title: Is hospitalisation for COPD an opportunity for advance care  planning? A qualitative study.
abstract: BACKGROUND
  It is recognised that patients with chronic obstructive pulmonary disease (COPD) should have the chance to discuss end-of-life care and advance care planning (ACP). Admission to hospital with an exacerbation may be a possible opportunity.
  
  
  OBJECTIVE
  To examine whether an admission to hospital for an exacerbation of COPD is an opportunity for ACP and to understand, from the patient perspective, the optimum circumstances for ACP.
  
  
  METHODS
  Patients who had a recent admission for an exacerbation of COPD were identified. Sixteen patients and their carers were interviewed. The interviews were analysed using qualitative methodology.
  
  
  RESULTS
  No patients recalled discussions about resuscitation or planning for the future. Hospital admission and discharge was seen as chaotic and lacking in continuity. Some patients welcomed the opportunity to discuss ACP and felt that their general practitioner (GP) would be the best person for this. Others wished to avoid end-of-life care discussions but there was evidence that, with empathetic and knowledgeable support, these discussions could be initiated.
  
  
  CONCLUSIONS
  The period of hospitalisation may not be an appropriate time to initiate ACP but may be a milestone that can lead to discussions. GPs should be alert to that opportunity after discharge from hospital.
authors.affiliation: The Honiton Research Practice, The Surgery, Honiton, Devon, UK. david.seamark@nhs.net
authors.forename: David
authors.initials: D
authors.lastname: Seamark
authors.forename: Susan
authors.initials: S
authors.lastname: Blake
authors.forename: Clare
authors.initials: C
authors.lastname: Seamark
authors.forename: Michael E
authors.initials: ME
authors.lastname: Hyland
authors.forename: Colin
authors.initials: C
authors.lastname: Greaves
authors.forename: Margaret
authors.initials: M
authors.lastname: Pinnuck
authors.forename: David
authors.initials: D
authors.lastname: Ward
authors.forename: Adam
authors.initials: A
authors.lastname: Hawkins
authors.forename: David
authors.initials: D
authors.lastname: Halpin
mesh_terms: D032722:Advance Care Planning; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000628:therapy*; D036301:Qualitative Research