Effectiveness of Caregiver Interventions to Reduce Household Secondhand Smoke Exposure on Pediatric Asthma Outcomes: A Systematic Review.

According to current guidelines, palliative care for Chronic Obstructive Pulmonary Disease (COPD) integrates palliative treatment, supportive care, and advance care planning (ACP) []. Its core lies in implementing personalised interventions based on a comprehensive assessment of the patient’s condition and individual needs. It is also defined as “supportive care,” aiming to address patients’ physical and psychological needs, including life-prolonging treatments when necessary. Therefore, integrating supportive care into long-term management and accurately assessing needs is crucial [, ]. Patients with advanced COPD face complex health issues, commonly experiencing a high burden of symptoms such as dyspnea, fatigue, pain, and anxiety. The severity of these symptoms can be comparable to lung cancer, and patients often have multiple comorbidities, leading to frequent acute exacerbations and increased mortality risk [–]. Studies indicate that patients in this stage often enter a “liminal state,” marked by profound loss and existential distress [, ]. Consequently, integrating comprehensive palliative care into management is essential to alleviate suffering and provide care aligned with patient values. However, despite the diverse palliative care needs of patients with COPD, the actual provision of such services remains significantly inadequate. Across the entire UK cohort, only 7.8% of patients had received palliative care; the uptake rate among patients with advanced COPD was also only 21.4% []. Although their symptom burden is comparable to that of patients with lung cancer, the proportion receiving specialist palliative care is less than a third of that seen in the latter group []. Although there are currently no nationwide survey data in China reporting on the uptake of palliative care among patients with COPD, existing studies indicate that the need for palliative care among patients with severe COPD is moderate, suggesting a heavy symptom burden and an urgent need for intervention []. In resource-limited settings, achieving a shared understanding of needs among patients, families, and healthcare professionals becomes critical. Stakeholder theory provides a useful analytical framework, suggesting that any goal achievement depends on identifying and aligning the interests of all groups affected by or able to influence the goal []. In the context of COPD palliative care, healthcare professionals, as medical experts, are responsible for determining the advanced status and initiating palliative care. Patients, as the individuals directly experiencing the illness, define the core orientation of palliative care through their priorities regarding quality of life. Family members, undertaking daily care responsibilities, can keenly observe the patient’s actual experiences and act as crucial bridges for communicating needs []. Only by systematically identifying, analysing, and balancing the concerns of all three parties can cognitive barriers be overcome, establishing effective pathways to improve the quality of palliative care. Therefore, this study conducted in-depth interviews with patients with advanced COPD, their families, and healthcare professionals to systematically explore their differing perceptions and actual needs regarding palliative care. The aim is to provide an evidence base for developing targeted intervention strategies, thereby alleviating patient suffering and enhancing their quality of life at the end of life.