ArticleBMJ open2025
How do clinicians navigate end-of-life care with NIV/CPAP? A thematic analysis study.
Article in BMJ open, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Authors and funding
5 authors.
Funding
Abstract
objectivesTo explore barriers and facilitators to a good death in patients with respiratory disease when advanced respiratory support, including non-invasive ventilation (NIV) and continuous positive airway pressure (CPAP), is used. Specifically, we examined healthcare professionals' perspectives on what constitutes a good death in this context, how treatment failure is recognised, how decisions to continue or withdraw therapy are made, and the impact of providing this care on staff.
designQualitative study using semistructured interviews and reflexive thematic analysis.
settingSecondary care services in a large UK National Health Service Trust, including acute medicine, general medicine, respiratory medicine and palliative care.
participants25 healthcare professionals (19 female, 6 male) from multidisciplinary backgrounds, including doctors, nurses and physiotherapists. Participants self-identified as experienced in the provision of NIV/CPAP at the end of life. Staff working primarily in intensive care units were excluded.
interventionsNone. OUTCOME MEASURES: Not applicable.
resultsHealthcare professionals described the complexity of caring for patients dying while receiving or recently withdrawn from NIV/CPAP. Five interrelated themes were identified: beliefs around dying well, symptom management during active treatment, recognition of treatment failure, negotiated decision-making and the process of withdrawal. Staff reported tensions between providing active treatment and ensuring comfort, inconsistent practices regarding symptom control and withdrawal, and conflicts within multidisciplinary teams. Nurses highlighted hidden psychological and relational labour in supporting patients, while doctors often described delays in decision-making to align families with treatment withdrawal.
conclusionsCaring for patients using NIV/CPAP at the end of life presents ethical, clinical and emotional challenges for staff, patients and families. Variation in practices and perspectives highlights the need for structured training, interdisciplinary approaches and greater recognition of the often hidden relational and emotional labour involved in this work, particularly among nursing colleagues. Further research should evaluate strategies to support consistent and compassionate withdrawal practices.
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