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Original research
Advance care planning in COPD: guidance development for healthcare professionals
  1. Elaine Meehan1,
  2. Catherine Sweeney2,
  3. Tony Foley2,
  4. Elaine Lehane3,
  5. Art Burgess Kelleher2,
  6. Ruth M Hally3,
  7. Deirdre Shanagher4,
  8. Bettina Korn5,
  9. Mary Rabbitte6,
  10. Karen Margaret Detering7,8 and
  11. Nicola Cornally3
  1. 1 School of Nursing and Midwifery, Cork, Ireland
  2. 2 School of Medicine, University College Cork, Cork, Ireland
  3. 3 School of Nursing and Midwifery, University College Cork, Cork, Ireland
  4. 4 Irish Hospice Foundation, Dublin, Ireland
  5. 5 Hospice Friendly Hospital Programme, St. James's Hospital, Dublin, Ireland
  6. 6 All Ireland Institute of Hospice and Palliative Care, Dublin, Ireland
  7. 7 Advance Care Planning Australia, Austin Health, Melbourne, Victoria, Australia
  8. 8 Faculty of Medicine Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
  1. Correspondence to Dr Nicola Cornally, School of Nursing and Midwifery, University College Cork, Cork T12 K8AF, Ireland; n.cornally{at}ucc.ie

Abstract

Objectives To examine current practices, attitudes and levels of confidence related to advance care planning (ACP) in patients with chronic obstructive pulmonary disease (COPD) among healthcare professionals working in Ireland. This will inform future clinical guidance development.

Methods A cross-sectional survey of healthcare professionals.

Results There were 143 participants (109 general practitioners, 25 nurses, 7 physiotherapists and 2 consultant physicians). The majority (82%, n=117) cared for patients with COPD weekly, but only 23% (n=33) had initiated ACP with a patient with COPD over the previous 6 months. Overall, 59% (n=85) answered ≥6 of 8 general knowledge questions correctly. Participants demonstrated positive attitudes towards ACP (mean score 3.6/5.0), but confidence levels were low (2.2/4.0). Most thought ACP was appropriate for patients with severe or very severe COPD (71%, n=101%, and 91%, n=130, respectively) but were unsure or felt that it was not appropriate for those with mild–moderate COPD. However, almost all participants (97%, n=139) stated that if a patient expressed a desire to have ACP discussions, they would comply. Topics most likely to be discussed related to diagnosis and treatment options. Death and end-of-life issues were rarely discussed. The death of a family member or friend and participation in support groups were identified as new ‘triggers’ for initiating ACP.

Conclusions Targeted education to improve general knowledge and confidence levels among healthcare professionals, together with initiatives to increase public awareness of ACP so that patients themselves might be more inclined to start the discussion, may help increase the uptake of ACP for this patient group.

  • advance care planning
  • chronic obstructive pulmonary disease

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

https://doi.org/10.1136/bmjspcare-2019-002002

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    Data availability statement

    All data relevant to the study are included in the article or uploaded as supplementary information.

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    Footnotes

    • Contributors CS, TF, EL, ABK, RMH, DS, BK, MR and NC conceived the study and participated in the design of the study, including the design of the survey. KMD provided one of the survey items and acted as an international advisor for the study. EM monitored data collection and participant recruitment, and completed the data entry. EM and NC developed the data analysis plan, analysed the data and drafted the manuscript. All authors read, revised and approved the final version of the manuscript.

    • Funding This study was supported by a GlaxoSmithKline (GSK) Independent Medical Education grant. GSK had no input in the design of the study, data collection, data analysis or interpretation, or in the preparation, review or approval of this manuscript.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.