Background Patients with COPD have a higher symptom burden than those with lung cancer. One year mortality following admission with an exacerbation of COPD (ECOPD) is 23.2%. The ‘Surprise Question’ is an established screening tool designed to select patients likely to have a poor prognosis and palliative care needs. We examined whether there was a correlation between a ‘No’ answer to this question and evidence of prognostic or advance care planning discussions.
Methods As part of the MoSHCOPD study (clinicaltrials.gov NCT03657121) unique, consecutive patients surviving hospital admission for ECOPD were recruited. During admission, the responsible consultant was asked ‘Would you be surprised if this patient died within the next year?’. On discharge, we recorded whether the patient had a Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decision in place (prognostic discussions not resulting in a DNACPR decision were not captured) and whether there was evidence of further advance care planning or specialist palliative care (SPC) input.
Results Of 314 patients recruited to date, a ‘No’ answer to the Surprise Question was given in 151 (48.9%). Of these, 87 (57.6%) had a DNACPR decision recorded on discharge and 15 (9.9%) had evidence of either advance care planning or SPC involvement. In patients with both a ‘No’ answer and an active DNACPR, 15 (17.2%) had evidence of either advance care planning or SPC involvement.
Conclusion Despite clinicians having a pessimistic expectation of one year survival in this patient group, rates of advance care planning and SPC involvement are disappointingly low, in keeping with previous research in this area. Clinicians’ lack of confidence in estimating prognosis following ECOPD is likely to contribute to these findings and needs to be urgently addressed. The MoSHCOPD study aims to improve prognostication following ECOPD, thus supporting clinicians to engage in advance care planning in this underserved patient group.
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