Communicating uncertainty: contrasting the communication experiences of patients with advanced COPD and incurable lung cancer

Nothando Ngwenya, Clare Crang, Morag Farquharc, Robert C Rintoul, Ravi Mahadeva, Lori D Calvert, Scott Murray, Stephen Barclay

Research output: Contribution to journalArticlepeer-review

Abstract

Background
Due to the uncertain disease trajectory and variable rate of progression in Chronic Obstructive Pulmonary Disease (COPD), health care professionals are challenged in explaining what the future may hold for patients compared to those with lung cancer. Support and communication of timely information can significantly improve health outcomes.
Objective
This study sought to identify factors that impact communication and support and recommend ways to improve patients’ understanding of living with life-threatening illness.
Methods
Semi-structured interviews with patients with lung cancer (n=22) and advanced COPD (n=18), their informal carers (21 lung cancer, 18 COPD) and health care professionals (n=51). Patients were recruited from primary and secondary care in the East of England, United Kingdom, during 2010-2012.
Results
Directness and clarity characterized communication in lung cancer, whereas uncertainty and limited explanations predominated in COPD. Discussions on how the disease might impact on decisions and preferences to be made in the future were less common in COPD Information for lung cancer patients was mainly from hospital clinicians, and any information for COPD patients mainly from primary care clinicians.
Conclusions
The experience of COPD patients could be improved by professionals soon after diagnosis explaining to them the typical pattern of decline in COPD, highlighting the inherent uncertainties about when exacerbations and death may occur. This conversation should lead to planning for the different challenges which the patient and informal carer recognise as most important to them. This contrasts with the “breaking bad news” conversation which oncologists are highly train
Original languageEnglish
JournalFamily Practice
DOIs
Publication statusPublished - 19 Apr 2021

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