Maeda Wakae, Saif-Ur-Rahman K M, Muraya Tsukasa, Hirakawa Yoshihisa
Department of Healthcare Quality and Patient Safety, Nagoya University Graduate School of Medicine, Japan.
College of Medicine, Nursing and Health Sciences, University of Galway, Ireland.
J Rural Med. 2024 Jul;19(3):158-165. doi: 10.2185/jrm.2023-044. Epub 2024 Jul 1.
Even though dynamic multidisciplinary team discussions are crucial for end-of-life care management and decisions concerning chronic obstructive pulmonary disease (COPD), the details of the discussion contents remain poorly understood. This study aimed to identify essential considerations in decision-making for patients with chronic respiratory diseases to enhance a consensus-based approach. A qualitative content analysis of focus group conversations on published clinical case reports in the Japanese community about end-of-life care for patients with chronic respiratory disorders was conducted. The cases were searched through Igaku Chuo Zasshi (ICHUSHI) and Google in February 2021, using the keywords: "COPD", "chronic respiratory diseases", and "end-of-life care". A total of 41 healthcare professionals participated in the focus group discussions. Four major themes evolved from the qualitative content analysis: unpredictable disease prognosis and stages, low awareness of patients on disease severity, acute exacerbations, and home oxygen therapy (HOT). The participants perceived that assessment of severity and prognosis in chronic respiratory diseases such as COPD was a core discussion point to enhance patients' decision-making. The study's findings also indicated that healthcare providers evaluate the influence of acute aggravation of the condition on patients' perceived health status and decision-making. The study reaffirms the significance of informed consent in patients with chronic respiratory disease. It details how, after a thorough assessment of disease severity, patients are given personalized explanations of standardized HOT. This approach ensures they fully understand the unpredictable nature and various stages of their condition resulting from acute exacerbations.
尽管动态多学科团队讨论对于终末期护理管理以及慢性阻塞性肺疾病（COPD）相关决策至关重要，但讨论内容的细节仍鲜为人知。本研究旨在确定慢性呼吸道疾病患者决策中的重要考量因素，以加强基于共识的方法。对日本社区已发表的关于慢性呼吸道疾病患者终末期护理的临床病例报告的焦点小组对话进行了定性内容分析。于2021年2月通过《医学中央杂志》（ICHUSHI）和谷歌搜索这些病例，使用的关键词为：“COPD”、“慢性呼吸道疾病”和“终末期护理”。共有41名医疗保健专业人员参与了焦点小组讨论。定性内容分析得出了四个主要主题：疾病预后和阶段不可预测、患者对疾病严重程度的认识不足、急性加重以及家庭氧疗（HOT）。参与者认为，对COPD等慢性呼吸道疾病的严重程度和预后进行评估是增强患者决策能力的核心讨论点。该研究结果还表明，医疗保健提供者会评估病情急性加重对患者感知健康状况和决策的影响。该研究重申了慢性呼吸道疾病患者知情同意的重要性。它详细说明了在对疾病严重程度进行全面评估后，如何向患者提供标准化家庭氧疗的个性化解释。这种方法可确保他们充分了解因急性加重导致的病情不可预测的性质和各个阶段。
