Background

Patients with COPD benefit from advance care planning because they experience acute exacerbations of their disease, which present risks of prolonged mechanical ventilation and death, and require stand-by decisions as to how to proceed. Advanced care planning derives from the principle of patient autonomy, wherein patients shape their healthcare decisions to match their values and preferences. In addition, advance care planning allows care providers to substitute better plans for those that would automatically happen in the absence of clear directions. Patients with COPD desire assistance with advance care planning, which is a responsibility of their caregivers.

Unfortunately, most patients with advanced COPD have not discussed their end-of-life wishes with their physicians or other caregivers. Only 19% of patients with advanced lung disease enrolled in pulmonary rehabilitation programmes have discussed, with their physicians, the appropriateness of life supportive care relative to their lung condition. In addition, only 15% of patients have discussed, with their physicians, the nature of intubation and mechanical ventilation and <15% of patients with advanced lung disease have confidence that their physicians understand their end-of-life wishes [1].

Formal, written documents, such as living wills and durable powers of healthcare, have not fulfilled their goals to improve end-of-life care, in part because they are too general and often too legalistic. Comprehensive advance care planning depends on a holistic approach to patient care tailored to individual needs. Patients need education on the nature of and likely outcome from life supportive interventions and the availability of palliative care to make valid end-of-life decisions.

Patients with advanced COPD suffering from disabling symptoms benefit from integrating palliative care into routine care, especially to relieve dyspnoea and to address emotional and spiritual issues. Patients dying from conditions other than COPD (such as lung cancer) also benefit from palliative services directed towards the relief of respiratory symptoms originating from coexisting COPD.