An exploratory study of the quality of life and care concerns of patients with advanced chronic obstructive pulmonary disease

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An exploratory study of the quality of life and care concerns of patients with advanced chronic obstructive pulmonary disease

 

Author: Fan, Lai-fa
Title: An exploratory study of the quality of life and care concerns of patients with advanced chronic obstructive pulmonary disease
Degree: M.Sc.
Year: 2003
Subject: Hong Kong Polytechnic University -- Dissertations
Lungs -- Diseases, Obstructive -- Patients -- Case studies
Department: School of Nursing
Pages: ix, 81 leaves : ill. ; 30 cm
Language: English
InnoPac Record: http://library.polyu.edu.hk/record=b1717739
URI: http://theses.lib.polyu.edu.hk/handle/200/869
Abstract: Introduction: Chronic obstructive pulmonary disease (COPD) is one of the most common and important respiratory diseases in Hong Kong. Although COPD is a benign disease the prognosis is poor and the mortality rate is similar to some malignant diseases (Shee, 1995). For advanced COPD patients, there is no "medical" solution to reverse the problem. What they are needed, as Saunders (1984) had pointed out that to accompany patients on their particular journey. It is worth to provide end-of-life care to the not willing to be intubated group as well as to include them into palliative care. Not because of their wills but also because their high score for the items of disease burdens, poor emotional well being and perceived poor QOL. Objectives: To describe the different dimensions, treatment preference, care concerns and quality of life (QOL) of patients with advanced chronic obstructive pulmonary disease (COPD). Explore the relationship between treatment choice and the patient's illness severity, symptom burdens, emotional, functional, socio-economic, and existential well-being. Method: This is a descriptive study using a structured questionnaire-The Quality of Life and Care Concern Inventory (QOLCAI-CQPD). Data was collected through structured interviews in an acute-care hospital. Findings: Of the full study group 72 subjects, 44.4% (n=31) chose not willing to be intubated, 48.6% (n=35) chose willing to be intubated and 0.69% (n=5) chose never think about it. The not willing to be intubated group had significantly poorer performance status, higher frequency of using hospital services. On average, the not willing to be intubated group had perceived poorer QOL associated with more negative psychological reaction and higher score for symptom burdens and discomfort level than the willing to be intubated group. Discussion: Patient's preference should be the first priority in decision-making process. As communication about preference for intubation were uncommon. Therefore, regular comprehensive assessment to detect any declination of QOL and treatment preference is recommended. Since there is no "medical" solution to reverse the problem of advanced COPD patients. So it is worthy to provide end-of-life care to the not willing to be intubated group as well as to include them into palliative care. Not only because of their wills but also because their high score for the items of disease burdens, poor emotional well being and perceived poor QOL. Conclusion: Health care providers caring for patients with advanced COPD should be cognizant patients' desires for comfort-focused care and more aggressively implement palliative treatment to them, while remaining open to provision of life-sustaining interventions according to patients' preference.

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