• Elaine Meehan, Tony Foley, Claire Kelly, Art Burgess Kelleher, Catherine Sweeney, Ruth M Hally, Karen Detering, and Nicola Cornally.
• School of Nursing and Midwifery, University College Cork, Cork, Ireland.
• J Pain Symptom Manage. 2020 Jun 1; 59 (6): 1344-1361.

ContextIndividuals with chronic obstructive pulmonary disease (COPD) typically experience a gradual worsening of the illness in the years before death. Owing to difficulties in predicting the disease trajectory or the timing of acute exacerbations, advance care planning (ACP) may be of particular importance for individuals with COPD.ObjectivesThe objective of this study was to review and summarize the available literature on current practices around ACP in COPD.MethodsA scoping review of the literature was conducted following the Arksey and O'Malley framework. Original research studies of any design were included.ResultsTwenty-eight studies were included. Across studies, there was agreement that ACP should be incorporated into routine COPD management. There was evidence that this does not occur in everyday practice, with conversations tending to focus on day-to-day symptom management. Barriers included prognosis uncertainty, insufficient time and training, and a lack of protocols for who is responsible for initiating ACP. Facilitators included the use of transition points for identifying the appropriate time to initiate ACP, and an increased focus on ACP in professional education. The occurrence of repeated episodes of acute care was identified as a key transition point for identifying the palliative stage of COPD and an appropriate time to initiate ACP.ConclusionThe findings of this review confirm agreement among health care professionals and patients with COPD and their carers that ACP should be incorporated into routine COPD management. The use of transition points may help health care professionals overcome the barrier of prognosis uncertainty and identify patients who might benefit from ACP.Copyright © 2019 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

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