• David Seamark, Susan Blake, Clare Seamark, Michael E Hyland, Colin Greaves, Margaret Pinnuck, David Ward, Adam Hawkins, David Halpin, and East Devon Respiratory Research Group.
• The Honiton Research Practice, The Surgery, Honiton, Devon, UK. david.seamark@nhs.net
• Prim Care Respir J. 2012 Sep 1;21(3):261-6.

BackgroundIt is recognised that patients with chronic obstructive pulmonary disease (COPD) should have the chance to discuss end-of-life care and advance care planning (ACP). Admission to hospital with an exacerbation may be a possible opportunity.AimsTo examine whether an admission to hospital for an exacerbation of COPD is an opportunity for ACP and to understand, from the patient perspective, the optimum circumstances for ACP.MethodsPatients who had a recent admission for an exacerbation of COPD were identified. Sixteen patients and their carers were interviewed. The interviews were analysed using qualitative methodology.ResultsNo patients recalled discussions about resuscitation or planning for the future. Hospital admission and discharge was seen as chaotic and lacking in continuity. Some patients welcomed the opportunity to discuss ACP and felt that their general practitioner (GP) would be the best person for this. Others wished to avoid end-of-life care discussions but there was evidence that, with empathetic and knowledgeable support, these discussions could be initiated.ConclusionsThe period of hospitalisation may not be an appropriate time to initiate ACP but may be a milestone that can lead to discussions. GPs should be alert to that opportunity after discharge from hospital.

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