End-of-Life Care Research Group, Ghent University & Vrije Universiteit Brussel (VUB), Ghent, Belgium.
Department of Internal Medicine, Ghent University, Ghent, Belgium.
NPJ Prim Care Respir Med. 2018 Jun 20;28(1):23. doi: 10.1038/s41533-018-0091-9.
Early integration of palliative home care (PHC) might positively affect people with chronic obstructive pulmonary disease (COPD). However, PHC as a holistic approach is not well integrated in clinical practice at the end-stage COPD. General practitioners (GPs) and community nurses (CNs) are highly involved in primary and home care and could provide valuable perspectives about barriers to and facilitators for early integrated PHC in end-stage COPD. Three focus groups were organised with GPs (n = 28) and four with CNs (n = 28), transcribed verbatim and comparatively analysed. Barriers were related to the unpredictability of COPD, a lack of disease insight and resistance towards care of the patient, lack of cooperation and experience with PHC for professional caregivers, lack of education about early integrated PHC, insufficient continuity of care from hospital to home, and lack of communication about PHC between professional caregivers and with end-stage COPD patients. Facilitators were the use of trigger moments for early integrating PHC, such as after a hospital admission or when an end-stage COPD patient becomes oxygen-dependent or housebound, positive attitudes towards PHC in informal caregivers, more focus on early integration of PHC in professional caregivers' education, implementing advance care planning in healthcare and PHC systems, and enhancing communication about care and PHC. The results provide insights for clinical practice and the development of key components for successful practice in a phase 0-2 Early Integration of PHC for end-stage COPD (EPIC) trial, such as improving care integration, patients' disease insight and training PHC nurses in care for end-stage COPD.
早期姑息性家庭护理（PHC）的整合可能会对慢性阻塞性肺疾病（COPD）患者产生积极影响。然而，作为一种整体方法的 PHC 在 COPD 晚期的临床实践中并未得到很好的整合。全科医生（GP）和社区护士（CN）高度参与初级和家庭护理，可以提供有关在 COPD 晚期早期综合 PHC 的障碍和促进因素的宝贵观点。组织了三个针对全科医生（n=28）的焦点小组和四个针对社区护士（n=28）的焦点小组，对其进行逐字转录和比较分析。障碍与 COPD 的不可预测性、对疾病认识不足和对患者护理的抵制、专业护理人员缺乏合作和 PHC 经验、缺乏有关早期综合 PHC 的教育、从医院到家庭的护理连续性不足以及专业护理人员之间缺乏有关 PHC 的沟通有关。促进因素包括利用早期整合 PHC 的触发时刻，例如在住院后或当 COPD 晚期患者变得需要吸氧或居家时，非正式护理人员对 PHC 的积极态度，在专业护理人员的教育中更加关注早期整合 PHC，在医疗保健和 PHC 系统中实施预立医疗照护计划，以及加强关于护理和 PHC 的沟通。这些结果为临床实践提供了见解，并为 EPIC 试验中 COPD 晚期阶段的 PHC 早期整合（0-2 期）的成功实践开发了关键组成部分，例如改善护理整合、患者对疾病的认识以及培训 PHC 护士对 COPD 晚期的护理。
