532702 research-article2014
PMJ0010.1177/0269216314532702Palliative Medicine X(X)Burge
Letter to the Editor Palliative Medicine 2014, Vol. 28(8) 1069–1070 © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0269216314532702 pmj.sagepub.com
Advance care planning education in pulmonary rehabilitation: A qualitative study exploring participant perspectives Dear Editor, I write in response to the letter by Crozier in the January 2014 edition of Palliative Medicine regarding the publication of ‘Advance Care Planning Education in Pulmonary Rehabilitation: A Qualitative Study Exploring Participant Perspectives’ in June 2013.1 We thank Dr Crozier for his congratulations and acknowledgement that the inclusion of advance care planning (ACP) education in pulmonary rehabilitation is a quality, patient-centred initiative suggested to supplement current processes of care. The literature supports Dr Crozier’s experience that clinician-directed communication regarding ACP typically occurs in an inpatient setting, and in fact, clinicians have reported frequent failure to discuss end-of-life care with their patient with advanced lung disease.2 In a recent Australian study, 56% of the respiratory physicians surveyed reported discussing ACP with ‘a few’ or ‘none or almost none’ of their patients.3 This sits uneasily beside their findings that 71% of the respondents either ‘agreed’ or ‘strongly agreed’ with the statement ‘ACP is a specialist physician’s responsibility’.3 The Australian National Framework for Advance Care Directives4 states that ‘information about ACP … should become part of routine contact with the health and aged care sectors … it is not essential that such discussion and advice are facilitated by a medical practitioner’. In addition to the acceptability to patients of other healthcare professionals as sources of ACP information,1,2 improved end-of-life care and patient and family satisfaction in elderly medical patients have also been demonstrated.5 In contrast to the suggestion that ‘protocolising the task of initiating ACP discussions to non-physicians is a slippery slope’, there are recommendations for standardised approaches to ACP discussion6 and encouragement for research to focus on the effectiveness of interventions that facilitate ACP in patients.7 Our paper was not the first to suggest that pulmonary rehabilitation is an appropriate and convenient service to incorporate provision of information about ACP to people
with chronic lung disease. The goals of pulmonary rehabilitation are synchronous with those of palliative care, as defined by the World Health Organization (WHO), as addressing symptom management, offering a support system to help people live as actively as possible, using a team approach and enhancing quality of life.8–11 This is, however, the first study to detail the perspectives of participants in pulmonary rehabilitation and maintenance programmes on the acceptability of a group ACP information session and the overwhelming acceptability of this format. Our hope is that this information will help provide ‘the right care for the right patient at the right time’,12 regardless of whether it is called pulmonary rehabilitation, palliative care or just good medical therapy.13 Declaration of conflicting interests The author declares that there is no conflict of interest.
Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.
References 1. Burge AT, Lee A, Nicholes M, et al. Advance care planning education in pulmonary rehabilitation: a qualitative study exploring participant perspectives. Palliat Med 2013; 27: 508–516. 2. Gott M, Gardiner C, Small N, et al. Barriers to advance care planning in chronic obstructive pulmonary disease. Palliat Med 2009; 23: 642–648. 3. Smith TA, Kim M, Piza M, et al. Specialist respiratory physicians’ attitudes to and practice of advance care planning in COPD: a pilot study. Respir Med. Epub ahead of print 19 December 2013. DOI: 10.1016/j.rmed.2013.12.002. 4. The Clinical, Technical and Ethical Principal Committee of the Australian Health Ministers’ Advisory Council. A National Framework for Advance Care Directives. September 2011, http://www.ahmac.gov.au/cms_documents/ AdvanceCareDirectives2011.pdf (accessed 24 February 2014). 5. Detering KM, Hancock AD, Silvester W, et al. The impact of advance care planning on end-of-life care in elderly patients: randomised controlled trial. BMJ 2010; 340: c1345. 6. Leadership and quality in end of life care Australia: round table recommendations. Australian Centre for Health Research, Melbourne, VIC, Australia, 27 February 2013,
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http://media.wix.com/ugd/ff9afa_e50539d713d0494292e985773bacd92a.pdf (accessed 24 February 2014). 7. Patel K, Janssen DJ and Curtis JR. Advance care planning in COPD. Respirology 2012; 17: 72–78. 8. http://www.who.int/cancer/palliative/definition/en/ (accessed 24 February 2014). 9. Hardin KA, Meyers F and Louie S. Integrating palliative care in severe chronic obstructive lung disease. COPD 2008; 5: 207–220. 10. Heffner JE. Advance care planning in chronic obstructive pulmonary disease: barriers and opportunities. Curr Opin Pulm Med 2011; 17: 103–109. 11. Sachs S and Weinberg RL. Pulmonary rehabilitation for dyspnea in the palliative care setting. Curr Opin Support Palliat Care 2009; 3: 112–119.
