1. Components Mechanisms of action Outcomes
Figure 1. Components, mechanism of action and outcomes of expert multidisciplinary palliative care
Components
Assessment and management of symptoms and concerns
Mechanisms of action
Discussing treatment preferences
Promotion of dignity and self-worth
Providing education around illness and prognosis
Treatments to help patients self-manage symptoms
Aids and therapies to improve function
↑ quality of life
↓ symptom burden
↓ health care utilisation
↑ patient and
caregiver satisfaction
Outcomes
Improved understanding
of illness
Planned care including admission avoidance
at end of life
Care coordination and liaison
More informed treatment decisions
Planning for end of life
Opportunity to face complex issues collaboratively
Labels for circles outside to inside
COMPONENTS OF PALLIATIVE CARE
MECHANISMS OF ACTION
OUTCOMES
Text for middle circle
Treatments to help patients self-manage symptoms
Improved understanding of illness leading to more informed treatment decisions
Planned, co-ordinated care including avoidance of hospital admission at end of life
Therapy provision to improve function
Promotion of dignity and feelings of self-worth
Opportunity to face complex issue collaboratively
Advocating for patients and families
Building relationships with patients and families

2. Figure 2. The lived experience of patients with advanced COPD
Understanding of condition
Insidious onset and normalisation of symptoms Realising life-limiting nature
Conflict in wanting information and maintaining hope Lack of discussion around end of life
Invisibility in social relations and to services Concerns of family members and friends
Sustained symptom burden
Breathlessness Pervasiveness
Simple tasks untenable
Visibility of symptoms
Fatigue Interruption to functioning
Altered behaviours
Frustration
Frailty Loss of capability
Disruption to social role
Frustration at dependence
Psychosocial impact
Anxiety Breathlessness
Night time distress
Fear of death
Social isolation A shrinking world
Loss of spontaneity
A spectator in life
Loss of hope Existing
Desolation
Maintaining meaning Keeping positive
Accepting the situation
Taking one day at a time
Adapted from Disler et al. J Pain Symptom Manage 2014;48(6):

3. Figure 3. Models of integrative working with palliative care for people with COPD
Disease trajectory
Function
Time
Ongoing respiratory medicine and primary care
Indications for palliative care:
Complex troublesome symptoms; unmet family caregiver needs; hospitalisation or transition in place of residence; acute inpatient care for respiratory failure; commencing oxygen therapy; referral for transplantation; acute functional decline; unable to attend pulmonary rehabilitation
Potential models for integrative working:
Symptom triggered services (e.g. refractory breathlessness)
Short-term Integrated Palliative Care (e.g. Breathlessness Support Service)
Advanced COPD clinics
Integrated Respiratory Care services (e.g. pulmonary rehabilitation, early supported discharge, hospital at home)