Improving inpatient palliative care delivery in COPD: a mixed-methods study.

Background

There is limited evidence to guide implementation of recommended collaborative palliative care (PC) models for hospitalized patients with chronic obstructive pulmonary disease (COPD). We sought to characterize palliative needs and identify barriers to PC delivery to inform inpatient collaborative care models.

Methods

We conducted a sequential explanatory mixed-methods study of hospitalized adults with COPD and physicians (hospitalists and pulmonologists) at two urban teaching hospitals in the United States. Patients rated their palliative needs in a survey, followed by a semi-structured interview. Physicians rated the perceived needs of a typical hospitalized patient with moderate-to-severe COPD, and then a purposive sample completed an interview. Survey data were summarized descriptively. Two independent coders conducted content analysis of interview transcripts to identify convergent and divergent perspectives across participant groups.

Results

Fifteen patients (mean age 67 years; 47% female, 47% Black, 47% White) and 39 physicians (56% hospitalists, 44% pulmonologists, 44% female, 64% White, 23% Asian) completed surveys. All patients and 15 physicians completed interviews. Participants identified three domains of palliative needs: physical symptoms, psychosocial and emotional distress, and communication. Although physicians rated palliative needs as more burdensome than patients did, they frequently deferred addressing these needs due to competing clinical demands, prognostic uncertainty, and the perceived limited value of inpatient PC consultation. Patients reported that their palliative needs often remained unaddressed.

Conclusions

Collaborative inpatient PC models for COPD should prioritize addressing common palliative needs, strengthen generalist PC skills, establish clear criteria for specialist PC involvement, and improve coordination across care settings.