How do clinicians navigate end-of-life care with NIV/CPAP? A thematic analysis study

Area of Science:

• Respiratory Medicine
• Palliative Care
• Healthcare Professional Well-being

Background:

• Advanced respiratory support, including non-invasive ventilation (NIV) and continuous positive airway pressure (CPAP), is increasingly used in patients with respiratory disease.
• The end-of-life care for patients receiving these therapies presents unique ethical, clinical, and emotional challenges for healthcare professionals, patients, and families.

Purpose of the Study:

• To explore barriers and facilitators to a good death for patients with respiratory disease using advanced respiratory support (NIV/CPAP).
• To examine healthcare professionals' perspectives on defining a good death, recognizing treatment failure, decision-making regarding therapy withdrawal, and the impact on staff.

Main Methods:

• A qualitative study employing semistructured interviews with 25 experienced healthcare professionals (doctors, nurses, physiotherapists) in UK secondary care.
• Reflexive thematic analysis was used to identify key themes related to end-of-life care with NIV/CPAP.

Main Results:

• Five themes emerged: beliefs about dying well, symptom management, recognition of treatment failure, decision-making processes, and therapy withdrawal.
• Staff reported tensions between active treatment and comfort, inconsistent practices, and conflicts within multidisciplinary teams.
• Nurses described significant psychological and relational labor, while doctors noted delays in aligning families with treatment withdrawal decisions.

Conclusions:

• Caring for patients on NIV/CPAP at end of life poses complex challenges, highlighting the need for structured training and interdisciplinary collaboration.
• Greater recognition of the emotional and relational labor, particularly for nursing staff, is crucial.
• Further research should focus on strategies to ensure consistent and compassionate end-of-life care and withdrawal practices.