Development of a systematic multidisciplinary clinical and teaching model for the palliative approaches in patients with severe lung failure

Abstract

Palliative medicine has traditionally focused on people affected by cancer with rapidly advancing disease progression. However, as more people live longer time with serious illnesses, including lung diseases, the need of palliative care for these patients if also increasing. There is a lack of research and clinical knowledge about what palliative care is for people affected by chronic obstructive pulmonary disease and interstitial lung disease. The aim of this paper is to describe the development process of an easy to use and clinically relevant model for the palliative care approach in people affected by severe illnesses. The developed model consists of four components, which originated the title" 4,2,4,2 model". Each number has a specific meaning: the first 4 = the four disease trajectories that patients may experience; 2 = the two forms of knowledge, objective, and intuitive that must be achieved by the health professionals to gain an understanding of the situation; 4 = the four dimensions of suffering physically, mentally, socially and existentially/spiritually; and 2 = the two roles that health-care professionals must be able to take in when treating patients with serious illnesses. The 4-2-4-2 model proposes an easy-to-use and clinically relevant model for palliative approach and integration of PC and pulmonary medicine. Another important purpose of this model is to provide HPs with different educational backgrounds and from different medical fields with a 'golden standard approach' to enhance the focus of the palliative approach in both the clinic and teaching. The effect and consequences of the use of the 4-2-4-2 model should be explored in future clinical trials. Furthermore, it should be investigated whether teaching the model creates a change in clinical approach to patients with serious illnesses as well as whether these changes are long-lasting.

Keywords: COPD; ILD; Model development; chronic care; education; integration rehabilitation and palliative care; palliative care; palliative care approach.

Figure 1.

Personalized management and palliation includes symtom treatment, rehabilitation, patient education and support. Palliative support, including pyschological, social and existential support, may continue into care for the informal caregiver after the patient’s death. Routine and early Advance Care Planning (ACP) provide the ability to adjust treatment goals during the disease trajectory.

Figure 2.

The development of the model. There are 3 different types of feedback, from clinicians who take the model into clinical use, from teaching sessions and from experts.

Figure 3.