. Patients with acute hypercapnic respiratory failure requiring non-invasive ventilation. RESULTS: Individuals recently treated with non-invasive ventilation describe feeling the future is beyond their control and instead controlled by their illness. Participants often recognised their poor prognosis but avoided discussing some difficult topics. The majority preferred not to undergo cardiopulmonary resuscitation but most had not discussed this with healthcare professionals. When participants voiced concerns about their future health to family members, they were met with polarised responses. Some encountered willingness for further discussion, while others met deflection, deterring further conversation. An overarching narrative of 'Looking through my illness to an uncertain but concerning future' unites these themes. CONCLUSION: This study suggests opportunities and barriers for advance care planning in individuals with chronic disease. Patients' understanding of their prognosis and their attitudes to cardiopulmonary resuscitation suggests an opportunity for advance care planning. Structuring discussions around patients' preferences for care during future exacerbations may foster a sense of control over the future despite illness. The diversity of familial responses to patients' concerns about their future health has implications for advance care planning. These findings have the potential to improve care for patients with respiratory failure and suggest an important ongoing research agenda.
Authors: Dagmar Giese; Jörg Blau; Walter Knüppel; Aggi Neumann-Schiebener; Andreas Günther; Christian Reinhardt; Wolfram Windisch; Stefan Andreas Journal: Dtsch Med Wochenschr Date: 2020-09-09 Impact factor: 0.628
Authors: Linda H Phung; Deborah E Barnes; Aiesha M Volow; Brookelle H Li; Nikita R Shirsat; Rebecca L Sudore Journal: J Am Geriatr Soc Date: 2021-06-01 Impact factor: 7.538