“We could do better”: the nature and meaning of information-giving in end-stage COPD

Background: End of life in Chronic Obstructive Pulmonary Disease (COPD) is typically difficult to predict, and although palliative care initiatives are developing, active treatment in the acute hospital setting often continues up to death. Staff delivering care but who may not be part of the treatment decision-making process express frustration at the lack of a palliative approach in end-stage disease and cite part of their role is to give information to assist decision-making for those in their care.
Overall study aim: To understand the meaning and experiences of information-giving of staff caring for acute severe COPD within the social context of the acute hospital setting.
Methods: In this exploratory, qualitative study, interviews and focus groups were undertaken with nurses and physiotherapists (n=10) who care for people with severe COPD in acute hospital settings in the North of England. A grounded theory approach to analysis was aided by the software NVivo.
Results: Although staff can act as information-givers to support their patients, time constraints lead to hesitancy on their part, and they often wait for the patient to express concerns for their future before intervening. Once the conversation is initiated, staff express a sense of responsibility to do the job well, and this is often difficult. More experienced staff feel better equipped to give information and discuss decisions on behalf of their patients, but the success of this is rooted in inter-disciplinary relationships and the nature of the ward hierarchy.
Conclusion: Inter-disciplinary relationships, professional experience and time constraints all create a challenge to effective information-giving in clinical practice when considering treatment decision-making for people with acute severe COPD.