Advance care planning in COPD: care versus "code status".

Area of Science:

• Pulmonary Medicine
• Palliative Care
• Health Services Research

Background:

• Advanced chronic obstructive pulmonary disease (COPD) is characterized by unpredictable decline and frequent, fatal exacerbations.
• Current advance care planning (ACP) for COPD is often reactive and crisis-driven, leading to inadequate decision-making.
• Physicians often bear the responsibility for initiating ACP, but tend to avoid it, contributing to suboptimal care.

Purpose of the Study:

• To explore the requirements for meaningful and effective advance care planning (ACP) in advanced COPD.
• To identify key elements for improving the process and outcomes of ACP in this patient population.

Main Methods:

• A qualitative study was conducted within a doctoral program.
• A "collaborative care" approach to ACP was implemented with eight patients and their carers living with advanced COPD.
• The approach incorporated a skilled clinician facilitator, educational elements, attention to readiness, and a focus on caring, hope, facilitator reflection, and contextual sensitivity.

Main Results:

• The collaborative care approach demonstrated potential for enhancing decision-making and goal setting in advanced COPD.
• This method showed promise for improving the efficiency of resource utilization and patient/family satisfaction with outcomes.
• Unique aspects like focusing on caring, engaging hope, and contextual sensitivity addressed identified barriers to ACP.

Conclusions:

• A well-executed collaborative care model can enhance advance care planning for individuals with advanced COPD.
• This approach has the potential to improve patient outcomes, resource efficiency, and satisfaction by addressing barriers faced by patients, families, and physicians.
• Meaningful ACP in advanced COPD can be achieved by integrating care, hope, and contextual sensitivity into the planning process.