Co Discovery (Trivago)

Due to the high number of people in the UK living with a long-term condition (Department of Health, 2012b), the government has set out a strategy to improve the outcomes for this group with the introduction of the community matron (CM) role (DH, 2004). The community management for patients with COPD in the community has changed since this implementation.There is, unsurprisingly, a high level of contact with health services for patients with COPD and lung cancer, due partially to their high

symptom levels. The majority of contact with healthcare professionals occurs outside the patient’s home. Specialist services such as specialist palliative care teams, specialist respiratory nurses, district nurses and community matron teams are often not available for patients with COPD (Elkington et al., 2004; Elkington et al., 2005; Goodridge et al., 2008). Patients with lung cancer receive a more holistic package of care. Gore et al.

(2000) showed that lung cancer patients received good access to specialist palliative care teams; alternatively the COPD patients had no equivalent package of care and their palliative care needs went unrecognised. Cooke and Thackray (2012) reported that equity of access to services was an important issue for patients and healthcare professionals alike but both groups had different views. The health care professionals expressed a concern that the patients were not utilising provided services, “people don’t tend to come forward so health beliefs prevent communication” (Cooke and Thackray, 2012 p.1527). The patients however believed there was no consistency in the referral process

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and felt they were being moved around healthcare services, GP to chest clinic to

physiotherapist. The study can be criticised however as the sample population is biased, both patients and professionals recruited to the study were not ethnically representative of the city population andincluded a range of volunteer clinicians and self-selected patients with their carers who provided or used the COPD services. Goodridge et al.

(2010) showed that location had an influence on service provision, finding that the likelihood of receiving specialist palliative care services was significantly reduced in rural or remote areas. However, the data represented one Canadian province only and

regional variation in practice may affect the generalisability of the findings. The data analysis did not allow for assessment of the quality of life, or the appropriateness and adequacy of care for those who died with respiratory illness. Researchers declared that using an administrative database could cause inaccuracy of coding and lack of contextual detail.

Patients with COPD can be accepting of their condition. Pinnock et al. (2011 p.4) described COPD as becoming ‘a way of life’, suggesting “it was something that had to be coped with ‘as best as you can’”, meaning patients did not actively seek out help. A study by Currow et al. (2008) explored the views of caregivers for patients with end stage lung disease. They reported that caregivers felt they had unmet needs in regard to support with physical care and symptom control and lacked knowledge about illness course and service provision. They admitted that assessment on patients who are near death was problematic. Patients may under report symptoms to avoid distressing their carers. When participants are interviewed after a life changing event (death) their recall of events could be compromised, questioning the reliability of the data. As only people who were living in remote settings were used for this study, not all cultural backgrounds were represented.

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People who lived alone, or whose caregiver subsequently died were not represented.

Participants whose first language was not English were also under-represented in the data, meaning participant bias affected this study.Edmonds et al. (2001) showed that none of the patients who had chronic lung disease in their study received care from a Macmillan or hospice nurse, whereas almost a third of patients with lung cancer received help from a Marie Curie nurse. Seamark et al. (2004) explored patient perceptions of living with COPD finding that relationships with healthcare professionals provided benefits such as being given a diagnosis and having confidence in the doctor, normally the GP. However, negative aspects such as confusion over the role of hospital clinics, specialist respiratory nurses and a perceived lack of follow up or surveillance of the disease were also apparent. This study is limited due to the results not being generalisable.

Some studies have reported positive attitudes towards healthcare services, Murray et al., (2002) showed that patients with lung cancer were happy with their care and appreciated the support of a hospital based lung specialist cancer nurse during treatment. Disler and Jones (2010) showed that patients with a malignant disease such as lung cancer were looked after well by district nurses in the community. They found however there were restrictions when engaging with COPD patients, even though their symptoms were severe and the patients were mainly housebound. The study’s results however cannot be generalisable due to the sample size of the survey (44% of

population). Exley et al. (2005) showed that patients with cancer were more likely to receive care from a district nurse than those with end stage lung disease. Evidence demonstrates that clear discrepancies between specialist services for COPD and lung cancer exist. This warrants further investigation.

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