Many patients and caregivers living with advanced COPD experience significant vulnerability arising from low socioeconomic status and education levels, high comorbidity, and social isolation. In addition, they contend with constraints caused by dyspnea, immobility, and oxygen-related equipment, and a panoply of emotional, psychologic, and existential concerns related to loss of meaning/purpose and hope and fear of death. The social and medical stigma associated with this smoking-related disease, the symptoms of which are often invisible to observers, simply compounds the situation.10,30‐32 This situation has led one author to characterize these patients as the “disadvantaged dying.”33 Current models of care tend to give little attention to this vulnerability with its attendant psychosocial and spiritual suffering, despite professional guidelines30 and organizational commitments to patient-/family-centered care.30,34,35 Because this is embedded within a largely unpredictable, progressively downward trajectory, the current “either/or” thinking (either cure or comfort) of biomedical care paradigms results in costly gaps in care.34‐36 A more patient-/family-centered “both/and” model would be responsive to evolving patient and caregiver needs—emotional, social, and spiritual, as well as physical. Patient-/family-centered care has been defined as “a partnership among patients, families, and health care providers to design patient-specific education and support to assist in making decisions that are respectful of the patient’s needs and wishes.”37 A more collaborative, patient-centered approach inclusive of palliative care for those living with advanced COPD requires the facilitation of effective communication among patients, caregivers, clinical team members, and colleagues. One element of this is clarifying a patient’s goals of care through to end of life via a process of effective ACP.