Respiratory Therapists' Attitudes and Beliefs Regarding High Flow Nasal Cannula Use at End-of-Life

Respiratory therapists (RTs) are frequently involved in managing high-flow nasal cannula (HFNC) at end-of-life (EOL). However, few studies have examined RTs' attitudes and beliefs about EOL HFNC management, which have important clinical, logistical, and ethical implications for providing goal-concordant care.

To determine whether RTs agree patients' goals for comfort-focused care affects their management of HFNC at EOL.

We conducted an anonymous survey of RTs at our institution between October and November 2024. This 32-question survey consisted of four sections examining RTs' attitudes and beliefs regarding HFNC use at EOL, perceived benefits and harms of HFNC, and self-competence. We also collected RT characteristics, such as gender, age, religion, years of experience.

Response rate was 69% (60 of 87 RTs). Thirty-five (58%, 95% CI: 45%-71%) RTs agreed that comfort-focused care goals affected EOL HFNC management. Twenty-nine (48%) RTs reported distress about prolonging suffering. Thirty (50%) felt distressed about prolonging dying by continuing HFNC at EOL. The majority perceived HFNC as beneficial for relieving dyspnea in conscious (n = 44; 73%) or hypoxemic patients (n = 42; 70%). Fewer perceived benefits for unconscious (n = 18; 30%) or nonhypoxemic patients (n = 24; 40%). Most reported feeling confident in their abilities to manage HFNC for comfort at EOL.

Only 58% of RTs agreed that goals for comfort-focused care at end-of-life affect their HFNC management. Almost half reported distress regarding HFNC use at EOL. Our findings underscore opportunities for guidance and support for RTs involved in EOL dyspnea management and the delivery of goal-concordant care.