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Original Research: COPD |

A Call for High-Quality Advance Care Planning in Outpatients With Severe COPD or Chronic Heart Failure

Daisy J. A. Janssen, MD; Martijn A. Spruit, PhD; Jos M. G. A. Schols, MD, PhD; Emiel F. M. Wouters, MD, PhD, FCCP
Author and Funding Information

From the Program Development Centre (Drs Janssen, Spruit, and Wouters), CIRO+, Centre of Expertise for Chronic Organ Failure, Horn; Proteion Thuis (Dr Janssen), Horn; CAPHRI (Dr Janssen), Maastricht University, Maastricht; the Department of General Practice (Dr Schols), Nursing Home Medicine, Faculty of Health Medicine and Life sciences/CAPHRI, Maastricht University, Maastricht; and the Department of Respiratory Medicine (Dr Wouters), Maastricht University Medical Centre+, Maastricht, The Netherlands.

Correspondence to: Daisy J. A. Janssen, MD, Program Development Centre, CIRO+, Centre of Expertise for Chronic Organ Failure, Hornerheide 1, 6085 NM Horn, The Netherlands; e-mail: daisyjanssen@proteion.nl


Funding/Support: This project was supported by Proteion Thuis and CIRO+, Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands; The Netherlands Asthma Foundation, Leusden, The Netherlands [Grant 3.4.06.082]; and Stichting Wetenschapsbevordering Verpleeghuiszorg (SWBV), Utrecht, The Netherlands.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2011 American College of Chest Physicians


Chest. 2011;139(5):1081-1088. doi:10.1378/chest.10-1753
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Background:  Patients with severe COPD or chronic heart failure (CHF) are often confronted with decisions concerning life-sustaining treatments. The aim of this prospective, observational study was to assess life-sustaining treatment preferences, advance care planning, and the quality of end-of-life care communication in Dutch outpatients with clinically stable but severe COPD or CHF.

Methods:  The following outcomes were assessed in outpatients with severe COPD (n = 105) or CHF (n = 80): life-sustaining treatment preferences (CPR and mechanical ventilation; Willingness to Accept Life-sustaining Treatment instrument), advance care planning, and quality of end-of-life care communication (Quality of Communication questionnaire).

Results:  Most patients asserted that in their current health status, they would prefer CPR (COPD, 70.5%; CHF, 62.5%) and/or mechanical ventilation (COPD, 70.5%; CHF, 66.3%). Patients’ treatment preferences were influenced by burden of treatment, outcome of treatment, and likelihood of outcome. Advance directives were discussed with the physician specialist by 5.9% of patients with COPD and 3.9% of patients with CHF. Patients rated quality of patient-physician end-of-life care communication as poor. Physicians rarely discussed prognosis, dying, and palliative care.

Conclusions:  Despite the fact that patients are able to indicate their preferences regarding life-sustaining treatments, based on burden of treatment, outcome of treatment, and likelihood of outcome, these preferences are rarely discussed with their physician specialist. This study shows a need for advance care planning, taking into account the burden of treatment, outcome of treatment, and likelihood of outcome, in patients with severe COPD or CHF. Finally, the quality of patient-physician end-of-life care communication needs to improve.

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