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A conceptual model: Redesigning how we provide palliative care for patients with chronic obstructive pulmonary disease

Published online by Cambridge University Press:  31 May 2017

Jennifer Philip ,
Gregory Crawford ,
Caroline Brand ,
Michelle Gold ,
Belinda Miller ,
Peter Hudson ,
Natasha Smallwood ,
Rosalind Lau  and
Vijaya Sundararajan
Jennifer Philip*
Affiliation:
Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
Gregory Crawford
Affiliation:
Northern Adelaide Palliative Service and Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia
Caroline Brand
Affiliation:
Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
Michelle Gold
Affiliation:
Department of Medicine, The Alfred Hospital, Melbourne, Victoria, Australia
Belinda Miller
Affiliation:
Department of Medicine, The Alfred Hospital, Melbourne, Victoria, Australia
Peter Hudson
Affiliation:
Centre for Palliative Care, St. Vincent's Hospital, Melbourne, Victoria, Australia
Natasha Smallwood
Affiliation:
Department of Medicine, Royal Melbourne Hospital, Melbourne, Victoria, Australia
Rosalind Lau
Affiliation:
Centre for Palliative Care, St. Vincent's Hospital, Melbourne, Victoria, Australia
Vijaya Sundararajan
Affiliation:
Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
*
Address correspondence and reprint requests to: Jennifer Philip, University of Melbourne, Eastern Hill Campus, St. Vincent's Hospital, P.O. Box 2900, Fitzroy, Victoria 3065, Australia. E-Mail: Jennifer.philip@svha.org.au.
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Abstract

Background:

Despite significant needs, patients with chronic obstructive pulmonary disease (COPD) make limited use of palliative care, in part because the current models of palliative care do not address their key concerns.

Objective:

Our aim was to develop a tailored model of palliative care for patients with COPD and their family caregivers.

Method:

Based on information gathered within a program of studies (qualitative research exploring experiences, a cohort study examining service use), an expert advisory committee evaluated and integrated data, developed responses, formulated principles to inform care, and made recommendations for practice. The informing studies were conducted in two Australian states: Victoria and South Australia.

Results:

A series of principles underpinning the model were developed, including that it must be: (1) focused on patient and caregiver; (2) equitable, enabling access to components of palliative care for a group with significant needs; (3) accessible; and (4) less resource-intensive than expansion of usual palliative care service delivery. The recommended conceptual model was to have the following features: (a) entry to palliative care occurs routinely triggered by clinical transitions in care; (b) care is embedded in routine ambulatory respiratory care, ensuring that it is regarded as “usual” care by patients and clinicians alike; (c) the tasks include screening for physical and psychological symptoms, social and community support, provision of information, and discussions around goals and preferences for care; and (d) transition to usual palliative care services is facilitated as the patient nears death.

Significance of results:

Our proposed innovative and conceptual model for provision of palliative care requires future formal testing using rigorous mixed-methods approaches to determine if theoretical propositions translate into effectiveness, feasibility, and benefits (including economic benefits). There is reason to consider adaptation of the model for the palliative care of patients with other nonmalignant conditions.

Keywords

Chronic obstructive pulmonary diseasePalliative careModels of careIntegrated care
Type
Original Article
Information
Palliative & Supportive Care , Volume 16 , Special Issue 4: Topics in Bereavement , August 2018 , pp. 452 - 460
Copyright
Copyright © Cambridge University Press 2017 

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