Knowledge and Attitudes of Allied Health Professionals Towards End-Of-Life and Advance Care Planning Discussions With People With COPD: A Cross-Sectional Survey Study

Abstract

Chronic obstructive pulmonary disease (COPD) is a progressive, life-limiting condition. End-of-life (EOL) and Advance Care Planning (ACP) discussions are essential, yet access and support remain inadequate. Allied health professionals (AHPs) commonly have ongoing relationships with patients and opportunities to discuss care outside acute crises as is considered best practice. Australian and New Zealand AHPs were invited to complete an anonymous, online, cross-sectional survey that aimed to explore knowledge, attitudes and practices, and associated perceived triggers and barriers to EOL and ACP discussions with patients with COPD. Closed survey responses were summarized descriptively and free-text thematically analysed. One hundred and one AHPs (physiotherapists, social workers and occupational therapists) participated. Many held positive attitudes towards ACP but lacked procedural knowledge. Half (50%) of participants routinely discussed EOL care with patients when perceiving this to be appropriate but only 21% actually discussed ACP with the majority of their patients. Many cited lack of training to engage in sensitive EOL discussions, with barriers including: 1) clinician lack of confidence/fear of distressing patients (75%); 2) perceived patient and family reluctance (51%); 3) organizational challenges (28%); and 4) lack of role clarity (39%). AHPs commonly have ongoing relationships with patients with chronic conditions but lack the confidence and role clarity to utilise this position to engage ongoing EOL and ACP discussions. While AHPs may not traditionally consider EOL and ACP discussions as part of their role, it is crucial that they feel prepared to respond if patients broach the topic.

Interdisciplinary strategies for establishing a trusting relation as a pre-requisite for existential conversations in palliative care: a grounded theory study

“…To emphasise the importance of ethical competence for quality patient care, particularly in PC, a combination of care ethics, clinical pro ciency, relational skills and effective communication is essential. (10,11,12) HCPs from diverse disciplines need to cooperate (10). In Sweden, PC teams are usually led by physicians and RNs in cooperation with related HCPs (7).…”

“…Good communication skills and the ability to listen attentively and with compassion facilitate these conversations (11). A previous study found that PTs and OTs generally hold positive beliefs about advanced care planning and end-of-life conversations, but common barriers to these discussions include a lack of con dence, perceived patient and family reluctance, organisational challenges and a lack of role clarity (12). Moreover, nursing home professionals such as ANs and care assistants are task-oriented and often lack the time to talk to patients and their next-of-kin (13).…”