"You don't want to know just about my lungs, you want to know more about me". Patients and their caregivers' evaluation of a nurse-led COPD supportive care service.

AIM: To evaluate a nurse-led model of supportive care in a COPD outpatient service from patient and caregiver perspectives. DESIGN: Case study methodology. METHODS: Data were collected from semi-structured interviews with patients (n = 12) and caregivers (n = 7) conducted between April 2020 and September 2022. A purposive sampling strategy was used. Interviews were transcribed verbatim and analysed using content analysis with an inductive approach. COREQ guidelines informed reporting of this study. RESULTS: Eight categories were identified from the data evaluating of the model of care relating to the most helpful aspects of COPD supportive care and suggested improvements to the model of care. The categories were: guidance with managing symptoms; participating in advance care planning; home visiting; expert advice; continuity and trust; caring; caregiver support and improvements to the model of care. CONCLUSION: In a nurse-led model of COPD supportive care, what patients and caregivers valued most was expert advice and guidance with symptom management, flexible home visiting, participation in advance care planning, caring and continuity within an ongoing trusted therapeutic relationship. Understanding what patients and caregivers value most is essential in designing and delivering models of care that meet the needs of patients living with chronic, life-limiting illness. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Nurses can lead effective models of supportive care that offer valuable support to patients living with COPD and their caregivers.

Embedding nurse-led supportive care in an outpatient service for patients with Chronic Obstructive Pulmonary Disease.

AIM: To describe a small multidisciplinary team's experience of the process of embedding nurse-led supportive care into an existing Chronic Obstructive Pulmonary Disease outpatient service. DESIGN: Case study methodology METHODS: Data were collected from multiple sources including key documents and semi-structured interviews with healthcare professionals (n = 6) conducted between June and July 2021. A purposive sampling strategy was used. Content analysis was applied to key documents. Interviews were transcribed verbatim and analysed using an inductive approach. RESULTS: Subcategories under the four-stage process were identified from the data. ASSESSMENT: evidence of needs of patients with Chronic Obstructive Pulmonary Disease; gaps in care and evidence of other models of supportive care. Planning: setting the supportive care service structure and intention; resources and funding; leadership, specialization and respiratory/palliative care roles. IMPLEMENTATION: relationships and trust; embedding supportive care and communication. EVALUATION: benefits and positive outcomes for staff and patients, and, improvements and future considerations for supportive care in the COPD service. CONCLUSION: A collaboration between respiratory and palliative care services resulted in successfully embedding nurse-led supportive care in a small outpatient service for patients with Chronic Obstructive Pulmonary Disease. Nurses are well placed to lead new models of care that aim to address unmet biopsychosocial-spiritual needs of patients. More research is needed to evaluate nurse-led supportive care in Chronic Obstructive Pulmonary Disease and other chronic illness settings; the effectiveness of nurse-led supportive care from the perspective of patients and caregivers and the impact of nurse-led supportive care on health service usage. PATIENT OR PUBLIC CONTRIBUTION: The development of the model of care is informed by ongoing discussions with patients with COPD and their caregivers. Data availability statement: Research data are not shared (due to ethical restrictions). IMPACT: Embedding nurse-led supportive care in an existing Chronic Obstructive Pulmonary Disease outpatient service is achievable. Nurses with clinical expertise can lead innovative models of care that address the unmet biopsychosocial-spiritual needs of patients with conditions such as Chronic Obstructive Pulmonary Disease. Nurse-led supportive care may have utility and relevance in other chronic disease contexts.

Nurse-led integration of palliative care for chronic obstructive pulmonary disease: An integrative literature review.

AIMS AND OBJECTIVES: To uncover what is known about nurse-led models or interventions that have integrated palliative care into the care of patients with chronic obstructive pulmonary disease. BACKGROUND: Chronic obstructive pulmonary disease is a highly symptomatic, incurable disease characterised by chronic symptoms that without appropriate palliation can lead to unnecessary suffering for patients and their caregivers. While palliative care practices can relieve suffering and improve quality of life, most palliative models of care remain cancer-focused. New models, including nurse-led care that integrates palliative care for patients with chronic obstructive pulmonary disease, could address patient suffering and therefore need to be explored. METHOD: A mixed-studies integrative review was undertaken. Seven databases were searched for articles published between 2008-2018. The PRISMA framework was applied to the search, and six studies met the review eligibility criteria. Content analysis of the articles was undertaken, and data were compared, looking for different nurse-led models and outcomes related to palliative care in chronic obstructive pulmonary disease. RESULTS: Nurse-led, integrated palliative care models for patients with chronic obstructive pulmonary disease are rare and just four of the six articles found in this review had published results. Advance care planning was found to be the most common focus for nurse-led interventions in chronic obstructive pulmonary disease, and in all cases, results demonstrated an improvement in end-of-life discussions and completion of advance care directives. Of the reviewed articles, none used a qualitative framework to explore nurse-led models that integrated palliative care in chronic obstructive pulmonary disease. CONCLUSION: While nurse-led advance care planning was one type of palliative care practice associated with positive patient outcomes, there is a need for deeper exploration of nurse-led models that holistically address the bio-psycho-social-spiritual needs of patients with chronic obstructive pulmonary disease, and their caregivers. RELEVANCE TO CLINICAL PRACTICE: Integrating nurse-led supportive care clinics into chronic obstructive pulmonary disease services could be a way forward to address the unmet bio-psycho-social-spiritual needs of patients with chronic obstructive pulmonary disease, and their caregivers.

Chronic obstructive pulmonary disease and advance care planning: A synthesis of qualitative literature on patients' experiences.

OBJECTIVE: Advance Care Planning supports patients to share their personal values, goals, and preferences for future medical care with their family members and healthcare professionals. The aim of this review was to uncover what is known about patients with Chronic Obstructive Pulmonary Disease and their experiences with Advance Care Planning. METHODS: A systematic review and thematic synthesis of qualitative studies was undertaken. Five databases were searched for qualitative articles published between 2009-2019. The review was guided by the PRISMA framework and seven studies met the eligibility criteria. Thematic synthesis of descriptive themes in each article was undertaken to develop overarching analytical themes, related to the experience of patients with Chronic Obstructive Pulmonary Disease and Advance Care Planning. RESULTS: Four analytical themes emerged from the review of the articles that met the inclusion criteria: patient readiness and willingness for Advance Care Planning discussions; considering the future; trusted relationships with healthcare professionals; and shared decision making. DISCUSSION: Patients with Chronic Obstructive Pulmonary Disease are generally open to Advance Care Planning discussions with healthcare professionals who are well-informed, and trusted by the patient. Models of care that integrate Advance Care Planning are beneficial in other non-malignant settings, and may be a way forward to support Advance Care Planning as part of routine care for patients with Chronic Obstructive Pulmonary Disease.