Skip to main content

Main menu

  • Home
  • Current issue
  • Early View
  • Archive
  • Authors/reviewers
    • Instructions for authors
    • Submit a manuscript
    • Institutional open access agreements
    • Peer reviewer login
    • WoS Reviewer Recognition Service
  • Alerts
  • Subscriptions
  • ERS Publications
    • European Respiratory Journal
    • ERJ Open Research
    • European Respiratory Review
    • Breathe
    • ERS Books
    • ERS publications home

User menu

  • Log in
  • Subscribe
  • Contact Us
  • My Cart

Search

  • Advanced search
  • ERS Publications
    • European Respiratory Journal
    • ERJ Open Research
    • European Respiratory Review
    • Breathe
    • ERS Books
    • ERS publications home

Login

European Respiratory Society

Advanced Search

  • Home
  • Current issue
  • Early View
  • Archive
  • Authors/reviewers
    • Instructions for authors
    • Submit a manuscript
    • Institutional open access agreements
    • Peer reviewer login
    • WoS Reviewer Recognition Service
  • Alerts
  • Subscriptions

Palliative and end-of-life care conversations in COPD: a systematic literature review

Nuno Tavares, Nikki Jarrett, Katherine Hunt, Tom Wilkinson
ERJ Open Research 2017 3: 00068-2016; DOI: 10.1183/23120541.00068-2016
Nuno Tavares
1Portsmouth Hospitals NHS Trust, Portsmouth, UK
2NIHR CLAHRC Wessex, Southampton, UK
3Faculty of Health Sciences, University of Southampton, Southampton, UK
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • For correspondence: nct1g14@soton.ac.uk
Nikki Jarrett
3Faculty of Health Sciences, University of Southampton, Southampton, UK
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Katherine Hunt
3Faculty of Health Sciences, University of Southampton, Southampton, UK
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Tom Wilkinson
2NIHR CLAHRC Wessex, Southampton, UK
3Faculty of Health Sciences, University of Southampton, Southampton, UK
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Data
  • Info & Metrics
  • PDF
Loading

Figures

  • Tables
  • Supplementary Materials
  • FIGURE 1
    • Download figure
    • Open in new tab
    • Download powerpoint
    FIGURE 1

    Literature search flow diagram.

Tables

  • Figures
  • Supplementary Materials
  • TABLE 1

    Databases and websites searched

    Databases searchedMedline; CINAHL; PsycINFO; HMIC; AMED; Web of Science; ASSIA; IBSS; Delphis; PubMed; ScienceDirect; Cochrane Library; EMBASE; BNI; AgeInfo and Scopus.
    WebsitesThorax Website; British Thoracic Society (BTS); National Institute For Health And Care Excellence (NICE); Medical Research Council (MRC); Department Of Health (DoH); Economic And Social Research Council (ESRC); National Institute For Health Research (NIHR); American Thoracic Association (ATS); British Lung Foundation (BLS); The National Council For Palliative Care (NCPC); The European Association For Palliative Care (EAPC); Association For Palliative Medicine (APM).
  • TABLE 2

    Inclusion criteria of papers selected for review

    Paper languagePapers were included if written in English. The first language of all authors is English, therefore the inclusion of papers written in any other language would pose a barrier to thoroughly analyse the papers.
    ParticipantsParticipants included were people with COPD and healthcare professionals aged above 18 years old. COPD diagnosis should be done according with GOLD, in which a spirometry is performed showing a FEV1/FVC lower than 70%.
    Papers were included if the sample represented 50% or more of patients with COPD, except if the papers were purposely comparing COPD with other diseases. Papers had to include approximately the same amount of COPD patients and patients with other conditions. A 10% margin was used to include or exclude papers. However, the 10% margin was only applied to the larger categories of patients with other diseases.
    Study designAll study designs were included in the review. The main purpose of the review was to identify and analyse all data published regarding this subject. Therefore, all study designs were included.
    Study qualityPapers were included if presented high or moderate quality. The inclusion of papers with low quality would contaminate the overall findings and conclusion of the review, leading to inaccurate and unreliable data.
    Country restrictionOnly papers from North America, Europe, Australia and New Zealand were included. This is thought relevant as literature from countries with different cultural believes towards health and from countries with small healthcare resources would not provide relevant and usable data for a European and North American society.
    Information presented in papersPapers were included if more than 50% of the information included was about palliative care conversations with COPD patients. This was done using word count. The papers excluded using this approach contained 30% or less of relevant information. Furthermore, the information contained in these papers did not present new information about the topic discussed.
    InterventionConversations included were conversations about the topic “palliative care” between a person with COPD and a healthcare professional.
    Discussion topicsPalliative care discussions addressed at least one of the following topics:
    •  “What are the patient's wishes and preferences for palliative and end of life care?”

    •  “What is the patient's and clinician's understanding of palliative care?”

    •  “What care can be offered to the dying patient?”

    •  “What may the end of life care and/or death look like?”

    •  “What may the future be like?”

    •  “What are the patient's preferences for life-sustaining treatments?”

    •  “How long does the patient have to live?”

    •  “What is the desired place of death?”

    •  “Who would the patient like to be present in the time of death?”

    •  “What are the arrangements for after death?”

    COPD: chronic obstructive pulmonary disease; GOLD: Global Initiative for Chronic Obstructive Lung Disease; FEV1: forced expiratory volume in 1 s; FVC: forced vital capacity.

