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A4880 - Intraprofessional Perspectives on Palliative and Supportive Care in Chronic Obstructive Pulmonary Disease: A Qualitative Study
Author Block: A. S. Iyer1, J. N. Dionne-Odom2, N. N. Ivankova3, d. P. Kirkpatrick1, L. O'Hare1, M. Hallpin1, M. T. Dransfield1, M. A. Bakitas2; 1Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL, United States, 2Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, AL, United States, 3School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, United States.
Rationale: National guidelines recommend early palliative care (PC) in COPD to improve quality of life. However, little direction exists on how to proactively integrate these specialties. We explored pulmonary and PC provider perspectives on the role of PC in COPD, including needs and barriers and facilitators to integration. Methods: We conducted a qualitative descriptive study of purposively sampled board-certified specialists from pulmonary-critical care medicine and PC affiliated with a tertiary care academic medical center in Birmingham, AL. We organized semi-structured in-depth interviews into two primary discussion topics: 1) perceptions of PC needs in COPD and 2) barriers and facilitators to integrating PC in COPD. We conducted in vivo coding, examined codes for recurring themes, and compared thematic differences/similarities between provider groups. Results: We interviewed 10 providers: 4 pulmonary-critical care and 6 PC physicians. Each group diverged on identifiable priorities for PC needs in COPD: pulmonary-critical care providers identified refractory respiratory symptoms (e.g., dyspnea and cough) as their highest PC priority; whereas, PC providers prioritized addressing emotional symptoms, weight loss, and illness trajectory understanding. Both groups shared a common theme on the importance of family caregiver engagement in helping the patient manage COPD, though groups diverged on comfort level. Regarding barriers to PC in COPD, pulmonary-critical care providers frequently interchanged “palliative care” with “hospice”, and PC providers recognized this misnomer as a possible barrier to referral. Both specialties shared the following similar barriers to early PC referral: 1) lack of consensus on timing and appropriate referral criteria for PC in COPD; 2) system limitations including personnel shortage and inadequate financial reimbursement for PC; and, 3) misaligned expectations on the role of PC in COPD. Furthermore, both specialties shared the following similar facilitators to early PC referral: 1) establishing clearly defined referral criteria; 2) agreement between specialties on the role of PC in COPD; and, 3) developing efficient models of integrated or primary PC. Conclusions: Pulmonary and PC providers share common concerns on barriers and facilitators to early PC in COPD including establishing consensus on appropriate timing and referral criteria and improving misconceptions on the definition and role of PC in COPD. These themes represent potentially modifiable targets for facilitating enhanced intraprofessional collaboration between pulmonary-critical care and PC specialists, which may help to improve early PC integration in COPD.