Preference for advance care planning in patients with pulmonary hypertension

Implementing advance care planning (ACP) is recommended in clinical guidelines. However, in pulmonary hypertension, patients' preference toward ACP remains unclear. We aimed to elucidate the preference of patients with pulmonary hypertension for ACP conversations and the association of ACP with important patient factors underlying treatment decision-making. We conducted a cross-sectional questionnaire-based study, assessing patients' preferred and actual participation in ACP conversations, as well as important patient factors underlying their treatment decision-making (including prognosis; patient values; physician recommendation; and symptom, financial, family, and social burdens). Univariate logistic regression analysis was conducted to identify patients with positive attitudes toward ACP conversations. Of 133 patients with pulmonary hypertension (median age, 60 years; mean pulmonary arterial pressure, 23 mmHg; female, 71.4%), 78.2% recognized the importance of ACP conversations. Regarding the patients' perception of appropriate ACP timing, 37.8% chose after repeated hospitalizations for worsening pulmonary hypertension and 22.4% chose during readmission for worsening pulmonary hypertension. Among these, 40.8% engaged in ACP conversations. A positive attitude toward ACP conversations was associated with marital status (married), having children, better oxygenation, and patients' preference toward physician recommendations in pulmonary hypertension treatment decision-making, but not with age, pulmonary hypertension etiology, or other patient preferences in treatment decision-making. Most patients with pulmonary hypertension preferred ACP conversations. A positive attitude toward ACP was associated with patients' preference toward physicians' recommendations in pulmonary hypertension treatment decision-making. Further research is required to establish an appropriate ACP approach that aligns with patient preference and physician recommendations for this patient population.