• Tracy A Smith, Rebecca T Disler, Christine R Jenkins, Jane M Ingham, and Patricia M Davidson.
• 1 St Vincent's Clinical School, Faculty of Medicine, UNSW Australia, Sydney, NSW, Australia.
• Palliat Med. 2017 Jun 1; 31 (6): 566-574.

BackgroundPatients requiring non-invasive ventilation for acute-on-chronic respiratory failure due to chronic obstructive pulmonary disease or heart failure exacerbations may have a poor prognosis underscoring the importance of advance care planning.AimWe aimed to describe attitudes to, and experiences of, discussing the future among patients recently treated with non-invasive ventilation.DesignQualitative research using thematic analysis.Settings And ParticipantsTertiary teaching hospital. Patients with acute hypercapnic respiratory failure requiring non-invasive ventilation.ResultsIndividuals recently treated with non-invasive ventilation describe feeling the future is beyond their control and instead controlled by their illness. Participants often recognised their poor prognosis but avoided discussing some difficult topics. The majority preferred not to undergo cardiopulmonary resuscitation but most had not discussed this with healthcare professionals. When participants voiced concerns about their future health to family members, they were met with polarised responses. Some encountered willingness for further discussion, while others met deflection, deterring further conversation. An overarching narrative of 'Looking through my illness to an uncertain but concerning future' unites these themes.ConclusionThis study suggests opportunities and barriers for advance care planning in individuals with chronic disease. Patients' understanding of their prognosis and their attitudes to cardiopulmonary resuscitation suggests an opportunity for advance care planning. Structuring discussions around patients' preferences for care during future exacerbations may foster a sense of control over the future despite illness. The diversity of familial responses to patients' concerns about their future health has implications for advance care planning. These findings have the potential to improve care for patients with respiratory failure and suggest an important ongoing research agenda.

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