Barriers and Facilitators in Exploring Patients’ Values, Whishes and Needs in End of Life, Perspective from Healthcare Professionals

Background/aims: Pulmonary fibrosis is a progressive disease with a
median survival of 4.5 years. Talking about the end of life, exploring and
monitoring personal values, wishes and needs is essential for the implementation of palliative care in pulmonary fibrosis care.
Aim: Gain insight in the barriers and facilitators to talk about end of life
with healthcare professionals(HCP).
Methods: A generic qualitative study was performed from March
2021 and Nov 2022. Semi structured interviews and focus groups
with HCP were performed by two interviewers, both interviewers
had a working relationship with the HCP. Data collection and analysis
were performed iteratively. A thematic analysis was performed
using atlas.ti.
Results: The perceived barriers and facilitators revealed five themes
Timing: HCP search for the right moment to start the conversation and
realize a proactive way of working and a better structure takes less time
in the end. However, there is always a reason to postpone a
conversation.
Knowledge: HCP talking with a patient with a better prognostic awareness is easier. HCP showed a lack of knowledge about coping, grieve,
competences of other professionals and laws and regulations.
Professional competences in communication are necessary for HCP to
feel confident to communicate with patients and partners.
Preconditions; shared values in palliative care integration, agreements in
multiprofessional collaboration, time, and structured documentation.
Within the person; Experiences (professional of private) support or
counter the conversation. Most HCPs are aware of their own pose and
way of talking during conversations about end of life.
Conclusions: HCP want to talk about end-of-life values wishes and
needs. Lack of knowledge, competences, experience and agreements
are the main barriers. Education and training on the job are essential for
implementing palliative care.
This study was funded by the Penders foundation