Making Palliative Care Work in Chronic Respiratory Diseases: A Nurse-Led Model.

Abstract

Palliative care (PC) is defined as a holistic, multidisciplinary, person-centered approach aimed at relieving symptoms and improving quality of life (QoL) for individuals with serious health-related disease. Although recommended by major respiratory societies, patients with advanced chronic respiratory diseases (CRD) continue to have insufficient access to PC, often limited to end-of-life (EoL) care. Compared with patients with lung cancer, patients with CRD experience greater symptom burden, are less informed about their illness, and are less involved in decision-making. Early PC has been shown to improve QoL, reduce depression, decrease avoidable hospitalizations, and support better EoL trajectories. To improve PC providing for patients living with CRD, an interdisciplinary, nurse-led, outpatient PC consultation model was developed and iteratively refined guided by the Plan-Do-Study-Act cycle, as an implementation framework. Patients are referred to the consultation based on symptom burden, decline in respiratory status, frailty, need for discussion on treatment choice, or caregiver strain. During the initial consultation, a PC physician and nurse explore patient and caregiver perceptions of PC, provide information about the aim of this service, and conduct a comprehensive symptom assessment. Follow-up is primarily coordinated by the specialist PC nurse, who ensures symptom evaluation, care coordination, and knowledge on pharmacological and non-pharmacological interventions. Integrative therapies such as hypnosis, reflexology, and Touch-Massage® are also offered, along with discussions around advance care planning when desired. Early, needs-based PC can be effectively integrated into CRD trajectories when delivered through a nurse-led interdisciplinary model of coordination.