Advance care planning education in Pulmonary Rehabilitation – results from an Irish nationwide survey of Pulmonary Rehabilitation Programmes

Abstract

According to widely recognised international guidelines (Spruit et al, ERS/ATS Statement 2013) Advance Care Planning (ACP) forms a key aspect of patient education in Pulmonary Rehabilitation Programmes (PRP). This study aimed to investigate the practice of ACP education within PRPs in Ireland. All 27 PRPs in the Republic of Ireland were surveyed between May and September 2015; eliciting detailed quantitative and qualitative information about ACP education delivery. Data wasanalysed using SPSS statistical software and thematic content analysis. Twenty-two (81.5%) of PRPs took part in the survey; with 86.4% (n=19) of these being delivered in a hospital setting. Forty-five percent (n=10) include ACP education of at least 20 minutes duration (n=5) or as part of another session (n=5). Advance care planning topics discussed included those recommended by the 2013 ERS/ATS Statement but differed significantly across PRP sites. Sessions were either delivered by respiratory nurses, physiotherapists, physicians or palliative care physicians. Of the 12 sites currently not providing ACP education in the PR Programme, almost half (n=5) indicated a willingness to include this in the near future. Respondents identified enablers and barriers to ACP education as well as staff education and service delivery gaps. The results demonstrate an overwhelmingly positive attitude towards ACP education, including from sites currently not delivering this education. There is a need for ACP specific education for all staff involved in PRPs. Practical guidance on how to deliver this patient education component needs to be developed.