Perspectives on Palliative Care Approaches in People with Advanced COPD: A Qualitative Study of Patients Attending a Breathe Easy Clinic and Day Hospice

Figures & Tables

Inclusion and exclusion criteria.

INCLUSION CRITERIA	EXCLUSION CRITERIA
Classification of airflow limitation severity in COPD: Severe III GOLD (30% ≤ FEV1 < 50% pred.), Very severe IV GOLD (FEV1 < 30% predicted). Attended a supportive clinic or a day hospice at least 2 times. Speaking English.	Diagnosed psychiatric or cognitive disorders other than depression, anxiety and panic attacks. Diagnosed progressive neurological or neuromuscular disorders. Active cancer. Another uncontrolled or unstable disease. Any other respiratory disease.

Characteristics of the participants.

CHARACTERISTICS	ALL PARTICIPANTS (n = 19)	BREATHE EASY CLINIC (n = 13)	DAY HOSPICE (n = 6)
Gender (male/female)	9/10	8/5	1/5
Age (mean, years)	67.3 ± 9.3	66.6 ± 6.5	68.67 ± 5.71
Smoking status (ex-smoker/smoker)	16/3	10/3	6/0
Educational level
Secondary	13	8	5
Vocational	4	4	0
Higher	2	1	1
Marital status
Married/partnership	10	9	3
Divorced/separated	3	3	0
Widowed	4	2	2
Single	2	2	1
Antidepressants (yes/no)	10/9	6/7	4/2
Therapies during the disease course
Group pulmonary rehabilitation	13	10	3
Individual pulmonary rehabilitation	8	7	1
Self-management programme	8	8	0
Relaxation therapy	8	5	3
Self-help group	5	4	1
Counselling	3	3	0
Massage	3	2	1
No therapies	3	1	2
Oxygen therapy (yes/no)	12/7	7/6	5/1
FEV 1% predicted (n = 17)*	32.4 ± 8.1	30.2 ± 7.6	39.58 ± 2.52
GOLD stage (n = 17)*
Severe	10	6	4
Very severe	7	7	0

[i] *Missing data.

Interview Schedule.

Understanding the diagnosis and everyday life

Social life and relationships

How would you describe your social life lately?
How has the disease affected your social life (for example, contact with relatives, and friends)?
What do you do to make yourself feel better?
What do you think could be done in order to change and improve your social life?

Psychological needs

How would you describe your mood recently?
How does living with COPD affect your mood and emotions?
If you experience periods of anxiety, how do you manage them?
Do you receive any psychological and social support? If yes, could you please describe what kind of support it is?
How would you describe the support you receive and your satisfaction with it?
Do you have some suggestions that could be made in order to change and improve your mood and emotions?

Experience and satisfaction from the healthcare service

Who helps you decide on the treatment and care you want to have?
What decisions have you made regarding your treatment and care?
What brought you to the hospice/Breathe Easy clinic? Could you please detail the process that led you to this service?
What suggestions could you make to improve the process?
What do you think about the service that is being provided to you?
Is there any type of therapy or treatment that you feel that helps you the most to feel better?
Which professionals do you consider most helpful?

Needs of patients

What do you feel is the most important factor in helping you to feel supported while living with COPD?
How would you describe your satisfaction with the support provided by the service you attend?
Do you feel you have been given enough information about your illness? If you had any questions about your disease, who would you think could answer them?

Themes and subthemes.

THEME	SUBTHEMES
Attending palliative care across services	Experiences of the variety of offered support Beneficial aspects of received treatment
Interaction and communication with healthcare professionals	Empathic attitude of healthcare professionals Timeliness and accessibility of care Early education and patient empowerment Clear communication
Value of having social connections	Connection and a feeling of belonging Emotional comfort Motivational influence