Article Text

Download PDFPDF

167 The surprise question in severe COPD exacerbations: correlation with dnacpr decisions and advance care planning
  1. Sarah M Gillespie,
  2. Nicholas D Lane,
  3. Katherine E Frew and
  4. Stephen C Bourke
  1. Respiratory Research Northumbria Healthcare NHS Foundation Trust, Institute of Cellular Medicine Newcastle University, Department of Palliative Medicine Northumbria Healthcare NHS Foundation Trust, Institute of Health and Society Newcastle University


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 ( 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.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.