A call for high-quality advance care planning in outpatients with severe COPD or chronic heart failure.
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.
Janssen
Daisy J A
DJA
Program Development Centre, CIRO+, Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands; Proteion Thuis, Horn, The Netherlands; CAPHRI, Maastricht University, Maastricht, The Netherlands. Electronic address: daisyjanssen@proteion.nl.
Spruit
Martijn A
MA
Program Development Centre, CIRO+, Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands.
Schols
Jos M G A
JMGA
Department of General Practice, Nursing Home Medicine, Faculty of Health Medicine and Life sciences/CAPHRI, Maastricht University, Maastricht, The Netherlands.
Wouters
Emiel F M
EFM
Program Development Centre, CIRO+, Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands; Department of Respiratory Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands.
D032722:Advance Care Planning / Q000592:standards*; D000368:Aged; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D005260:Female; D006333:Heart Failure / Q000628:therapy*; D006801:Humans; D008297:Male; D057240:Patient Preference; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000628:therapy*; D012720:Severity of Illness Index