Abstract
BackgroundEnd-stage cardiac and respiratory diseases are common in the UK. People with these end-stage conditions experience similar, or even worse, symptomatic suffering to cancer patients but are less likely to receive specialist palliative care services. The objective of this study is to explore health professional perceptions and current practices in relation to specialist palliative care for patients with end-stage cardiac and respiratory disease.MethodsQualitative study using in-depth interviews with health professionals, audio recorded and transcribed verbatim for thematic analysis. The study was conducted with doctors and nurses from cardiology, respiratory, and palliative care specialities in the UK. The participants had to be involved clinically in providing care to people with end-stage cardiac or respiratory diseases.ResultsA total of 16 health professionals participated (5 cardiology, 5 respiratory, and 6 palliative care). Participants reported variable disease trajectories in these diseases making deciding on timing of palliative care involvement difficult. This was complicated by lack of advance care planning discussions, attributed to poor communication, and lack of health professional time and confidence. Participants reported poor interdepartmental education and limited specialist palliative care involvement in multidisciplinary teams.ConclusionsPalliative care for end-stage cardiac and respiratory diseases needs more attention in research and practice. Better integration of advance care planning discussions and early patient education/professional awareness are needed to enable timely referral to palliative care. Moreover, increased interdepartmental working for health professionals via joint educational and clinical meetings is perceived as likely to support earlier and increased referral to specialist palliative care services.
Highlights
End-stage cardiac and respiratory diseases are common in the UK
Cancer accounted for 28.1% of deaths in the UK in 2017, circulatory diseases account for 25%, and respiratory diseases for 13.8% [6]
Specialist palliative care may be as beneficial in these diseases as it is for cancer patients, with strong evidence supporting the benefits [8, 9, 11]
Summary
End-stage cardiac and respiratory diseases are common in the UK People with these end-stage conditions experience similar, or even worse, symptomatic suffering to cancer patients but are less likely to receive specialist palliative care services. The objective of this study is to explore health professional perceptions and current practices in relation to specialist palliative care for patients with end-stage cardiac and respiratory disease. Chronic heart failure (CHF) and end-stage respiratory diseases are common chronic conditions in the UK and globally, with increasing prevalence [1, 2]. It is estimated that the number of COPD cases globally in 2010 was 384 million, with a prevalence of 11.7%. Specialist palliative care may be as beneficial in these diseases as it is for cancer patients, with strong evidence supporting the benefits [8, 9, 11]. Suggested reasons include difficulty prognosticating, as well as limited knowledge and inaccurate perceptions of palliative care by health care professionals (HCPs) and patients [14, 15]
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