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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. 1School of Nursing and Midwifery, Cork, Ireland
  2. 2School of Medicine, University College Cork, Cork, Ireland
  3. 3School of Nursing and Midwifery, University College Cork, Cork, Ireland
  4. 4Irish Hospice Foundation, Dublin, Ireland
  5. 5Hospice Friendly Hospital Programme, St. James's Hospital, Dublin, Ireland
  6. 6All Ireland Institute of Hospice and Palliative Care, Dublin, Ireland
  7. 7Advance Care Planning Australia, Austin Health, Melbourne, Victoria, Australia
  8. 8Faculty 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}


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

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  • 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.

  • Patient consent for publication Not required.

  • Ethics approval University College Cork’s Social Research Ethics Committee granted ethical approval (2018–059).

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

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