Perceptions of Physicians on the Adoption of a Palliative Care Approach in Patients with Chronic Obstructive Pulmonary Disease
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Models of care released over a decade ago advocate for an early and concurrent adoption of disease-modifying and palliative care approaches to address the needs of patients with a life-limiting illness, such as Chronic Obstructive Pulmonary Disease (COPD). However, research suggests patients with COPD continue to receive insufficient palliative care. While endorsing these models of care is justified, no study has demonstrated their adoption by physicians caring for patients with COPD. The purpose of this study is to examine the extent to which resident and attending physicians adopt a palliative care approach in patients with COPD. A qualitative design with an exploratory approach was used. Semi-structured interviews conducted over a 5-month period involved 7 residents and 7 attending physicians from internal medicine, respirology, emergency medicine and family medicine. Following verbatim transcription and member checking, the data were inductively analyzed with the aid of the computer software Atlas.ti to identify recurrent themes. Results showed that interviewed physicians unknowingly practice some elements of a palliative care approach with their patients with COPD. Residents repeatedly describe influences from attending physicians’ practices. Physicians’ misperceptions of palliative care and its role in COPD limit their full adoption of this approach, creating disparity on its timely introduction. In conclusion, physicians delay the adoption of palliative care simultaneously with disease-modifying therapies, largely due to three barriers: 1) physicians misperceive palliative care as an approach focused on comfort, 2) physicians fear the negative perceptions held by patients about palliative care; and 3) physicians use a reactive approach to palliative care rather than a proactive approach. However, they hold a propensity to concurrently adopt a palliative care approach with disease-modifying therapies, albeit delayed, suggesting a shift in medical culture. Residency education about the role of palliative care in the management of patients with COPD is lacking. This should be complemented by providing targeted education for attending physicians to meet the needs of patients with COPD.