A Qualitative Study of Unmet Healthcare Needs in Chronic Obstructive Pulmonary Disease. A Potential Role for Specialist Palliative Care?

Abstract

Rationale: Patients with chronic obstructive pulmonary disease (COPD) have high symptom burdens and poor health-related quality of life. The American Thoracic Society issued a consensus statement outlining the need for palliative care for patients with chronic respiratory diseases. A better understanding of the unmet healthcare needs among patients with COPD may help determine which aspects of palliative care are most beneficial.Objectives: To identify the unmet healthcare needs of patients with COPD hospitalized for exacerbation using qualitative methods. Methods:We conducted 20 semistructured interviews of patients admitted for acute exacerbations of COPD focused on patient understanding of diagnosis and prognosis, effect of COPD on daily life and social relationships, symptoms, healthcare needs, and preparation for the end of life. Transcribed interviews were evaluated using thematic analysis. Conclusions: There are many unmet healthcare needs among patients hospitalized for COPD exacerbation. Relief of symptoms, physical limitations, emotional distress, social isolation, and concerns about the future may be better managed by integrating specialist palliative care into our current care model. Measurements and Main

Chronic obstructive pulmonary disease comorbidities

“…Clinical outcomes are worse for study participants with anxiety or depression, compared with COPD patients without these comorbidities, including higher economic burden [59], hospital readmissions [60 & ], and interference with successful disease self-management [61]. Although there are limited clinical trials or specific programs designed to manage anxiety and depression in COPD [62,63], they should be considered for all patients [64 & ]; unfortunately, only a minority of persons with COPD have their emotional needs appropriately addressed [65].…”

Psychosocial consequences of living with breathlessness due to advanced disease

“…They used several coping strategies during these scary moments such as trying to calm down, trying to regulate breathing, use of a fan, or opening windows and doors [12,16 & ]. Other patients lack adequate management strategies to cope with their breathlessness [24].…”

“…The need to use aids, such as wheelchairs in public made some patients avoid going out [30]. Patients report being housebound and feeling lonely because they cannot keep up with the things that everyone else is doing [24]. Disability may also lead to financial problems, for example if patients have to give up working or partners have to give up their jobs to care for them [12].…”

The assessment of work productivity and activity impairment in Behçet’s disease

“…However, disease-related problems often vary among patients. Uncontrolled symptoms or flare ups of chronic conditions can cause emotional distress such as fear and anxiety (1,2). In such circumstances, self-regulation and coping strategies are utilized by patients to overcome the psychological impact of the disease (3).…”