    • TABLE 3

      Topics discussed during palliative care conversations

      Rarely discussed topicsFrequent topics
      • The process of dying and the discussion of prognosis

      • Spiritual or religious beliefs

      • What dying might be like

      • How long the patient has to live

      • Getting sicker

      • Future treatment decisions

      • Preferences for life sustaining treatments, such as intubation, tracheostomy, oxygen, tube feeding, intravascular fluids and hospital care

      • The possibility of an intensive care unit admission

      • The intubation procedure

      • The patient's inability to speak or to eat while being ventilated

      • The likelihood of death if mechanical ventilation was not performed

      • The death rate associated with mechanical ventilation

    • TABLE 4

      Most common barriers and facilitators endorsed by patients and physicians

      PatientsPhysicians
      Barriers
      • Patients focused on staying alive [18, 21, 37]

      • Patients not certain of which doctor would be taking care of them [21, 37]

      • Patients do not know what kind of care they would want in the future [21, 37]

      • Limited understanding of palliative care and COPD [5, 29]

      • Denial of health status and of the possibility of dying [15, 18, 24]

      • Emotional distress of conversations and of palliative care [18, 29, 38]

      • Patients' readiness to discuss palliative care [37]

      • Lack of time in appointments to discuss all topics [18, 37]

      • Discussions may take away patients' hope [37]

      • Lack of feedback and documentation [18, 30, 40, 45]

      • Lack of thorough knowledge of the patient [3, 18]

      • Difficulty to start conversations and to choose the right time [3, 18, 22, 26, 30, 39, 40, 44, 45]

      • Difficulty for patients to understand and accept information in short periods of time [3, 29, 52]

      • Vision of palliative care as confined to the last days of life and exclusive of life sustaining treatments [29, 30]

      • Uncertainty to prognose in COPD [5, 18, 22, 39, 40, 45]

      • Reluctance of palliative care services to care for patients with COPD [29]

      • Complex discharge planning for COPD patients [18]

      Facilitators
      • Patients who had relatives or friends who had died recently [37]

      • Patients' trust in their physician [37]

      • Patients interpret physicians' skills as very good [37]

      • Patients' belief that physicians truly care about the patient [37]

      • Good patient-physician relationship [29, 37]

      • Physicians who cared for many patients with lung disease [37]

      • Physicians who care for patients with previous acute episodes [37]

      • COPD: chronic obstructive pulmonary disease.

    Supplementary Materials

    • Figures
    • Tables
    • Supplementary Material

      Please note: supplementary material is not edited by the Editorial Office, and is uploaded as it has been supplied by the author.

      Supplementary tables 00068-2016_supplementary_tables

    • Supplementary Material

      T. Wilkinson 00068-2016_Wilkinson

    PreviousNext
    Back to top
    Vol 3 Issue 2 Table of Contents
    ERJ Open Research: 3 (2)
    • Table of Contents
    • Index by author
    Email

    Thank you for your interest in spreading the word on European Respiratory Society .

    NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

    Enter multiple addresses on separate lines or separate them with commas.
    Palliative and end-of-life care conversations in COPD: a systematic literature review
    (Your Name) has sent you a message from European Respiratory Society
    (Your Name) thought you would like to see the European Respiratory Society web site.
    CAPTCHA
    This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
    Print
    Citation Tools
    Palliative and end-of-life care conversations in COPD: a systematic literature review
    Nuno Tavares, Nikki Jarrett, Katherine Hunt, Tom Wilkinson
    ERJ Open Research Apr 2017, 3 (2) 00068-2016; DOI: 10.1183/23120541.00068-2016

    Citation Manager Formats

    • BibTeX
    • Bookends
    • EasyBib
    • EndNote (tagged)
    • EndNote 8 (xml)
    • Medlars
    • Mendeley
    • Papers
    • RefWorks Tagged
    • Ref Manager
    • RIS
    • Zotero
    Share
    Palliative and end-of-life care conversations in COPD: a systematic literature review
    Nuno Tavares, Nikki Jarrett, Katherine Hunt, Tom Wilkinson
    ERJ Open Research Apr 2017, 3 (2) 00068-2016; DOI: 10.1183/23120541.00068-2016
    del.icio.us logo Digg logo Reddit logo Technorati logo Twitter logo CiteULike logo Connotea logo Facebook logo Google logo Mendeley logo
    Full Text (PDF)

    Jump To

    • Article
      • Abstract
      • Abstract
      • Introduction
      • Methods and analysis
      • Results
      • Discussion
      • Supplementary material
      • Disclosures
      • Footnotes
      • References
    • Figures & Data
    • Info & Metrics
    • PDF

    Subjects

    • COPD and smoking
    • Tweet Widget
    • Facebook Like
    • Google Plus One

    More in this TOC Section

    • Physiotherapy for large airway collapse
    • Communicating with patients with IPF
    • E-cigarette and conventional cigarette use
    Show more Review

    Related Articles

    Navigate

    • Home
    • Current issue
    • Archive

    About ERJ Open Research

    • Editorial board
    • Journal information
    • Press
    • Permissions and reprints
    • Advertising

    The European Respiratory Society

    • Society home
    • myERS
    • Privacy policy
    • Accessibility

    ERS publications

    • European Respiratory Journal
    • ERJ Open Research
    • European Respiratory Review
    • Breathe
    • ERS books online
    • ERS Bookshop

    Help

    • Feedback

    For authors

    • Instructions for authors
    • Publication ethics and malpractice
    • Submit a manuscript

    For readers

    • Alerts
    • Subjects
    • RSS

    Subscriptions

    • Accessing the ERS publications

    Contact us

    European Respiratory Society
    442 Glossop Road
    Sheffield S10 2PX
    United Kingdom
    Tel: +44 114 2672860
    Email: journals@ersnet.org

    ISSN

    Online ISSN: 2312-0541

    Copyright © 2023 by the European Respiratory Society