Idiopathic pulmonary fibrosis (IPF) is a progressive and ultimately fatal lung disease. The majority of IPF patients die in hospital settings in Japan not only due to severe symptoms but also late end-of life (EOL) decision. This report presents four cases where advance care planning (ACP) allowed patients to choose their own EOL setting. Case 1 70s male with IPF for 3 years with a stable condition but eventually worsen due to pneumothorax. Through ACP, he chose his home as the place of death. Case 2 60s male with IPF for 8 years but conditions eventually worsen due to severe pulmonary hypertension caused by pulmonary embolisms (PE). After ACP, he decided to remodel the house, allowing him to stay at home for 20 days before dying Case 3 70s female diagnosed with familial IPF 3 years ago but conditions worsen due to acute heart failure due to PE. After recovering 7 months later, she decided to move to a nursing home through ACP. Case 4 70s male with IPF for 12 years, with existing malignant lymphoma, the condition gradually deteriorated leading to the decision to stay at a hospice through ACP

In conclusion, ACP was helpful in the cases mentioned above as it gave the patients the power to make their own decision. Although, medical professionals tend to lean towards disease-centered management they understand the difficulties in deciding the best timing to discuss EOL issues so that patients will not lose hope too early on