Respiratory nurses have a role in advance care planning

Saturday, 25 Mar 2017


Tension still exists about how and when to initiate conversations with patients regarding advance care planning in COPD, a survey of Australian and New Zealand respiratory nurses has shown.

Although they are well placed to facilitate such discussions, the survey of 112 nurses found 33% did not feel confident about delivering ‘bad news’.

Most (83%) perceived that respiratory physicians infrequently initiated advance care planning discussions.

Dr Rebecca Disler, senior lecturer in chronic disease and community care at the University of Sydney, said the evidence clearly supports the benefit of early advance care planning.

Yet respiratory nurses were concerned they might destroy patients’ hopes or were uncertain about whether early conversations make a difference in later decisional crises.

“People know it’s a good thing in principle. In practice, it creates a lot of conflict,” she told the limbic in an interview.

“COPD is a long-term progressive condition but there is not a good understanding that it is a life-limiting, terminal disease. There is also difficulty with prognostication – will they live for another ten years or until the next severe exacerbation?”

“Yet we need to move towards creating earlier opportunities for patients to voice their wishes.”

She said severe exacerbations were an appropriate time to broach difficult conversations given the evidence that about half of patients with COPD survive for two years after an exacerbation requiring hospitalisation.

Dr Disler told the TSANZSRS meeting in Canberra that nurses were largely in agreement (72%) that advance care planning was part of their professional role.

A high proportion of nurses (73%) correctly answered key knowledge indicators although there was more doubt about legal issues.

For example, only 51% nurses correctly identified that a formal template was not required for an advanced care directive to be legally binding.

Dr Disler said good training and education along with clear guidelines were important to support nurses in having sensitive discussions with patients and their families.

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