The advance care planning in respiratory rehabilitation of chronic obstructive pulmonary disease (COPD) patients

Introduction Despite a severely degraded quality of life in the advanced stages, chronic obstructive pulmonary disease (COPD) patients rarely discuss end-of-life issues and have little access to palliative care. After knowing this fact, some organisations recommend advance care planning integrated into the respiratory rehabilitation. Considering the important role played by physiotherapists in this rehabilitation, the aim of this study is to understand the professional practices of physiotherapists regarding this planning during rehabilitation and the factors influencing these practices. Methods The research consisted of a qualitative study with physiotherapists practising in France and conducting respiratory rehabilitation with COPD patients. Semi-structured interviews were conducted, followed by a thematic analysis. Results This study shows that discussions relating to the end of life are very frequent during respiratory rehabilitation. This high prevalence appears to be influenced both by the context in which respiratory rehabilitation is completed and by the trusting relationship established between the physiotherapist and their patients. Nevertheless, these discussions are merely a draft of advance care planning, which is a broader concept. It appears that a lack of knowledge about advance care planning itself, combined with insufficient training in palliative care among professionals, as well as a lack of rigour in therapeutic education, hinders the implementation of advance care planning. Conclusion In spite of the limited training in palliative care and sometimes the imprecise therapeutic education, physiotherapists appear to play an important role in addressing end-of-life issues during respiratory rehabilitation. However, physiotherapists are not the only professionals who should raise these topics. This is especially important in the French healthcare system, where fewer than half of COPD patients have access to rehabilitation with a physiotherapist.