• Anna MacPherson, Catherine Walshe, Valerie O'Donnell, and Aashish Vyas.
• North Western Deanery, UK. anna_macpherson@hotmail.com
• Palliat Med. 2013 Mar 1;27(3):265-72.

BackgroundChronic obstructive pulmonary disease (COPD) is a major cause of death worldwide and there are concerns that end-of-life care for these patients is inadequate. Advance care planning is encouraged, with the hope that it will improve communication and avoid unwanted interventions, which have been particular concerns; in practice, these discussions rarely occur. We have little knowledge of the views of patients with COPD on advance care planning. Understanding this could help integrate advance care planning into the routine management of patients with COPD.AimTo explore the views of people with severe COPD about advance care planning.DesignQualitative design, with data collection incorporating audio recorded semi-structured interviews. Analysis followed a grounded theory approach.Setting/ParticipantsPatients with severe COPD (n =10, Gold Standards Framework criteria) were recruited from primary and secondary care settings.ResultsParticipants felt they had not been given enough information about their diagnosis and prognosis, and were keen for more discussion with healthcare professionals. They wanted more involvement in decisions about their treatment when those decisions were required. Participants were happy to discuss their general views about future care, but felt uncomfortable with the traditional model of binding 'advance directives'.ConclusionsConsidering advance care planning as a repeated process of discussion of prognosis, concerns and probable preferences for care would be more useful than encouraging binding advance decisions. Further research should assess the effectiveness of this approach. Local coordination of who is responsible for information provision is needed, and greater involvement of patients with COPD in management decisions as they arise.

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