Exploring the psychosocial impact of patients living with advanced chronic obstructive pulmonary disease attending palliative care services

Introduction
People living with advanced COPD (Chronic Obstructive Pulmonary Disease) experience high physical burden, compromised quality of life (QOL), mental health and reduced social activities. Palliative care (PC) services are a valuable resource supporting well-being and improving social life, yet little is known about PC aspects of people living with advanced COPD.

Aims
To explore the psychosocial impact of living with advanced COPD on patients and the role of PC in the context of COPD.

Method
22 people with advanced COPD were recruited from a supportive care clinic and hospice day services. A concurrent embedded mixed methods approach was employed. Data was collected through semi-structured interviews and analysed with Framework Analysis. McGill Quality of Life-Revised questionnaire (MQOL-R) was used to measure QOL and Hospital Anxiety and Depression Scale (HADS) assessed mood. Both were analysed with a regression model.

Results
From the regression a significant model emerged: F (5,79) = 27.451, p=.000, in which HADS score was the only predictive factor of the MQOL-R score. The model explains 55.7% of the variance in MQOL-R questionnaire (adjusted R2=.557). Findings revealed three themes: loss of identity, adjustment and formal and informal support, demonstrating that empathy from healthcare professionals and involvement from informal caregivers positively impacted patients’ experiences. Triangulation pointed to the importance of psychological distress associated with the unpredictable nature of the disease and growing dependence on informal carers.

Conclusion
Despite PC supports, participants continued to experience high levels of depression and anxiety. Early referral to PC is beneficial in enhancing patients’ self-management, which can further alleviate psychological distress. Improved self-management stems from a good relationship with healthcare workers, involvement of patients and carers in the care and their good education.

Impact
This research is first that has explored psychosocial aspects of living with advanced COPD of people receiving PC presenting possible ways to improve patients’ psychological distress.