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  • ‘It’s a hard conversation to have’. Healthcare professionals’ views concerning advance care discussions with young people affected by life-limiting neuromuscular diseases: an interview study

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Research
‘It’s a hard conversation to have’. Healthcare professionals’ views concerning advance care discussions with young people affected by life-limiting neuromuscular diseases: an interview study
  1. Andy Hiscock1 and
  2. Stephen Barclay2
  1. 1 Cambridge University Hospitals NHS Foundation Trust, Addenbrooke’s Hospital, Cambridge, UK
  2. 2 Department of Public Health and Primary Care, University of Cambridge, University Senior Lecturer in Palliative Care and General Practice, Primary Care Unit, Cambridge, UK
  1. Correspondence to Andy Hiscock, Neuromuscular Care Advisor, Box 165 Addenbrooke’s Hospital, Cambridge CB2 0QQ, UK; andrew.hiscock{at}nhs.net

Abstract

Objective Life-limiting neuromuscular disease, such as some of the muscular dystrophies, are often diagnosed in early childhood: when death comes, commonly in the second or third decade of life, patients rarely have advance care plans in place or documented end-of-life care preferences. There is very limited literature concerning the discussions about end-of-life plans healthcare professionals have with young people affected by life-limiting neuromuscular diseases. The aim of this study was to investigate the views and experiences of healthcare professionals concerning having discussions about advance care plans and end-of-life care with teenagers and young adult patients affected by life-limiting neuromuscular diseases.

Methods Semistructured interviews with a maximum variety sample of nine professionals involved in the care of young people with life-limiting neuromuscular diseases in one region of the UK.

Results While recognising the inevitable progression of the conditions, there was no consensus among interviewees concerning best approaches to discuss end-of-life care plans. Several environmental and personal barriers were identified that lead to avoidance of the emotionally challenging and difficult conversations.

Conclusions Community-based professionals with well-established relationships with patients and families may be best placed to take the lead and coordinate discussions, but individual case-by-case preferences need to be carefully considered.

  • Communication
  • Family management
  • Neurological conditions
  • Supportive care
  • Transitional care

https://doi.org/10.1136/bmjspcare-2017-001369

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    Footnotes

    • Funding AH was funded to undertake this study by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) East of England at Cambridgeshire and Peterborough NHS Foundation Trust.

    • Patient consent Study did not involve patients, just health professionals who were interviewed.

    • Ethics approval University of Cambridge Psychology Ethics Committee.

    • Provenance and peer review Not commissioned; internally peer reviewed.

    • Correction notice This paper has been amended since it was published Online First. Owing to a scripting error, some of the publisher names in the references were replaced with ’BMJ Publishing Group'. This only affected the full text version, not the PDF. We have since corrected these errors and the correct publishers have been inserted into the references.