12. Nici L. A bill of ‘rights’ for patients with COPD: the ‘right’ therapy for the ‘right’ patient at the ‘right’ time. Thorax 2010; 65: 2–3. 13. Reticker AL, Nici L and ZuWallack R. Pulmonary rehabilitation and palliative care in COPD: two sides of the same coin? Chron Respir Dis 2012; 9: 107–116. Angela T Burge Physiotherapy Department, The Alfred, Prahran, VIC, Australia Corresponding author Angela T Burge, Physiotherapy Department, The Alfred, PO Box 315, Prahran VIC 3181, Australia. Email: [email protected]
Downloaded from pmj.sagepub.com at GEORGIAN COURT UNIV on April 19, 2015
PMJ0010.1177/0269216314532702Palliative Medicine X(X)Burge
Letter to the Editor Palliative Medicine 2014, Vol. 28(8) 1069–1070 © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0269216314532702 pmj.sagepub.com
Advance care planning education in pulmonary rehabilitation: A qualitative study exploring participant perspectives Dear Editor, I write in response to the letter by Crozier in the January 2014 edition of Palliative Medicine regarding the publication of ‘Advance Care Planning Education in Pulmonary Rehabilitation: A Qualitative Study Exploring Participant Perspectives’ in June 2013.1 We thank Dr Crozier for his congratulations and acknowledgement that the inclusion of advance care planning (ACP) education in pulmonary rehabilitation is a quality, patient-centred initiative suggested to supplement current processes of care. The literature supports Dr Crozier’s experience that clinician-directed communication regarding ACP typically occurs in an inpatient setting, and in fact, clinicians have reported frequent failure to discuss end-of-life care with their patient with advanced lung disease.2 In a recent Australian study, 56% of the respiratory physicians surveyed reported discussing ACP with ‘a few’ or ‘none or almost none’ of their patients.3 This sits uneasily beside their findings that 71% of the respondents either ‘agreed’ or ‘strongly agreed’ with the statement ‘ACP is a specialist physician’s responsibility’.3 The Australian National Framework for Advance Care Directives4 states that ‘information about ACP … should become part of routine contact with the health and aged care sectors … it is not essential that such discussion and advice are facilitated by a medical practitioner’. In addition to the acceptability to patients of other healthcare professionals as sources of ACP information,1,2 improved end-of-life care and patient and family satisfaction in elderly medical patients have also been demonstrated.5 In contrast to the suggestion that ‘protocolising the task of initiating ACP discussions to non-physicians is a slippery slope’, there are recommendations for standardised approaches to ACP discussion6 and encouragement for research to focus on the effectiveness of interventions that facilitate ACP in patients.7 Our paper was not the first to suggest that pulmonary rehabilitation is an appropriate and convenient service to incorporate provision of information about ACP to people
with chronic lung disease. The goals of pulmonary rehabilitation are synchronous with those of palliative care, as defined by the World Health Organization (WHO), as addressing symptom management, offering a support system to help people live as actively as possible, using a team approach and enhancing quality of life.8–11 This is, however, the first study to detail the perspectives of participants in pulmonary rehabilitation and maintenance programmes on the acceptability of a group ACP information session and the overwhelming acceptability of this format. Our hope is that this information will help provide ‘the right care for the right patient at the right time’,12 regardless of whether it is called pulmonary rehabilitation, palliative care or just good medical therapy.13 Declaration of conflicting interests The author declares that there is no conflict of interest.
Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.
References 1. Burge AT, Lee A, Nicholes M, et al. Advance care planning education in pulmonary rehabilitation: a qualitative study exploring participant perspectives. Palliat Med 2013; 27: 508–516. 2. Gott M, Gardiner C, Small N, et al. Barriers to advance care planning in chronic obstructive pulmonary disease. Palliat Med 2009; 23: 642–648. 3. Smith TA, Kim M, Piza M, et al. Specialist respiratory physicians’ attitudes to and practice of advance care planning in COPD: a pilot study. Respir Med. Epub ahead of print 19 December 2013. DOI: 10.1016/j.rmed.2013.12.002. 4. The Clinical, Technical and Ethical Principal Committee of the Australian Health Ministers’ Advisory Council. A National Framework for Advance Care Directives. September 2011, http://www.ahmac.gov.au/cms_documents/ AdvanceCareDirectives2011.pdf (accessed 24 February 2014). 5. Detering KM, Hancock AD, Silvester W, et al. The impact of advance care planning on end-of-life care in elderly patients: randomised controlled trial. BMJ 2010; 340: c1345. 6. Leadership and quality in end of life care Australia: round table recommendations. Australian Centre for Health Research, Melbourne, VIC, Australia, 27 February 2013,
Downloaded from pmj.sagepub.com at GEORGIAN COURT UNIV on April 19, 2015
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http://media.wix.com/ugd/ff9afa_e50539d713d0494292e985773bacd92a.pdf (accessed 24 February 2014). 7. Patel K, Janssen DJ and Curtis JR. Advance care planning in COPD. Respirology 2012; 17: 72–78. 8. http://www.who.int/cancer/palliative/definition/en/ (accessed 24 February 2014). 9. Hardin KA, Meyers F and Louie S. Integrating palliative care in severe chronic obstructive lung disease. COPD 2008; 5: 207–220. 10. Heffner JE. Advance care planning in chronic obstructive pulmonary disease: barriers and opportunities. Curr Opin Pulm Med 2011; 17: 103–109. 11. Sachs S and Weinberg RL. Pulmonary rehabilitation for dyspnea in the palliative care setting. Curr Opin Support Palliat Care 2009; 3: 112–119.
12. Nici L. A bill of ‘rights’ for patients with COPD: the ‘right’ therapy for the ‘right’ patient at the ‘right’ time. Thorax 2010; 65: 2–3. 13. Reticker AL, Nici L and ZuWallack R. Pulmonary rehabilitation and palliative care in COPD: two sides of the same coin? Chron Respir Dis 2012; 9: 107–116. Angela T Burge Physiotherapy Department, The Alfred, Prahran, VIC, Australia Corresponding author Angela T Burge, Physiotherapy Department, The Alfred, PO Box 315, Prahran VIC 3181, Australia. Email: [email protected]
Downloaded from pmj.sagepub.com at GEORGIAN COURT UNIV on April 19, 2015
