Discussing an uncertain future: end-of-life care conversations in chronic obstructive pulmonary disease. A systematic literature review and narrative synthesis
- 1NIHR CLAHRC for Cambridge and Peterborough, Institute of Public Health, University of Cambridge, Cambridge, UK
- 2North Street Medical Practice, Peterborough, UK
- 3University of Cambridge Medical School Library, School of Clinical Medicine, Cambridge, UK
- 4General Practice and Primary Care Research Unit, Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Cambridge, UK
- Correspondence to Dr Stephen Barclay, General Practice and Primary Care Research Unit, Department of Public Health and Primary Care, University of Cambridge, Institute of Public Health, Robinson Way, Cambridge CB2 0SR, UK;
Contributors The study was designed and led by SB, literature searching was undertaken by NM, ES and IK, screening of abstracts and papers by NM, PH, SB and ES, data extraction by NM and PH, journal hand-searching by NM and PH, and synthesis by NM, PH and SB. All the authors have contributed to writing the paper. SB is the guarantor.
- Received 7 March 2012
- Accepted 7 June 2012
- Published Online First 16 July 2012
Background Guidelines recommend open discussions between patients and healthcare professionals as the end-of-life (EOL) approaches. Much of the knowledge about the EOL is based on the needs of patients with cancer and the applicability of this to other diseases is often queried. A literature review was undertaken concerning EOL care (EOLC) conversations in chronic obstructive pulmonary disease (COPD).
Design A systematic literature review and narrative synthesis obtained papers reporting on EOLC conversations between patients with COPD and their healthcare professionals with respect to the prevalence of conversations; each party's preferences for timing and content; and the facilitators and blockers. Inclusion criteria were articles published in peer-reviewed journals, written in English, reporting studies of adult patients with COPD and/or their healthcare professionals concerning discussions of care at the EOL.
Results 30 papers were identified. Most patients reported that they have not had EOLC discussions with healthcare professionals. While many patients would like these conversations, a potentially large minority would not; the proportions varied among studies. Healthcare professionals find these discussions difficult and many prefer patients to initiate them.
Conclusions Patients' preferences for EOLC conversations vary greatly. Healthcare professionals need to respect the wishes of those not wanting to discuss EOLC and provide multiple opportunities for those who do wish to have these discussions. Recommendations on how to approach the conversation are made.
Funding This study was funded by the NIHR CLAHRC (Collaborations for Leadership in Applied Health Research and Care) for Cambridgeshire and Peterborough and Macmillan Cancer Support: their support is gratefully acknowledged. The opinions expressed are those of the authors not the funders.
Competing interests None.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement We would be prepared to share data extraction sheets.